Problems with the Mental Status Exam
A letter in Psychiatric News discusses the problems with the mental
status examination:
The MSE, often characterized as psychiatry's equivalent of the
physical exam, is in fact a mixture of historical information,
observations, and conclusions. "Thought process" is known from
examination, but what we describe as "thought content" is
history--phobias, compulsive behavior, and suicide ideation, for
example. Hallucinations occurring at the time of the examination are
"current mental state"; yesterday's hallucinations are history.
"Judgment" is an evaluation.
The MSE is flawed because of a lack of agreement about the meaning of
some of the terms. "Mood" and "affect" are often confounded.
"Orientation to person" refers to the patient's awareness of his or
her own identity, but some take it to mean recognition of the
examiner, while "orientation to situation" is not a standard question.
"Judgment" may reflect the patient's answers to test questions, or it
may reflect recent conduct, such as fighting with a police officer or
giving money to a con man. Some describe a patient as having impaired
judgment if he or she has a drug habit or stops taking prescribed
medication.
Note to medical students: the mental status examination is an
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