7th November 2023

The Mental State Examination

The MSE is an essential clinical tool in psychiatry. It forms the building blocks of a psychiatrist’s ability to evaluate a patient’s mental state, which paves the way for diagnosis, treatment, risk assessment, mental state monitoring and prognosis.

The MSE provides the examiner with a snapshot in time, otherwise known as a cross-sectional account, of the patient’s psychological and behavioural functioning. It consists of the following domains, a selection of which are covered in the chapters of this book: appearance, behaviour, mood and affect, thought content, thought form, perception, insight, cognition and judgement.

Serial MSEs taken over time or longitudinally allow the clinician to monitor the psychopathology of a patient, which helps us evaluate the patient’s progress from the treatment they are being prescribed, which subsequently guides treatment decisions.

The MSE comes from a psychological method called descriptive psychopathology or descriptive phenomenology, which was developed by the philosopher and psychiatrist Karl Jaspers. He believed that to understand a patient’s mental state, it was necessary for the patient to provide their own description (through non-judgmental questioning) rather than a psychoanalytic approach, which was based on interpretation of the patient’s account and exploring unconscious processes. The modern approach to performing MSEs has evolved to be based on this original descriptive psychopathology combined with observing the patient to build a complete picture.

References

• Häfner, H. (2015). Descriptive psychopathology, phenomenology, and the legacy of Karl Jaspers. Dialogues in Clinical Neuroscience. 17(1), 19–29