Psychiatric history and mental state examination The mental state examination

Psychiatric history and mental state examination The mental state examination

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Psychiatric history and mental state examination The mental state examination The mental state examination, or MSE for short, is an essential aspect of taking a psychiatric history. It allows you to get a brief insight into the mental state of the patient by looking at relevant symptoms and signs, which could direct you to the type of questions that you could ask, as well as help you with the diagnosis of any mental illness that may be present. Whilst being a separate component of the psychiatric history, the MSE is carried out as soon as the patient enters the room and lasts until the patient leaves. Ideally with enough practice, you should be able to do an MSE in less than 5 minutes. The exam looks at different aspects of a patient, such as how they dress, what they say and what they know about their condition and medication. The exam will be described below, listing some of the aspects of a patient that can be examined, as well as some key phrases that can be used when describing a patient. Certain parts of the exam don’t require specific details, such as appearance, where just a general observation is sufficient. On the other hand there are some parts where the specific details are necessary, such as thought content, perception, cognition and insight. If there are abnormalities in any of these four areas, it is important to get as much as detail as possible, for example with auditory hallucinations, it is important to known the number of voices, the sex of the voices, and whether the voices talk about the patient or to the patient. Appearance Apparent age – lack of correspondence between apparent and actual age can be a sign of mental illness but beware of other factors, such as physical illness or smoking, which can affect this Self care / cleanliness – can indicate whether there is any self neglect which could be a sign of certain mental illnesses such as depression or substance abuse Race – Some races or ethnicities are more prone to developing mental illness (e.g Afro Caribbeans have a higher rate of admissions under the Mental Health Act when compared to Caucasians. 1 ) Style of dress – Outlandish outfits or inappropriate dress may present in patients in the manic phase of bipolar disorder Physical build – can point to eating disorder or self neglect through malnutrition Abnormal movements – Can be a sign of mental illness (e.g. Tourettes syndrome, a disorder that presents with sudden repetitive, nonrhythmic movements or tics) but should be differentiated from neurological disease (e.g. epilepsy) Behaviour
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Appropriateness – looked at in terms of speech or actions but should be distinguished from normal behavior e.g. flirtatious behavior, which could be normal or a sign of mania
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Psychiatric history and mental state examination The mental state examination

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