Insight and Judgment in Mental Health

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the mental status examination and makes use of practical and fictional examples to delve deeper into the skills and concepts

Learning Objectives:

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to…

1. Explain the utility and purpose of the mental status examination in psychiatry

2. Describe the major components of the mental status examination and be familiar with some of the common vocabulary used

3. Incorporate the mental status in a way that respects patients in presentation, documentation and formulation in clinical practice 

Topics:

• 2:37 - Learning objectives

• 3:10 - Definition of the MSE

• 6:48 - History of the MSE

• 9:00 - Limitations of the MSE

• 15:37 - Strengths of the MSE

• 21:30 - ASEPTIC Mnemonic

• 23:04 - Appearance and Behaviour

• 37:42 - Speech

• 51:51 - Emotion (mood and affect)

• 1:03:51 - Perception

• 1:08:38 - Thought Form and Content

• 1:17:30 - Insight and Judgement

• 1:27:40 - Cognition

Hosts: Andreea Chiorean (CC4), Saja Jaberi (IMG), Dr. Weam Seiffien (PGY2), Angad Singh (CC2), Dr. Annie Yu (PGY1), and Dr. Alex Raben, staff psychiatrist.

Guest Experts: Us!

Video clips:

• Speech: 

• Mojo Jojo: https://youtu.be/y4qNWPPlYE4?t=48

• Family guy video: no longer available

• Emotion

• Eeyore: https://youtu.be/7xPnUe6Xcbw?t=12

• Squidward: https://youtu.be/FjrOWnywPok?t=195

• Bubbles: https://youtu.be/rAC4W563Ayk?t=339

• Perception

• A Beautiful Mind: https://youtu.be/vNa37tOB4rE

• Insight and Judgement

• Simpsons: no longer available

• Mr. Magoo: https://youtu.be/eWEnzLFd4P4?t=201

• Cognition

• Still Alice: https://youtu.be/mhiXAJO8kBc?t=67

Resources:

• MSE template: https://www.therapistaid.com/therapy-worksheet/mental-status-exam

• Emotion wheel: https://feelingswheel.com/

• MSE vocabulary: http://www.columbia.edu/itc/hs/medical/psychmed/1_2004/mental_status_exam.pdf

References:

• Bell, R. (1977). The Mental Status Examination. 16(5).Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198.

• Donnelly, J., Rosenberg, M., & Fleeson, W. P. (1970). The evolution of the mental status—past and future. American Journal of Psychiatry, 126(7), 997-1002.

• Norris, D. R., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. 94(8).

• Norton, J. W., & Corbett, J. J. (2000, February). Visual perceptual abnormalities: hallucinations and illusions. In Seminars in neurology (Vol. 20, No. 01, pp. 0111-0122). Copyright© 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

• Notes, T. (2020). Comprehensive Medical Reference and Review for the Medical Council of Canada Qualifying Exam (MCCQE) Part I and the United States Medical Licensing Exam (USMLE) Step II 36th ed: Toronto Notes for Medical Students.

• Recupero, P. R. (2010). The Mental Status Examination in the Age of the Internet. The Journal of the American Academy of Psychiatry and the Law, 38(1).

• Robinson D. J. (2002). Mental status exam explained (2nd ed.). Rapid Psychler Press.

• Robinson D. J. (1998). Brain Calipers: a guide to a successful mental status exam. Rapid Psychler Press.

• Ross, C. A., & Leichner, P. (1988). Residents Performance on the Mental Status Examination. The Canadian Journal of Psychiatry, 33(2), 108–111. https://doi.org/10.1177/070674378803300207

• Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (10th ed.). Lippincott Williams & Wilkins Publishers.

• Segal, D. L. (Ed.). (2019). Diagnostic interviewing. Springer.

• Snyderman, D., & Rovner, B. (2009). Mental status examination in primary care: a review. American family physician, 80(8), 809-814.

• Spencer, R. J., Noyes, E. T., Bair, J. L., & Ransom, M. T. (2022). Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination. Clinical Gerontologist, 45(3), 454–466. https://doi.org/10.1080/07317115.2022.2032523

• The Collected Papers of Adolf Meyer. Volume III: Medical Teaching. (1952) JAMA. 148(17):1544.

• https://www.statpearls.com/ArticleLibrary/viewarticle/24998

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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