32. The Mental State Examination (MSE)

A psychiatric diagnosis involves the systematic collection, categorisation, interpretation and communication of medical-psychological information. The mental state examination (MSE) is part of a ‘classifying diagnosis’, i.e. an assessment of mental functions as the basis for a structural diagnosis. A structural diagnosis includes not only the signs and symptoms but also how they developed, the patient’s subjective experience and the impact on activities of daily living, and biological, psychological and social factors (including stress). Mental functions are divided into ‘cognitive’, ‘affective’ and ‘conative’, i.e. ‘thought’, ‘feelings’ and ‘actions’ respectively. The aim of an MSE is to assess these mental functions, by listening to what the patient says, actively asking questions (exploration), observing how the patient says something and behaves, and being aware of the interaction between your own mental functions and the conversation (self-observation). Do not hesitate to tackle difficult subjects, e.g. suicidality or delusions (‘crazy ideas’). Remain empathetic and authentic while asking questions, and accept the patient as they are unconditionally.