PsychEd Episode 50: The Mental Status Examination

12 snips

Jan 27, 2023

Dive into the world of the mental status examination, exploring its definition, history, and limitations. Discover the strengths of this key psychiatric tool and learn effective strategies for conducting it with respect to patients. The hosts analyze speech patterns using humorous examples from beloved characters, revealing how they can indicate mental health issues. The importance of emotions and the nuances of insight and judgment are discussed, emphasizing the complexity of cognitive assessments in mental health.

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INSIGHT

MSE Definition and Purpose

The MSE is psychiatry's equivalent of a physical exam, relying on observation and questioning.
It's a crucial part of the objective section in SOAP notes, informing assessments and plans.

INSIGHT

MSE Subjectivity and Bias

The MSE's subjectivity can lead to varying interpretations among different clinicians.
Experience and cultural context significantly influence observations and conclusions.

ANECDOTE

Language and Cultural Context

Saja Jaberi shared how her Arabic background sometimes led to mispronunciations or word switches during MSEs.
This highlights the importance of considering a patient's language and cultural background during assessments.

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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…

Explain the utility and purpose of the mental status examination in psychiatry
Describe the major components of the mental status examination and be familiar with some of the common vocabulary used
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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