Are their clothes clean and in wearable condition?.Did they choose clothes that reflect their mood? (Bright/dark/dull).Have they dressed appropriately for the season, setting and occasion?.Age, gender, D/O/B, religion, ethnicity….It is also important to ask the patient if they find attending to their personal care difficult in any way, if they need prompting or if they require help physically doing so. It is important to recognise that if a patient appears ‘well-groomed’, this does not mean that their mental state is well. Observing a patient’s appearance can help you identify clues about their mental status. If this is not possible, the focus must be upon risk. The undertaking of an MSE requires time.This MSE includes all 10 aspects: appearance, behaviour, speech, mood, affect, thoughts, perception, cognition, insight and judgement and clinical judgement.However, the MMSE can be used for more detailed testing in the cognitive section of this MSE. The MSE is not to be confused with the Mini-Mental State Examination (MMSE), which is a brief neuropsychological screening test for cognitive impairment and suspected dementia.Consider physical health problems which can impact the mental state.Is an interpreter required to make the assessment fair and accurate?) Take into account the patient’s age, culture, ethnicity, language and level of premorbid functioning.Write down the patient’s words and the order in which they are expressed verbatim.Maintain privacy, encourage open conversation and always acknowledge and respect the patient’s concerns and distress.Welcome the patient, state the reasons for meeting and make them feel comfortable.MSEs are usually incorporated into every mental health assessment and clinical contact. It can also be helpful to use as part of a working diagnosis and identifies possible areas for intervention. The MSE is a structured tool and process that allows you to observe and assess a patient’s current mental state.The psychiatrist must be first and foremost and all the time a physician… In fact, psychiatry is neurology without physical signs, and calls for diagnostic virtuosity of the highest order… The simple fact (is) that a psychiatrist is a physician who takes a proper history at the first consultation. The undertaking of an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors. The mental state examination is an integral, and essential, skill to develop in a psychiatric evaluation.
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