In this section
A typical MSE includes consideration of the
A person's appearance can provide useful clues
into their quality of self-care, lifestyle and daily living
As well as noting what a person is actually
doing during the examination, attention should also be paid to
behaviours typically described as non-verbal
communication. These can reveal much about a person's
emotional state and attitude.
It can be useful to conceptualise the
relationship between emotional affect and mood as being similar to
that between the weather (affect) and the season (mood).
Affect refers to immediate expressions of emotion, while mood
refers to emotional experience over a more prolonged period of
Speech can be a particularly revealing feature
of a person's presentation and should be described behaviourally as
well as considering its content (see also section on
Thoughts). Unusual speech is sometimes associated with mood
and anxiety problems, schizophrenia, and organic pathology.
This refers to a person's current capacity to
process information and is important because it is often sensitive
(though in young people usually secondary) to mental health
A person's thinking is generally evaluated
according to their thought content or nature, and
thought form or process.
Thought process refers to the formation and
coherence of thoughts and is inferred very much through the
person's speech and expression of ideas.
Screening for perceptual disturbance is
critical for detecting serious mental health problems like
psychosis (this is relatively rare in young people, though peak
onset is between 19 and 22 years), cases of severe anxiety, and
mood disorders. It is also important in trauma or substance
abuse. Perceptual disturbances are
typically marked and may be disturbing or frightening.
Insight and judgement is particularly
important in triaging psychiatric presentations and making
decisions about safety.
Unusual or incongruous features noted in a MSE
may indicate the need for the involvement of Mental Health
services, particularly where there is disturbed perception and/or
thought processes. Consideration of the above domains will
help in this determination, and will facilitate the process of
seeking a secondary consultation or making a mental health
referral. Please note again that if there is any indication
of current suicidal or homicidal ideation the person must be
referred for risk assessment by a qualified mental health
Please see our clinical practice guideline Immunisation of Outpatients
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