Psychosis (Schizophrenia) | Mental State Examination (MSE) | OSCE Guide | SCA Case | UKMLA | CPSA

Introduction

This tutorial provides a step-by-step guide on performing a Mental State Examination (MSE) for a patient exhibiting signs of psychosis, specifically in the context of schizophrenia. The MSE is a critical component in psychiatric evaluations and helps clinicians assess a patient's mental condition. This guide is based on the instructional video from Geeky Medics, which outlines the process clearly and effectively.

Step 1: Opening the Consultation

• Introduce yourself to the patient and explain the purpose of the consultation.
• Ensure a comfortable environment to encourage open communication.
• Use open-ended questions to establish rapport, such as:
  • "How have you been feeling lately?"
  • "Can you tell me about any recent changes in your thoughts or behavior?"

Step 2: Assess Appearance, Behaviour and Speech

• Observe the patient's appearance for any significant changes or neglect.
• Note their behavior, including any unusual movements or mannerisms.
• Assess speech:
  • Look for volume, tone, and pace.
  • Determine if the speech is coherent, relevant, and organized.

Step 3: Evaluate Mood and Affect

• Ask the patient to describe their mood.
• Observe the patient's affect (emotional expression) during the conversation.
• Consider if the mood is congruent with their discussion or appears flattened or inappropriate.

Step 4: Assess Thought Processes

• Evaluate the content of the patient's thoughts.
• Look for:
  • Logical connections between ideas.
  • Presence of delusions or hallucinations.
• Ask clarifying questions to gain insight into their thought patterns.

Step 5: Conduct a Risk Assessment

• Inquire about any self-harm or harm to others.
• Assess the patient's level of insight regarding their condition.
• Discuss any history of suicidal thoughts or behaviors.

Step 6: Evaluate Perception

• Ask the patient about any experiences of hallucinations (e.g., hearing voices or seeing things that aren't there).
• Clarify if these experiences are ongoing or have changed over time.

Step 7: Assess Cognition

• Test cognitive function through orientation questions:
  • Time: "What is today’s date?"
  • Place: "Where are we right now?"
  • Person: "Can you tell me your name?"
• Observe their ability to concentrate and follow simple commands.

Step 8: Evaluate Insight and Judgement

• Discuss the patient's understanding of their illness.
• Ask questions to gauge their ability to make sound decisions:
  • "What do you think is happening to you?"
  • "What would you do if you felt unwell?"

Step 9: Closing the Consultation

• Summarize your findings and discuss the next steps.
• Ensure the patient understands any recommendations or follow-up care.
• Thank the patient for their time and cooperation.

Conclusion

Performing a Mental State Examination is a vital skill for assessing patients with psychosis. This guide highlights the key steps to ensure a thorough and compassionate evaluation. Always adhere to local guidelines and practices when conducting an MSE. For further practice, consider reviewing additional clinical skills resources or participating in simulation exercises.