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MSE

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hi friends,

How do you all describe Speech, mood and thoughts under MSE

under each heading what all you say

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Speech: Rate tone rhythm and volume;

If the pt's speech is continuous/ coherent and relevant

If the pt is not... describe verbatim... for eg: latency of speech/ very little output/ mute...

not coherent and why... dysarthric/ slang/ slurred/ FTD

Sometimes it is better to describe thought and speech under the same heading... because speech is the verbal representation of thought...

Thought: specifically stream [flow - pressure/blocking/ latency, etc]

, form [ FTD - FOI, LOA, Circumst/tangential]

content [poverty of content/ delusions] and

possession [ some people describe obsessions here/ some people in content... and then the other delusions of thought control - withdrawal etc]

Mood : Subjective and objective... if not mood and affect

affect - whether it is appropriate to the mood/ thought; range of affect

Good format would be the one in the Synopsis (Sadock)

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If during the exam you don't know what's the exact word to define something, just describe it with your own words. E.g. don't mention 'flight of ideas' if you interview somebody who appears to wander in his/her thoughts because their concentration is poor... (just say that). You may be asked to demonstrate the patient has flight of ideas during the observed interview!

Also, keep the structure, but don't mention every single heading.

My advice: try to demonstrate the examiners that you know what you're talking about and cover most areas (don't miss any key items). The clinical exam is not about demonstrating that you've learned all the important headings of the MSE.

Good luck!

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I found this earlier today. The 'possible descriptors' should be useful.

VI. Speech and Language (Observed)

A. Quantity - Possible descriptors:

• Talkative, spontaneous, expansive, paucity, poverty.

B. Rate - Possible descriptors:

• Fast, slow, normal, pressured.

C. Volume (Tone) - Possible descriptors:

• Loud, soft, monotone, weak, strong.

D. Fluency and Rhythm - Possible descriptors:

• Slurred, clear, with appropriately placed inflections, hesitant, with good articulation, aphasic.

VII. Mood (Inquired): A sustained state of inner feeling – Possible questions for patient:• “How are your spirits?”

• “How are you feeling?”

• “Have you been discouraged/depressed/low/blue lately?”

• “Have you been energized/elated/high/out of control lately?”

• “Have you been angry/irritable/edgy lately?”

VIII. Affect (Observed): An observed expression of inner feeling. - Possible descriptors:

• Appropriateness to situation, consistency with mood, congruency with thought content.

• Fluctuations: Labile, even.

• Range: Broad, restricted.

• Intensity: Blunted, flat, normal intensity.

• Quality: Sad, angry, hostile, indifferent, euthymic, dysphoric, detached, elated, euphoric, anxious, animated,

irritable.

IX. Thought Processes or Thought Form (Inquired/Observed):

logic, relevance, organization, flow and coherence of

thought in response to general questioning during the interview. - Possible descriptors:

• Linear, goal-directed, circumstantial, tangential, loose associations, incoherent, evasive, racing, blocking,

perseveration, neologisms.

X. Thought Content (Inquired/Observed) – Possible questions for patient:

• “What do you think about when you are sad/angry?”

• “What’s been on your mind lately?”

• “Do you find yourself ruminating about things?”

• “Are there thoughts or images that you have a really difficult time getting out of your head?”

• “Are you worried/scared/frightened about something or other?”

• “Do you have personal beliefs that are not shared by others?” (Delusions are fixed, false, unshared beliefs.)

• “Do you ever feel detached/removed/changed/different from others around you?”

• “Do things seem unnatural/unreal to you?”

• “What do you think about the reports in papers such as The National Enquirer?”

• “Do you think someone or some group intend to harm you in some way?”

• [in response to something the patient says] “What do you think they meant by that?”

• “Does it ever seem like people are stealing your thoughts, or perhaps inserting thoughts into your head? Does

it ever seem like your own thoughts are broadcast out loud?”

• “Do you ever see (visual), hear (auditory), smell (olfactory), taste (gustatory), and feel (tactile) things that are

not really there, such as voices or visions?” (Hallucinations are false perceptions)

• “Do you sometimes misinterpret real things that are around you, such as muffled noises or shadows?”

(Illusions are misinterpreted perceptions)

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