Psych · Professional skills — mental state examination
Mental state examination
Also known as MSE · Mental status examination · Psychiatric mental status exam · Descriptive psychopathology interview · Psychiatric interview MSE · CASC mental state
Exam-exhaustive fellowship reference on the Mental State Examination — all core domains (appearance, behaviour, speech, mood, affect, thought form and content, perception, cognition, insight, judgement), documentation standards, worked patterns for psychosis/depression/mania, organic discriminators, cultural caveats, rating-scale adjuncts, and CASC skills. FRANZCP-primary, globally tagged.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Fluctuating attention, clouded consciousness, or predominant visual hallucinations — treat as possible delirium/encephalopathy until proven otherwise
- Active suicidal plan/intent or command hallucinations to harm self/others with diminished resistance — immediate safety actions and structured risk assessment
- First-episode or atypical age of onset psychosis with fever, seizures, or focal neurology — do not stop at a primary psychiatric MSE label
- Equating non-English speech, cultural affect display, or religious belief with thought disorder or delusion without interpreter and cultural formulation
- Documenting pejorative labels ('manipulative', 'attention-seeking') instead of observable behaviour and patient quotes
- Treating Schneider first-rank symptoms as pathognomonic for schizophrenia
Meet the patient
A registrar hands you a referral at 8pm: "28, thought disorder, query first-episode psychosis, please assess." You walk in. He is sitting forward, staring at the curtain rail, answering every question five seconds late. He says the nurses are broadcasting his thoughts on the ward television.[1][6]
The referral has already done the thing the MSE exists to prevent — it has diagnosed before it described. Your job in the next forty minutes is to replace that label with a cross-section another clinician could reproduce at 3am, and to let the pattern, not the referral, tell you whether this is psychosis, delirium, mania, or a medical mimic wearing a psychiatric coat.[1][2]
References18ShowHide
- [1]Daza C, Mauriziano C, Liberona A, et al. Mapping the Mental Status Examination: Insights from a Scoping Review of Popular Psychiatry Textbooks Acad Psychiatry, 2025.PMID 40495096
- [2]Lenouvel E, Chivu C, Mattson J, et al. Instructional Design Strategies for Teaching the Mental Status Examination and Psychiatric Interview: a Scoping Review Acad Psychiatry, 2022.PMID 35318592
- [3]Andreasen NC Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability Arch Gen Psychiatry, 1979.PMID 496551
- [4]Andreasen NC Thought, language, and communication disorders. II. Diagnostic significance Arch Gen Psychiatry, 1979.PMID 496552
- [5]David AS Insight and psychosis Br J Psychiatry, 1990.PMID 2207510
- [6]Nordgaard J, Arnfred SM, Handest P, et al. The diagnostic status of first-rank symptoms Schizophr Bull, 2008.PMID 17562695
- [7]Peralta V, Cuesta MJ Schneider's first-rank symptoms have neither diagnostic value for schizophrenia nor higher clinical validity than other delusions and hallucinations in psychoses Psychol Med, 2023.PMID 32943125
- [8]Folstein MF, Folstein SE, McHugh PR "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician J Psychiatr Res, 1975.PMID 1202204
- [9]Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment J Am Geriatr Soc, 2005.PMID 15817019
- [10]Carson N, Leach L, Murphy KJ A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores Int J Geriatr Psychiatry, 2018.PMID 28731508
- [11]Kay SR, Fiszbein A, Opler LA The positive and negative syndrome scale (PANSS) for schizophrenia Schizophr Bull, 1987.PMID 3616518
- [12]Young RC, Biggs JT, Ziegler VE, et al. A rating scale for mania: reliability, validity and sensitivity Br J Psychiatry, 1978.PMID 728692
- [13]Hamilton M A rating scale for depression J Neurol Neurosurg Psychiatry, 1960.PMID 14399272
- [14]Kroenke K, Spitzer RL, Williams JB The PHQ-9: validity of a brief depression severity measure J Gen Intern Med, 2001.PMID 11556941
- [15]Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7 Arch Intern Med, 2006.PMID 16717171
- [16]Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults Am J Psychiatry, 2011.PMID 22193671
- [17]Lam PC, Lewis-Fernández R, Aggarwal NK The Cultural Formulation Interview: Building the Case for Cultural Competence in Clinical Care Psychiatr Serv, 2023.PMID 36722093
- [18]Padilla A, Benjamin S, Lewis-Fernandez R Assessing Cultural Psychiatry Milestones Through an Objective Structured Clinical Examination Acad Psychiatry, 2016.PMID 27084719