Mental State Exam
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A mental state examination (MSE) is an important part of a psychiatric assessment. It is often conducted during history taking with a patient – by making observation of the patient whilst taking with them.

The MSE should not be confused with the Mini Mental State Examination (MMSE) which is an assessment of cognitive function used in the diagnosis of dementia.

The Mental State Examination is divided into the following sections:

  • Appearance and Behaviour
  • Mood
  • Speech
  • Thoughts
  • Perceptions
  • Cognitive function
  • Insight

Appearance and behaviour

  • How does the patient enter the room?
    • quickly? slowly?
  • What is the patient’s attitude to the interview?
    • aggressive? reluctant? Can you build a rapport with them?
    • can you engage them?
  • Eye contact?
    • Do they make any? Is there too much? None at all?
  • Clothes
    • Eccentric? Clean? Mismatch – (inability to co-ordinate thoughts)
  • Facial
    • Tattoos (on the face high indication to mental illness, sign of past imprisonment, gang involvement) Scars
    • Facial expression
  • Psychomotor
    • unusual movements
    • agitation / retardation
  • General
    • tearful
    • anxious
    • overactive
    • underactive


  • Description
    • Elated (overly happy)
    • Dysphoric (very low)
    • Euthymic (normal)
    • Labile (constantly fluctuating)
    • Subjective – patient’s opinion of their mood and state
    • Objective – our opinion of their mood and state


  • Rate / Rhythm / Tone
  • Accent
  • Language
  • Form
  • Spontaneous?
  • Do they answer questions



Ask the patient to describe any preoccupations or worries:

  • Content
    • Can they form construct thoughts? Do they make sense?
    • Are there any thoughts they seem to be preoccupied with?
    • e.g persecution, health, weight
    • Interference: Insertion, withdrawal, broadcasting
    • Passivity phenomenon feels as if they’re being taken over.
  • Nature
    • Delusions : A false belief, which is firmly held despite contrary evidence and is out of keeping with the patient’s cultural or religious background.
    • Obsessions: A recurrent thought, impulse or image that enters the subject’s mind despite resistance.
    • The patient may realise that it’s not necessarily true but can’t resist thinking about it.
    • May be compulsive in nature
    • An overvalued idea: A belief not held quite as strongly as a delusion, and is typically more understandable.
  • Flow
    • The content may be normal but the flow (form) may not be : Formal thought disorder
    • flight of ideas, connections e.g. rhyming, do the ideas join together?
    • Suicide / self harm / harm to others
    • Future plans



Have you ever heard anything that other people couldn’t? Do things / people seem diffirent from normal.

  • Hallucinations: A perception experienced as real in the absence of a stimulus
    • Auditory (psychotic) – 2nd person (talking to them), 3rd person (talking about them)
    • Visual (acute confusional state)
    • Tactile
  • Illusions: A misperception e.g. seeing someone in the shadows when there is no-one there
  • Depersonlization: A feeling of detachment from the normal sense of self “ As if i’m acting”

Cognitive function

  • Mini mental state
  • Orientation – time, place, person
  • Show patient 3 items and ensure they have registered them – test recall after 2mins


  • Spectrum – fluctuates according to mental state
  • Are they aware of their behaviour
  • Do they believe they need treatment
  • Do they believe they have a mental disorder
  • Capacity


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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