What are the findings regarding perception and thought processes in a Mental Status Examination (MSE)?

From the Guidelines

Perception and thoughts are crucial components of a mental status examination (MSE) that provide insight into a patient's cognitive functioning, and should be assessed using a combination of open-ended questions and validated brief cognitive assessment tests, such as the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE), as recommended by the Alzheimer's Association 1. When assessing perception, focus on identifying any hallucinations (false sensory perceptions without external stimuli) across all sensory modalities, illusions (misinterpretations of real stimuli), or depersonalization/derealization experiences. For thought assessment, evaluate both thought form (how thoughts are connected and expressed) and thought content (what the patient is thinking about). Note any formal thought disorders like tangentiality, circumstantiality, thought blocking, or flight of ideas. For thought content, document the presence of delusions, obsessions, phobias, suicidal or homicidal ideation. During the examination, use open-ended questions followed by specific inquiries about unusual experiences. Document findings objectively using the patient's own words when possible. These assessments help differentiate between various psychiatric conditions such as psychotic disorders, mood disorders, anxiety disorders, and cognitive impairments, guiding appropriate treatment planning and monitoring response to interventions over time, as outlined in the American Psychiatric Association practice guidelines for the psychiatric evaluation of adults 1. Some key points to consider when assessing perception and thoughts include:

• Using a structured approach to obtain history and systems review information in the key domains of cognition, daily function, mood and behavior, and sensorimotor function, as recommended by the Alzheimer's Association 1
• Performing a dementia-focused neurologic examination to efficiently screen for potential abnormalities of cranial nerve function, somatosensory or motor function, or postural/gait abnormalities, as recommended by the Alzheimer's Association 1
• Considering the use of validated brief cognitive assessment tests, such as the MoCA or MMSE, to detect potentially clinically significant lower-than-expected or impaired cognitive performance, as recommended by the Alzheimer's Association 1
• Referring to a specialist if unsure about the interpretation or implication of abnormalities on the neurologic exam, as recommended by the Alzheimer's Association 1.

From the Research

Perception and Thoughts in MSE

• The mental status examination (MSE) is a crucial tool for evaluating psychiatric disorders, including perception and thoughts 2.
• The MSE assesses various components, such as appearance, behavior, speech, mood, thought process, thought content, perceptual disturbances, sensorium, cognition, insight, and judgment 2, 3.
• Perceptual disturbances, including hallucinations and delusions, can be evaluated through the MSE, and specific questions and methods can help identify features of various psychiatric illnesses 2.
• Cognitive functions, such as attention, executive functioning, and memory, can also be tested during the MSE, using tools like the Mini-Mental State Examination and the Mini-Cog 3.

Treatment of Hallucinations and Delirium

• Antipsychotic medication is the first-line treatment for hallucinations in schizophrenia, with olanzapine, amisulpride, ziprasidone, and quetiapine being equally effective 4.
• Clozapine is the drug of choice for patients who are resistant to two antipsychotic agents, and cognitive-behavioral therapy (CBT) can be used as an augmentation to antipsychotic medication 4.
• For delirium, haloperidol, risperidone, olanzapine, and aripiprazole are equally effective in managing symptoms, but differ in their side-effect profiles, with extrapyramidal symptoms being most frequent with haloperidol and sedation occurring most frequently with olanzapine 5.

Assessment of Cognitive Function

• The Mini-Mental State Examination (MMSE) is a useful tool for assessing global cognitive function, and correlations between MMSE scores and improvements in behavioral disturbances have been found 6.
• Baseline cognitive function may influence treatment response, and significant correlations have been found between MMSE scores and improvements in behavioral disturbances 6.