The Mental State Examination, or MSE, is an ordered, comprehensive estimate to evaluate a patient turning with mental health symptoms. Just like we would perform a cardiovascular examination in a patient with chest pain, we use the MSE in a patient presenting with mental health sickness. The MSE is commonly used to diagnose and assess the progress of mental health conditions. We use it in the fields of Psychiatry, Primary Care, and Emergency Medicine.
Introduction to the ASEPTIC Framework
In this article, we’re going to cover the ASEPTIC framework, which is a handy acronym to remember the Mental State Examination. We’ll also include how to assess suicide risk after the MSE. Stay fluid until the end of the article to see an example of the Mental State Examination in deal. Let’s get started.
The A in ASEPTIC stands for Appearance and Behavior. Appearance refers to a basic description of the patient and can include what they’re wearing, their levels of personal hygiene, body habitus, and any physical signs of disease or self-harm. Behavior refers to how well the patient engages during the consultation. It can carry their level of eye contact, facial expression, body language, and the presence of any abnormal movements such as tremors, ticks, forced movements, or posturing.
Examples of Appearance and Behavior Changes
For example, in a patient with depression, you may note that they arrive to have poor self-care and hygiene, avoid eye contact, and have psychomotor check or slow movements or slowed responses to questions. In a patient with Mania, you may notice that they appear to wear bright bright outfits, they’re hyperactive, maintain intense, unrelenting eye contact, and can have psychomotor unrest.
Speech Assessment in ASEPTIC
The S in ASEPTIC stands for Speech. The assessment of a patient’s speech can be further broken down into rate, quantity, tone, volume, and rhythm. A patient’s rate of speech can range anywhere from slow to pressured speech, which is when they are speaking rapidly and can be difficult to interrupt.
Speech Quantity, Tone, Volume, and Rhythm
Quantity refers to the amount of speech and can range from being mute to having very little or poverty of speech, all the way to excessive speech. Tone refers to intonation or the variability in speech. Some examples include monotonous speech or tremulous speech, which can be seen in anxiety disorders. The patient’s volume of speech can range from quiet to loud.
Speech Characteristics Examples
Rhythm of speech can refer to characteristics of speech such as stammering, stuttering, slurring, or stilted speech. For example, a patient with dole may have slow, quiet, monotonous, and debt of speech. A quite with Mania, on the other hand, may have pressured, loud, and confident speech that is difficult to delay.
Emotion: Mood and Affect
Next, we move on to the E in ASEPTIC, which stands for Emotion. Emotion can be broken downward into its two components: mood and affect. Mood is personal and refers to the patient’s own estimate of their current moving state. This can easily be delayed by querying the patient, “How are you feeling?” Patients may label their mood as low,afraid, angry, enraged, euphoric, or callus, to name a few.
Affect and Congruency
Conversely, affect is objective and refers to what the examiner observes during the consultation. Affect includes the patient’s apparent emotion. It also includes the reactivity of their emotional state, which can be described as fixed, restricted, or labile. Affect can also be described in terms of intensity; for example, affect can be exaggerated, blunted, flat, or normal.
Assessment of Mood and Affect Congruency
Lastly, it’s always important to make an assessment of congruency. That means: does the patient’s reported mood match their affect? If it does, we say that the mood and change are identical. If there is an error between mood and affect, we say that they are different.
Examples of Congruent and Incongruent Affect
For example, someone with depression may have a low mood with a flat change. Someone who is manic may have an inflated mood with a labile affect. Someone with schizophrenia may appear happy when vivid upsetting events. This would be an example of an different mood and affect.
Perception and Perceptual Abnormalities
Next, we move on to the notion, which is the P in ASEPTIC. Perception refers to check the sensory information of the world around us, and there can be different types of emotional abnormalities.
Hallucinations and Pseudohallucinations
For example, a hallucination is when someone sees, hears, feels, smells, or smells something that isn’t well there. It feels completely solid to the person even though there is no external source. For example, a patient with aural illusions may hear a choir but there is no sound now.Illusion can happen in settings like schizophrenia,lunacy, or drug use.
A pseudohallucination is just like an illusion but with one key difference, and that is that the lone note that it is not real. An illusion is a misconception of a real foreign stimulus.
Illusions and Other Perceptual Abnormalities
Unlike hallucinations where there is no real stimulus, illusions occur when something is actually present but the brain perceives it incorrectly. For example, a patient may hear the sound of the wind and think that someone is whispering.
Depersonalization is another example of a perceptual abnormality. It refers to a feeling of being detached or disconnected from yourself as if you’re watching yourself from the outside.
Derealization Examples
Derealization is a sense that the world around someone is not a true matter. For example, a patient with schizophrenia may say, “I hear a choir talking about me all the time,” when in fact there is no sound over them. This is an auditory hallucination.
Other example is that a calm person with post-traumatic weight disorder, or PTSD, may say, “It feels like I’m alerting myself from the outside,” which is an example of depersonalization.
Thought Content, Form, and Possession
The T in ASEPTIC stands for Thought, and thought can be further broken down into thought content, thought form, and thought possession.
Thought content refers to the actual substance of the patient’s thoughts. This can be delayed by asking the patient, “What’s been on your mind recently?” Examples of thought happy include delusions, which are fixed false spirit; obsessions; overvalued ideas.
It’s also important to fix if the patient is having any fatal or violent thoughts.
Abnormalities in Thought Form
Thought form refers to how a patient moves from one thought to another. In healthy individuals, thought form should be logical and at a steady pace.
Abnormalities in thought form can include loose associations, where a patient moves rapidly from one topic to another with no apparent connection between the topics. It can also include circumstantial thoughts, which include lots of unnecessary or irrelevant detail but eventually come assessed back to the same point.
Perseveration refers to the repetition of a particular response. For example, the patient may keep repeating their name in response to all of the questions being asked of them during the examination.
Neologisms is when a patient has made up words which are unintelligible or don’t make sense, and a word salad is when a patient speaks a random string of words without relation to one another.
Thought Possession Beliefs
Tangential thoughts include digressions from the main subject of conversation. Flight of ideas refers to fast, pressured speech when ideas run into one another, making it difficult for the observer to follow the conversation.
Thought blocking refers to a sudden cessation of thought, typically mid-sentence, with the patient unable to recover what they previously said.
Thought possession refers to things like thought insertion, which is a belief that thoughts can be inserted into the patient’s mind. You can audit for this by asking the patient, “Do you think people can put information into your head without your control?”
Thought withdrawal hints to a view that one’s thoughts can be removed from their mind, and this can be by asking the patient, “Do you feel like others can remove memories or thoughts from your mind?”
Thought broadcasting is the belief that others can hear a patient’s thoughts, and this can be delayed by asking the patients, “Do you think that other people can listen your thoughts?”
Examples of Thought Content in Schizophrenia
For example, a fully with schizophrenia may say, “The FBI has been following me for months.” This would be an example of a persecutor illusion.
They may say, “The government is jolt thoughts in my head,” which would be an example of thought injection, and they may say, “The sun is radiant today. I like oranges. Orange is around like the Earth,” and this would be an example of a loose association.
Insight and Judgment in ASEPTIC
The I of ASEPTIC refers to Insight and Judgment. Insight refers to the patient’s ability to understand their own condition and can be assessed by asking them, “Do you think you have a problem at the moment?”
Insight can be referred to as intact, partially present, or impaired.
Feel refers to the patient’s skill to make decisions or solve problems in their current psychological state. For example, you may ask them, “What would you do if you could smell fog in your house?” and check their response as one being intact or harmed.
For example, a patient with dumps may say, “I don’t need to take medication, I’m fine,” and this would prove that they have poor vision.
A patient who has Mania may say, “I’m sure to quit my job all of a hurry and spend all of my savings on a new business deal. I’m sure it’ll make me a millionaire.” This would be an example of poor wisdom.
Cognition Assessment in ASEPTIC
Next, we have a mind, which is the C in ASEPTIC. This should carry an estimate of the patient’s level of consciousness; for example, are they alert,dazed, delirious, or in a coma?
It should also assess whether they are wise to person, time, and place; an estimate of their memory, for example short-term contrast long-term memory and whether it remains intact; and we also need to assess their ability to focus and whether they need redirection during the conversation or are easily unstable.
When check cognition, it may be helpful to use a formal estimate tool that’s been allowed, such as the Mini Mental State or MMSE, or the Montreal Cognitive estimate or MoCA.
For example, a patient with worry may have difficulty concentrating and expose signs of memory loss.
Importance of Risk Assessment
After you’ve ended ASEPTIC, don’t forget to complete a risk estimate. This is a key component of the Mental State Examination.
The danger opinion includes the patient’s risk to themselves and their risk to others.
When poll the patient’s risk to themselves, you can ask them a question such as, “Have you had any thoughts to hurt or harm yourself or take your own life?”
It’s grave to check the patient’s speeuku risk, whether they’ve had any toxic thoughts, have they made any plans, and have they acted on those slate .
It’s also important to assess the patient’s self-harm risk and look for bold of injury.
It’s also important to tag risk points for the patient, such as vulnerability, which could include stufff homelessness, orexile
When assessing the patient’s risk to others, you may ask them, “Have you had any thoughts to harm others?”value them for clash or push can be major in this spot
Example: John Doe’s Mental State Examination
Let’s run over a swift example. We have John Doe, a 32-year-old male who is now with constant low mood and weakness. You’ve been asked to assess his Mental State Examination.
He is a Caucasian male of fixed age, draining dark slacks and a blue t-shirt. He’s .lightly crude and is not making eye contact at all. His tone is soft,easy, and monotonous, with long pauses back replying.
John reports feeling empty and exhausted. His affect is flat and restricted with minimal reactivity. His mood and affect are congruent.
He does not news any illusion and he’s not responding to any external stimuli. His thought process is wise but slow. He has feelings of worthlessness and guilt.
He blocked having any insanity and reports passive suicidal thoughts but does not have any intent or a specific plan. He acknowledges feeling unhappy but attributes it to personal failure a little than a medical condition.
His judgment is intact although he’s pessimistic about seeking help. He’s alert and oriented and has some reduced concentration. His memory is intact.
Summary and Further Information
So there you have it, guys, that’s a summary of the Mental State Examination using the ASEPTIC framework. Don’t forget to assess the patient’s risk at the end.
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