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Definition
The MSE is the psychiatric history and physical or the physical examination of psychiatry. It is the
observing (inspection), touching on (palpation), sounding out (percussion), and listening to (auscultation)
psychiatric signs and symptoms. The MSE is analogous to placing a stethoscope on the brain and
assessing cognitive functions. The set of standardized questions and observations are designed to
evaluate:
1. Sensorium
2.
3.
4.
5.
The information and data gathered in these five domains are used to establish a diagnosis and a treatment
plan. All psychiatric diagnoses are made clinically in an interview situation. There are no blood work
studies or diagnostic imaging procedures to assist with the process.
Almost half of the MSE is obtained free through observation and listening to what is being said in other
parts of the interview.
Free Parameters
Level of consciousness
Appearance
Behavior
Cooperation
Reliability
Affect
Thought form
MSE Component
Appearance
Behavior
Orientation
LOC
Cooperation
Thought Form
Thought Content
Affect
Mood
Suicidal/Homicidal Ideation
Elements of Cognitive Function
General Knowledge
Perception
Insight & Judgment
Formal Cognitive Teaching
Drug intoxication/withdrawal
Eating disorders from vomiting
Anorexia/bulimia nervosa
Skin
Callus/laceration on knuckles
Scars from slashing
Scars from trauma
Needle marks/tracks
Cigarette burns
Dermatitis or excoriated skin
Unusual pattern of hair loss
Lanugo hair
Edema
Repeated movements
Alcohol abuse
Muscle atrophy
Nature of Disturbance
A false belief that is inconsistent with cultural beliefs and values, is not
altered with proof to the contrary, preoccupies the patients thoughts, is not
resisted by the patient, and ranges from implausible to impossible
They are mood congruent when a depressed patient expresses themes of guilt,
worthlessness, and hopelessness
They are mood incongruent when a depressed patient expresses delusions of
grandeur and omnipotence
Egosyntonic symptoms are not foreign or distressing to the patient
Egodystonic symptoms are alien and unwanted by the patient
Overvalued Ideas
Different from delusions in that they are less firmly held and not as absurd
They preoccupy the patients mind and drive their behavior
Examples include superstitions or magical thinking
Obsessions
Phobias
Marked and persistent fears that are viewed by the patient as excessive and
unreasonable
Related to clearly defined objects and situations
Exposure to the object or situation causes such great distress and anxiety that
the patient will do almost anything to avoid
Patients who have lost parents to suicide may suffer from anniversary
reactions where they unconsciously act in a self-destructive manner at the
same age the parent was when s/he died
Some of the most compelling stressors are family death (includes pets), loss
of a friend, divorce/separation, serious medical illness, financial ruin, firing
from a job, or retirement
Flow of Speech
Directness of Replies
Flow of Ideas
Vocabulary
Flow of Information
Nature of Disturbance
Circumstantiality
Tangentiality
Flight of Ideas
Rambling
Loose Associations
Thought Blocking
Thought Derailment
Syntax remains intact, but speech suddenly halts (blocking) and then shifts
(derailment)
Patients may or may not return to the previous topic and are unaware a block
has occurred
I think the Packers will win the Super Bowl this year, they have made some good
changes..I have to catch a plane to England
Fragmentation
Verbigeration
Jargon
Word Salad
Incoherence
Clang Associations
Echolalia
Preservation
Made on the basis of sound; it is typically done by rhyming the last word in
the sentence
I have to go you know
Neologisms
5
4
3
Answer
Question
&
Posed
Goal
2
2
Goal directed logical thought that addresses the point and answers the question directly.
Circumstantial thought contains a mass of digressions, subsidiary clauses, and talking around
the point. People are sometimes aware of their wordiness and that their style of speech
(thought) is an impediment to direct goal attainment.
Tangential thought is not goal directed, though it starts out being relevant and generally stays
in the vicinity of the topic. However, the point or question is never addressed and the thought
process is overly detailed.
Flight of Ideas is a form of accelerated speech. As such, it takes off more quickly and radically
than tangential speech. Rapid, uncensored associations are made due to increased distractibility
and a sense of pressure to keep talking.
Loosening of Associations is the loss of meaningful connections between words and phrases.
Transitions in topics are not based on logical connections between ideas.
Movement Abnormalities
Akathisia
A state of inner tension to keep moving; side effect of drugs. Patients have to get
up and move around, appear ill at ease, or move their legs rhythmically.
Automatisms
Catatonia
Choreiform
Involuntary movements of the face and arms that are jerky, irregular, spasmodic,
and quasi-purposeful. For example, the persons hand shoots up to the face and
s/he incorporates this into an adjustment of the hair.
Athetoid
Ballismus
Compulsions
Repetitive behavior that is carried out to reduce stress and prevent a dreaded
event. Not grounded in reality; follows an obsession.
Extrapyramidal Symptoms
Dystonia
Pisa Syndrome
Rabbit Syndrome
Tardive Dyskinesia
Tic
Tremors