How to Perform a Mental State Examination (MSE) in Psychiatry

[@tearfulxsoul]

Thankyou so much! Clinical psychology student here! So grateful for this. I find doing an MSE hard because I have lived experience where reading my MSE was so horrible & incorrect that when I started working I made sure all documentation for clients was kind, tactful and detailed and something I wouldn’t be worried about if they read. So the uni MSE has been hard.

[@PsychiatrySimplified]

That’s really inspiring! Well done!

[@DheerajKattula]

Really liked it. This interview shows that history and MSE aren't fully separate. There is also a smooth flow to the interview, however it covered all important aspects. This is the way we do in real world practice. In India, we are supposed to do MSE in prescribed format with digit span, etc for our exams. It feels a bit artificial, but that's the way it it is. I hope residents see interviews like this and learn the skills. Thanks for this Dr Rege.

[@PsychiatrySimplified]

Thanks for your feedback. It is artificial with an actor script. As best as we could get to real life with a script. Main aim was to highlight key questions etc. Really appreciate the valuable feedback. 🙏

[@carlyvanwyk6582]

This video is very helpful. I have to do an MSE for my psych honours class, and watching this video gives me a bit more clarity on what the process is about and how to perform it.

[@Rose-xi2ll]

I have been researching psychiatric interviewing techniques to help me with history and symptoms. Thanks for the video and text descriptors

[@PsychiatrySimplified]

Thank you for the feedback 🙏

[@ozzinine]

Me too! I sometimes struggle with HPI. I work at a private inpatient psych hospital and I conduct the intake assessments, MSE’s etc. We get referrals from all different hospitals and I’ve read many other HPI’s and assessments authored by other mental health clinicians, social workers, PhD.‘s, and M.D.’s and it seems as though there is no one way to conduct the intake assessment and HPI. I want to be as concise as possible while also making sure to include all pertinent information that may be relevant to the clinicians on the units. It’s been a frustrating process.

[@saishrinithi7107]

Absolutely brilliant MSE with clear running notes

[@PsychiatrySimplified]

Thank you for your feedback 🙏🏼

[@g-noraturab3052]

Thank you for post. Now I understand better the capacity assessment. I am taking a seizure medication by Neurologist to manage it. 🙂

[@PsychiatrySimplified]

Pleasure. Wish you well.

[@g-noraturab3052]

@@PsychiatrySimplified I appreciate it ✅

[@Punny95]

Thank you very much for making this video. A request to please post a video on psychiatric management and cases as well. Thanks again🙏

[@PsychiatrySimplified]

Thanks for the feedback. Will do.

[@ghostghost7067]

Thanks for sharing, helped me know what to expect

[@PsychiatrySimplified]

Thank you for your feedback.

[@drsmiless]

Thank you for this. Very structured.

[@PsychiatrySimplified]

Thank you for the feedback.

[@mazid671]

It would have been interesting to see if he stopped during questioning to check if she was okay and not reliving distress.

[@PsychiatrySimplified]

Thank you for your comment. This interview is an artificial scenario with an actor for teaching purposes. Discussions usually are much longer and empathy, checking, summarising, validation are all interview techniques used.

[@avinashkaur1950]

This was so helpful, Thank you!

[@PsychiatrySimplified]

Thank you for the feedback 🙏🏻

[@jeewanrajnirola4789]

Thank you sir its really helpful

[@PsychiatrySimplified]

Thanks for the feedback.

[@LucidSteve]

I faved this video. excellent.

[@PsychiatrySimplified]

Thank you for your feedback.

[@serida0531]

Thanks for this video ☺️

[@ozzinine]

I work as a clinician within an acute inpatient psychiatric hospital. The intake assessment, HPI and MSE are essential but I feel as though I’m interrogating the patients. Any advice? I’m reading journal articles trying to learn various techniques but my role is unique. I need to get the patient admitted to the hospital and gather pertinent information such that the therapists on the unit can then take it from there and conduct daily 1:1 sessions. It’s akin to “setting the bone” such that others “can place the cast”

[@PsychiatrySimplified]

Hi, good question. There are a range of interview techniques and each of these depend on the aim of the assessment. So in acute settings because the goal is focus on key issues - this requires a targeted interview due to time constraints for example - hence can come across as an interrogative interview - usually in such cases i start of the interview explaining my aim / my role and what we( patient and doctor ) are trying to achieve - in order to do that I would like to focus on key aspects such as ....give examples to patient - and tell them it may seem like we are moving from one area to another and you may need to interrupt them but you don't mean to be rude. Thats just one example. In community settings - less urgent - techniques such as reflections/interpretations/summation etc can be used more frequently because the interview may be for an hour for example. ultimately to act in the best interest we must recognise the aim of the interview - then devise the most efficient way of obtaining that information - and explain how the interview will proceed so they don't feel like its an interrogation (many patients have the impression that all psychiatric interviews delve deep into past history and trauma - but in many cases doing that at the first interview can lead to reactivation of trauma and if the patient has only one contact with the clinician it can do more harm than good. hope this helps

[@ozzinine]

@@PsychiatrySimplified thank you for e feedback. I agree, the initial assessment or interview can serve as a double edged sword and serve to turn the patient “off” and in fact do more harm than good. Quite honestly, in my setting I need gather the info and get them admitted. I would say it feels more business like but then again, it’s a private psych hospital and unfortunately it’s run like a business. Thanks again! Be well.

[@apongfundan9458]

Does a pschological person can enter a treatment even he's until concious in everything and can debate on anything regarding the fact on his sorroundings

[@thereGoMapo]

This examination is an interrogation. It looks quite tough for her emotionally. You are asking the person to relive a lot of their trauma. When they are vulnerable, there should be more empathy. You may get a more accurate assessment.

[@PsychiatrySimplified]

Thank you for your feedback. This interview is an artificial scenario and the ‘patient ‘ is an actor. The video is designed to cover the main aspects in a short time for the exams . Exam scenarios are 8-15 mins. So we take your point in real life this interview would be much longer and would allow for the finer nuances You mention. Thanks once again for your feedback.

[@Kay-zo3wl]

agree. I wish they dont work in suits, should be more casual clothing. He ask to many questions. I wish you would let her tell you her own story or journey. and avoid bringing a pen or paper. its really interrogation. I bet she will feel interrogate

[@muhammedmurshid7034]

@@Kay-zo3wl in MSE all the questions should be asked to get proper teatment.so you should not avoid any questions.its a systematic examination of patient mental status.not a psychologic interview, where we support the patient and allow empathy to heal her.in psychiatry we examine patient conditions detailly and prescribe medicine based on all the answers. usually MSE examination in our college is more like an artificial schematic interview. and this interview feel a lot better, this should be the way how we should practice really in clinics.

[@Kay-zo3wl]

@@muhammedmurshid7034 yeah i get that its sysyematic but why not allow her tell her side story.

[@lookingupwithwonder]

@@Kay-zo3wl they don't always wear suits, they are mostly just wearing smart clothes, pretty much what they want to wear.

[@sywakit]

TAHNKS

[@pietersmit6031]

May I say that it appears to me that Psychiatry does not recognize spiritual input to some people through "voices" especially like this lady who hears a voice from the right hand side. If they do Path of the Masters" by Julian Johnson gives some serious hints in this direction which could help the interview technique without laying bed for answer by leading questions and switching subjects so fast. Love shown through more listening is so helpfl in some cases but thank ou for sharing your way.

[@rollingrock3480]

Some of those books on the bookshelf behind the psychiatrist are a little unscientific in my opinion. At first I thought they stuck our hero in some business major's office but then I saw the "Companion to Psychiatric Studies" book on the far right. Perhaps it's shared office space? I just think Stop Bitching Start Pitching is not exactly a good look to have on a shelf visible over your shoulder when you're asking someone to describe their symptoms for you hahaha :) (not a doctor BTW, just a patient with bipolar disorder). That gripe aside, I found this video very informative; the psychiatrist knows exactly where he's going next in his evaluation.

[@PsychiatrySimplified]

Thanks for that feedback. This was an office hired for the filming. Hence the mixture of books. Appreciate your candid comment 🙏

[@debrabooth5676]

So interviewing actors is easier than actual people with mental health disorders. People with mental health are much more guarded and don’t answer or offer information easily. I almost purchased the training course.

[@PsychiatrySimplified]

There are medicolegal issues with confidentiality in interviewing actual patients. The techniques are the same that can be applied to real life. Yes some patients can be guarded and the process should be changed to factor in time. These are videos that are used for training psychiatrists. Over 2000 doctors, nurses, general practitioners and allied Heath professionals have used it for training. Hope this helps.

[@PsychiatrySimplified]

Another reason why actors are used is so the entire script and process of interviewing can be shown. In the interview course - we have simulated guarded patients, angry individuals and how to diffuse or use appropriate interview techniques.

[@tprime2702]

A family member of mine recently had an interview with a nurse psychologist who, alongside the physician, diagnosed the family member with schizo-affective disorder. However, the interview did not go smoothly at all and the family member lied multiple times about different things, such as their history of drug use, chronic drug addiction to Marijuana and cigarettes, as well as becoming physically iolent at the mention of their multiple clonic-tonic seizures. If not for family member witness accounts present, I doubt a proper diagnosis would've been made. Since diagnosis, the family member has grown more violent and disposed of their meds, but continues hearing sounds in the walls and voices. Hospitalization has resulted in nothing being done, not even a form 1. What advice could you offer for such a volatile situation and uncooperative patient?

[@PsychiatrySimplified]

It's a challenging situation. If the situation is urgent, in some countries if harm to the person or others is a concern, the police and/or the crisis team can be involved. Individual advice is difficult to provide as there are so many aspects to consider. This is best discussed with a local professional. Wish you and your family member well.

[@psunil922]

Sir, this video is a old video. It was previously uploaded.

[@PsychiatrySimplified]

This is the full version. The previous video was 3 minutes if I'm not mistaken.

[@erinlynflick7093]

Well I failed to arrive on time to my mental exam, as I have a brain deficit due to a horse kick to the back of my head, I struggle with issues and this is why I am seeking help. What do I do now?

[@erinlynflick7093]

I tried to call analyst, but didn't speak to anyone, did I close this door what happens now?

[@erinlynflick7093]

Could use some input

[@PsychiatrySimplified]

Sorry to hear. You should see a psychiatrist or a neuropsychiatrist to carry out an examination.

[@tomtee4442]

Sorry to hear about your accident. If you decide to take doctor prescribed prescription pills look very closely at the side effects. 250,000 people a year die from doctor prescribed prescription pills because of the side effects when they stop taking the medicine most of the medicine causes suicidal thoughts that's why so many people die from prescription pills legally issued by doctors. Doctor prescribed prescription pills changes one's mind and the way they think. I turned to holistic medicine they were first they're still there and in my opinion they're the only choice to fix problems. Doctor prescribed prescription pills are man-made, synthetic, acidic and have very bad side effects and health risks on the body and some of them are irreversible and the damage they do to someone's body their family and friends is unthinkable. And sadly so many people get hooked on the pain, panic, anxiety, depression, nerve and psych pills. And this turns into generations of acceptable drug use my doctors that are all for profit and not for your health and mental well-being. What doctors are doing is like a hole in an oil pan doctors are putting duct tape on the problem which leads to other problems and most of the time a tragic ending. A good book to turn to is prescription for nutritional healing it's $776 pages by Phyllis a Bach. I'm pretty sure it's the third edition you can get it online pretty cheap for around $8.00

[@debrabooth5676]

Are these actual patients or actresses and actos?

[@caoimhec7697]

The patient is an actress.

[@apongfundan9458]

As long a person can read and think, count, can tell any person he knows, can go to other places, supposed to be he's still normal... hope you will comment just tell me if am i right or wrong.... hoping to answer my questions... thank you.......

[@camilleturalba5694]

well people with personality disorders can do all those you have mentioned. Those things that you said mainly tells you about a person’s orientation. that’s like just one component of the mse / mental status exam.

[@lookingupwithwonder]

She said she has been on cloz for 20 years at first then 10 years

[@PsychiatrySimplified]

It’s an actor - forgot the script 😁. Good pick up

[@cameronfarrell7875]

Is psychiatry a psychiatrist? i probably sound stupid but just curious

[@QUVO1900]

Psychiatrist is a practitioner of psychiatry.

[@tashamorriss8997]

I am a trained and experienced mental health professional. This interview is too formal & too interogatory in style. Many ill patients would find this style very intimidating & would not open up. It should be pointed out as well that this patient (or the actress involved) has already been given a previous diagnosis and been on Clozapine for 10 years, which is waaaay too long to be on this medication - it can cause severe organ damage and agranulocytosis. Other, safer treatment or medications can be utilised instead, or ECT can help for certain treatment resistant mental illnesses. I've worked as a menta health professional for years and I have never ever seen or met a patient that was on Clozapine this long. Not good!

[@PsychiatrySimplified]

Thanks for your comment . Firstly this interview is for OSCE training that has a time limited approach. It is not a typical interview: secondly clozapine is indicated for treatment resistant schizophrenia . It is a long term treatment for most. In fact the Fin-11 and Fin-20 studies showed ( 11 and 20 years follow up) showed that clozapine reduces all cause mortality: clinically we see this significant improvement over the long term. Clozapine is for treatment resistance when treatments have failed. So other medications have been trialled .

[@akhilapalakattil166]

Hi tasha

[@Wan-ft4xg]

He sounds like a fortune teller🤣🤣🤣

[@capresti3537]

Pseudoscience.. diagnosis based on opinion rather than science.