What is the recommended wording when starting a Mental Status Examination (MSE)?

Recommended Wording for Starting a Mental Status Examination (MSE)

When starting a Mental Status Examination, begin with a clear explanation to the patient such as: "I'd like to ask you some questions to assess your thinking and memory. This is a standard part of our evaluation that helps us provide the best care for you." 1

Approach to the MSE

Initial Introduction and Setting

• Ensure the patient is in a comfortable, nonjudgmental environment without family member input or other distractions to avoid affecting examination results 2
• Explain the purpose of the examination in simple terms to reduce anxiety and establish rapport 3
• Clarify that this is a routine part of the medical evaluation, not an indication that you suspect a problem 1

Core Components to Assess

The MSE should systematically evaluate:

1. General appearance and behavior

   • Observe nutritional status, coordination, gait, and involuntary movements 1
   • Note any abnormalities of motor tone that may indicate neurological issues 1

2. Speech assessment

   • Evaluate fluency and articulation as indicators of cognitive and neurological function 1
   • Document any abnormalities in rate, volume, or content 4

3. Mood and affect evaluation

   • Assess level of anxiety and emotional state 1
   • Document hopelessness if present, as this is critical for suicide risk assessment 1

4. Thought process and content

   • Evaluate for organization, coherence, and logical flow 1
   • Screen for suicidal or aggressive ideation, including specific plans if present 1

5. Perception and cognition

   • Assess for hallucinations or delusions 1
   • Use validated cognitive assessment tools appropriate to the clinical setting 1

Validated Assessment Tools

When formal cognitive assessment is indicated:

• Brief screening (2-3 minutes): Mini-Cog has 76% sensitivity and 89% specificity for possible dementia 1
• Comprehensive assessment (10-15 minutes): Montreal Cognitive Assessment (MoCA), St. Louis University Mental Status Examination (SLUMS), or Short Test of Mental Status (STMS) 1
• For specialty settings: Consider Addenbrooke's Cognitive Examination (ACE-III) or Frontal Assessment Battery (FAB) for more detailed evaluation 1

Practical Implementation

For Primary Care Settings

• Begin with open-ended questions about the patient's concerns 5
• Follow an organized structure such as ABC-STAMPS (appearance, behavior, cooperation; speech, thought process and content, affect, mood, perceptions, suicidality) 3
• Document both your observations and the patient's responses 5

For Emergency Department Settings

• In patients with acute mental health or behavioral problems, focus first on ruling out medical causes of altered mental status 1
• When evaluating for suicide risk, ensure the patient undergoes a personal belongings search and is placed in a safe setting with close supervision 1

For Specialty Settings

• Use more comprehensive tools that provide specific domain scores (attention, memory, language, etc.) 1
• Consider the patient's educational level and cultural background when interpreting results 1

Common Pitfalls to Avoid

• Diagnostic overconfidence: Remember that MSE tools have varying sensitivity and specificity and are not diagnostic on their own 4
• Inadequate privacy: Ensure confidentiality to facilitate honest responses, especially regarding suicidal thoughts 1
• Cultural insensitivity: Be aware that cultural factors may influence responses and interpretation 1
• Premature conclusion: Abnormal responses in one domain may suggest a diagnosis but require context and clinical judgment 2

The MSE is a critical component of psychiatric evaluation that requires practice and clinical judgment. When properly conducted, it provides valuable information for diagnosis, treatment planning, and risk assessment.