The Process of Mental State Examination and its Reporting

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Do curso por The University of Melbourne

Foundations of International Psychiatry

16 ratings

The University of Melbourne

Foundations of International Psychiatry

16 ratings

What are some of the skills required when interviewing patients? What information is required when taking a patient history or completing a mental state examination? These are just some of the questions you'll seek answers to as you work through the course material. Mental health is an important public issue across the world, and the role of the psychiatrist is crucial in helping to address these. This course aims to give you a more nuanced understanding of the role of a psychiatrist, developing clinical skills and therapeutic relationships. Understanding the impact of mental illness in society and ethics in medicine are some of the key themes central to this course. This course is designed to provide essential background knowledge and practical skills that apply to any mental health clinical setting.

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Mental state examination

The Mental State Examination (MSE) is a core skill in psychiatry, and an integral part of the patient interview. This week we will look at each component of the MSE, and how to classify, interpret, and document the patient’s presentation

The Process of Mental State Examination and its Reporting4:24

The Affect in the Mental State Examination5:34

The Thought Process in the Mental State Examination3:46

Thought Content and the Delusion10:31

Conheça os instrutores

Greg Shields
Dr.
Department of Psychiatry
Mahesh Jayaram
Dr
Department of Psychiatry

The process of the mental state examination

begins when the patient enters into the room

and concludes when they leave it.

It includes elements of passive observation as the history is being conducted,

such as observations of the appearance of the patient

and their behaviour during the interview.

Crucially, the examination also involves

an active exploration of the patient's experience of the world.

This is the empathic process of

the phenomenological method we discussed in the previous section.

It utilizes the techniques of history taking you've already heard about

and is driven hopefully by your curiosity and

inquisitiveness in seeking to place yourself in the patient's world

to understand their subjective experience of the world,

and to describe it objectively.

It becomes obvious that the process of interviewing a patient is not a simple one.

Three parallel and related processes are occurring.

There is not only an exploration of the patient's account of the events

prior to the interview and they're psychosocial constitution,

that is their history,

a passive observation and active

exploration of their experience of the world in the here and now,

that is their mental state examination,

and a process of formulation,

that is putting together an understanding of the patient that drives further inquiry.

An example of this complexity might be

an inquiry into a patient's perception of the world.

This may involve passive observations

of the manner in which the patient attends to the interview,

whether they look at you,

or whether their eyes are drawn to a part of the room,

whether they turn their heads as if to

listen attentively to a different part of the room.

While this is being observed,

the questioning of the patient may involve

inquiry into the sensory experience of the patient

and are they hearing of the sounds apart from your voice? How many?

Are they loud or soft?

Simple sounds or voices?

Male or female voices?

What is the tone of voice?

What are the voices saying?

How are you feeling about what they are saying?

Et cetera.

Following the termination of the interview,

there's a convention involved in reporting the findings.

To some degree, the convention is arbitrary,

and the sequence of its reporting,

generally begins with the passive observations of the patient's appearance,

followed by their behaviour,

and the motor aspects of their speech.

The general appearance of the patient should involve

several sentences devoted to creating a pin portrait of the patient,

sufficient for one of your colleagues to pick them from a small crowd.

The types of observations you might make

are suggested in the accompanying slides.

The behaviour is again

a passive observation of the psychomotor activity of the patient during the interview

and the speech description is devoted to the form of the speech, for example, volume,

pronunciation, etc, rather than its

content, which more correctly relates to the patient's thoughts.

The further categories of reporting

a mental state examination are expanded in the next few videos

and the following convention of affect,

followed by thought and perception, cognition and insight.

It is important to remember that the mental state examination

seeks to describe the here and now of the patient at the interview.

It is not a history of the symptoms experienced by

the patient before the interview, which is the task of the history,

of the presuming complaint,

nor is it the task of the mental state examination to interpret

the patient's experience of the world in the context of the patient's life,

which is the task of the formulation.

A common error is for students to report in

the mental state examination

the patient's subjective description of their experiences leading up to the interview,

for example, hallucinations, rather than

the patient's experience of hallucinations at the interview.

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