Clinical Pearl The MSE is analogous to the physical exam. It focuses on current signs, symptoms, affect, behaviour and cognition. ...
Clinical Pearl
The MSE is analogous to the physical exam. It focuses on current signs, symptoms, affect, behaviour and cognition.
General Appearance and Behaviour
- dress, grooming, posture, gait, physical characteristics, body habitus, apparent vs. chronological age, facial expression (e.g. sad, suspicious)
- psychomotor activity (agitation, retardation), abnormal movements or lack thereof (tremors, akathisia, tardive dyskinesia, paralysis), attention level and eye contact, attitude toward examiner (ability to interact, level of co-operation)
Speech
- rate (e.g. pressured, slowed), rhythm/fluency, volume, tone, articulation, quantity, spontaneity
Mood and Affect
- mood - subjective emotional state; in patient’s own words
- affect - objective emotional state; described in terms of quality (euthymic, depressed, elevated, anxious), range (full, restricted, flat, blunted), stability (fixed, labile), mood congruence, appropriateness, intensity
Mnemonic
Clinical PearlMental Status Exam: ASEPTIC
Appearance and behaviour
Speech
Emotion (mood and affect)
Perception
Thought content and process
Insight and judgment
Cognition
Spectrum of Affect : Full > Restricted > Blunted > Flat
Thought Process
- coherence-coherent, incoherent
- logic- logical, illogical
- stream
- goal- directed
- circumstantiality - speech that is indirect and delayed in reaching its goal; eventually comes back to the point
- tangentiality -speech is oblique or irrelevant; does not come back to the original point
- loosening of associations -illogical shifting between topics
- flight of ideas - quickly skipping from one idea to another where the ideas are marginally connected, associated with mania
- word salad - jumble of words lacking meaning or logical coherence
- perseveration -repetition of the same verbal or motor response to stimuli
- echolalia - repetition of phrases or words spoken by someone else
- thought blocking - sudden cessation of flow of thought and speech
- clang associations - speech based on sound such as rhyming or punning
- neologism - use of novel words or of existing words in a novel fashion
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