Mental state examination — structured clinical viva

Manic MSE pattern. Expect flamboyant or disorganised dress relative to baseline, overfamiliar or irritable behaviour, pressured speech, elevated or irritable mood (quote), expansive or labile affect, flight of ideas as form, grandiose or irritable content, possible hallucinations if psychotic mania, distractible attention with usually preserved orientation, limited insight into need for treatment, impaired judgement (spending, risk).[1]

Contrast depression. Retardation, soft slow speech, low mood with restricted congruent affect, negative/suicidal content, form usually intact (or poverty), concentration complaints, guilt/worthlessness themes.[1]

Insight. Use multidimensional language: awareness, relabelling, treatment attitude — e.g. may admit 'I'm energetic' but deny illness and refuse medication.[2]

Scales. YMRS adjunct for mania severity; PHQ-9 if depressive pole or mixed features; MoCA/MMSE if cognitive concern or older adult — never instead of free-text MSE.[1]

Culture. Religious grandiosity versus shared cultural belief; need CFI-informed exploration and interpreter; do not pathologise normative practices.[4]

CASC vs notes. Notes are structured, timestamped, quoted. CASC is empathic conversation that still covers risk, mood, psychosis screen, and cognition when indicated — not a robotic checklist.[5]

First-rank symptoms. Document if present; state they are not pathognomonic for schizophrenia.[3]