MSE - CONSCIOUSNESS, SPEECH, MOOD, AND AFFECT
The Mental Status Exam can cover a myriad of areas, and each mental health professional will need to decide what is important. Professionals from different disciplines are likely to be interested in areas relative to their specialty and area of expertise. For example, a neuropsychologist will be interested in neurological processes as they relate to behavior. Hence, an MSE conducted by a neuropsychologist might be detailed in assessment of attention, concentration, language, memory, etc. A psychiatrist, on the other hand, may focus more on issues related to thought processes, mood, and anxiety level. Of course, this is not clearly defined, as many areas of mental health treatment are cross-disciplined. The point is, one "good" MSE does not necessarily look like another. It can be adapted to one's theoretical orientation as well as the specific information that is required at the particular time. As a rule, the interviewer must adapt to the situation based on information and observation. Below is a brief case example.
A 25-year-old Hispanic female is brought into your office by her mother. The mother reports that her daughter is depressed. You speak to the girl alone and find that she is indeed depressed. In the course of the interview, you note that she uses an occasional word that you have never heard before. Since she is Spanish, and you do not speak Spanish, you assume she is substituting occasional Spanish for English words. However, these words do not "sound" Spanish, so (in passing) you ask about them. After discovering that these are made up words, you decide to pursue a more detailed inquiry into language, thought processes, and thought content.
Along the way, you must follow the clues brought up in the interview. In the above case, the client may have been exhibiting neologisms (made up words - often related to formal thought disorder and psychosis) or she could have been creating her own private language (for a variety of non-pathological reasons), or she might simply have some articulation problems related to organic brain damage. The interviewer should be "curious" about everything that comes up in the interview.
Some areas of inquiry are easily identified. If the interviewee is clearly drowsy, somnolent, or stuporous, this becomes primary to other areas of inquiry. However, if a person is alert and responsive, it is not necessary to conduct a Glasgow Coma Scale.
Mood and affect are areas commonly evaluated in almost all Mental Status Examinations. Mood is a "sustained" emotional state, such as: depressed, euphoric, elevated, anxious, angry, and irritable. Affect is more the observable emotional state at the time of the interview. These include descriptors such as: flat, blunted, restricted, and inappropriate.
In inquiry about mood, affective clues are important. Facial expression, quality of voice (timber pitch, intensity), eye contact, and muscular tension (among others) all give clues as to mood. Of course, self-report is one of the best ways to evaluate mood. One interesting and useful bit of information for clarifying the difference between anxiety and depression is to use Brenner's Definitions. A pervasive feeling that something bad "has happened" is indicative of depression. If one has a pervasive feeling that something bad is "going to happen" this indicates anxiety.