Skills in Mental State

Examination Dr Michael Bowden

Dr Karen Veary

NSW Institute of Psychiatry

Introduction

‣ What is the MSE?

‣ What to look for

‣ How to report the MSE

‣ Practice

‣ Feedback and knowledge test

Introductions

‣ What is your name and where are you from?

‣ What is the most important thing you want to

gain from the workshop today?

Knowledge Test

‣ Complete the pre-workshop knowledge test

‣ We just want to see if you learn anything from

the workshop!

What is the MSE?

‣ Examination of psychological symptoms,

function and emotional state

‣ Part of overall mental health assessment and

evaluation of person’s strengths

‣ Used whenever a person contacts MH

services

Purpose of MSE

‣ Clarify nature of person’s problems

‣ Evaluates present mental state

‣ Identifies areas for intervention

‣ Establish record and baseline

‣ Assists with rapport

Components

‣ Appearance

‣ Behaviour

‣ Mood and Affect

‣ Speech

‣ Perception

Components 2

‣ Thought

‣ Judgement

‣ Insight

‣ Cognition

‣ Impulsivity

Small Group Discussion

‣ Discuss the elements of the MSE you have

been assigned

‣ Define your components

‣ What questions can you ask to elicit each?

‣ What words can you use to describe each?

Also consider . . .

‣ Individual and clinician’s

• Attitude

• Expectations and assumptions

• Reactions to individual

‣ Recovery focus

MSE & MMSE

‣ Mini Mental State Examination

• Cognitive assessment

Discussion

‣ How does all this fit into a busy General

Practice?

PANIC

ALTERNATIVE?

‣ D – Danger; immediate risk

‣ R – Reconnoitre;

‣ A – Airways; keep calm

‣ B – Breathe; remember to breath,

calm doc helps calm patient

‣ C – Circulation; communicate with patient and staff

FOCUS

BATHE

‣ B ackground

‣ A ffect

‣ T rouble

‣ H ow handling it

‣ E mpathy

‣MMSE

‣MSE

RISK

Risk Assessment Q’s

‣ life is not worth living?

‣ felt hopeless?

‣ thought about hurting or killing yourself?

‣ how often?

‣ how long?

‣ what’s happening in your life?

‣ thought of a way to hurt or kill yourself?

‣ planned how to do it?

‣ access to weapons or pills?

‣What has stopped you?

‣ who makes you feel safer or that you can rely on?

‣ hope in your future?

‣ past attempts?

‣ how long ago?

‣ plan or impulse?

‣ how did you do it?

‣ is now similar?

Modified Scale for Suicidal Ideation

‣ Ivan W. Miller

‣ William H. Norman

‣ Stephen B. Bishop

‣ Michael G. Dow

‣ Department of Psychiatry and Human Behaviour

‣ Brown University and Butler Hospital

‣ Available from Medicare Locals

ASSESS

‣ Investigations

‣ -FBC, E/LFTs, TSH, 25 OHD

‣ Screening tools

‣ - DASS21

‣ - K10

Mental Health Care Plan

‣ New appointment

‣ MSE

Audio

Circumstantiality Clang associations Echolalia

Flight ideas Loosening association Neologism

Preservation Tangentiality Word salad

Harry

‣ 18 year old high school student

‣ BIB Police to ED for assessment

‣ Running into traffic

‣ Uncooperative and aggressive

Harry 2

‣ Decline in academic and social fn 1/12

‣ Disturbed sleep

‣ Fluctuates between sad and angry

‣ Drugs

Video

‣ Watch the video

‣ How would you ask the questions to assess

his mental state?

‣ How would this fit into your practice as a GP?

Harry: MSE

‣ Complete the MSE for Harry

‣ Concentrate on

• Thought Processes and content

• Insight

• Perception

• Judgement

‣ Harry Video

Discussion

‣ What other factors would you consider if he

was 16 years old?

‣ What strengths does he have?

‣ How would you assess MSE in your General

Practice?

Jess

‣ 57 year old Aboriginal woman

‣ Recent Dx of Diabetes Mellitus Type 2

‣ Feeling confused

‣ Poor sleep

‣ Son died

Jess 2

‣ Withdrawn from family

‣ Not taking care of the house

‣ May be drinking again

Video

‣ Watch the video

‣ Write up the MSE

‣ Compare your MSE to the model provided

‣ Jess Video

Discussion

‣ Would you do anything different to this

interviewer?

‣ Any questions or concerns about the MSE?

Evaluation

‣ Evaluation and post-workshop knowledge test

www.nswiop.nsw.edu.au

‣ Mental Health courses specifically for GPs

‣ Grad Cert, Grad Dip, Masters

‣ Workshops

‣ Single Units of study

‣ Scholarships for NSW residents