In general hospital and community settings, the term ‘physical examination’ is almost always applied to the procedures used by medical and other staff to examine the body, including the nervous system, of patients. In mental health settings, the terms ‘psychological examination’ or ‘mental examination’ might seem most appropriate for the procedures used to examine the mind. However, the lengthier term ‘mental state examination’ is usually used, often with capitals, for reasons of tradition. This term is often shortened to MSE. You will find that effective communication of the results of the MSE requires familiarity with many new terms and with their precise meanings. It is important that you grapple with these issues early on in your training. Like specific diagnostic terms, the terms for specific abnormalities of mental state become an effective shorthand, aiding communication between healthcare professionals. The goal of the MSE is to elicit the patient’s current psychopathology, that is, their abnormal subjective experiences, and an objective view of their mental state, including abnormal behaviour. It therefore includes both symptoms (what the patient reports about current psychological symptoms, such as mood, thoughts, beliefs, abnormal perceptions, cognitive function, etc.) and signs (what you observe about the patient’s behaviour during the interview). Inevitably, the MSE (i.e. now) merges at the edges with the history of the presenting problems (recently). Behavioural abnormalities which the patient reports as still present, but which cannot be observed at interview (e.g. disturbed sleep, overeating, cutting) are part of the history of the presenting illness. A symptom which has resolved, such as an abnormal belief held last week but not today, should usually form part of the history, but will not be reported in the MSE. In contrast, an abnormal belief held last week which is still held today will be reported in both the history of the presenting problems and the MSE. The components of the MSE are listed in Box 5.1. In taking the history, the interviewer will have learnt about the patient’s symptoms up to the time of the consultation. Often the clinical features on the day of the examination are no different from those described in the recent past, in which case the mental state will overlap with the recent history.
Inside the Mind Reader's Tool Kit: Projection and Stereotyping in Mental State Inference.
