Mental State Examination 3 – Perception and Mood
Author(s): Farah Rozali
By the end of this CAL you will be able to:
- Describe the general purpose and component parts of the Mental State Examination (MSE), specifically patients’ perception and mood.
- Evaluate patients’ perception and mood in their mental state and use appropriate terminology to describe abnormalities.
Thank you to Neelom Sharma, Alexandra Pittock, Meroe Grove, Maia Forrester and Mercedes Smith for their major contributions to the content of this module.
Introduction Part 1 of 11
Hope you got on well with the last session!
Let’s just quickly recap over it one last time before we move on…
Perception Part 2 of 11
Perception can be considered as processed sensation. In other words, it is the meaning we give to sensory input, based on current context, past (learned) experiences, current emotional state etc.
Abnormal perceptual experiences form part of the clinical picture of many mental disorders. Equally, the range of normal perceptual experience is very wide.
For the MSE, we’re going to split perception into ‘perception of the world’ and ‘perception of the self’.
Hallucinations Part 3 of 11
Auditory Hallucinations Part 4 of 11
Other Hallucinations Part 5 of 11
These are hallucinations of the visual modality. They occur most commonly in organic brain disturbances (e.g. delirium, occipital lobe tumours, epilepsy, dementia) and in the context of psychoactive substance use.
Olfactory and Gustatory Hallucinations
These are false perceptions of smell and taste, respectively. They commonly occur together because the two senses are closely related.
Illusion Part 6 of 11
Quick Summary on Perception Part 7 of 11
If patients admit to problems with perception, it is important to ascertain:
- Whether the abnormal perceptions are hallucinations, illusions, or intrusive thoughts
- If it is a hallucination – from which sensory modality the hallucinations appear to arise (i.e. are they auditory, visual, olfactory, gustatory or somatic hallucinations)
- If it is an auditory hallucinations – elementary or complex?
- If complex, are they experiences in the first person (audible thoughts, thought echo), second person (critical, persecutory, complimentary or command hallucinations) or third person (voices arguing or discussing the patient, or giving a running commentary).
It is also important to note whether patients seem to be responding to hallucinations during the interview, as evidenced by them laughing inappropriately as though they are sharing a private joke, or suddenly tilting their head as though listening, or quizzically looking at hallucinatory objects around the room.
As with describing thought disorder, when reporting disorders of perception should be described by classifying the type of false perception e.g. first person auditory hallucinations or depersonalisation, followed by a quote (if possible) of what they said that made you arrive to this deduction.
Also note that the MSE should only report symptoms and signs that are present at the time of the examination, thus if the patient says that they’ve been hearing voices an hour ago but are not hearing them at the time of the examination, then that would be reported in the history, and the MSE report would be negative for any abnormal perception.
Finally, make sure you give your own objective assessment of any perceptual disturbance – e.g. do they appear distracted? do they appear to be responding to unseen stimuli? – as sometimes a patient cannot (or will not) disclose any abnormal experiences.
Mood Part 8 of 11
Affect Part 9 of 11
Affect is a component of feeling that is short-term, reactive to internal or external circumstances and rapidly changeable.
Variations in affect, from happiness to sadness, irritability to enthusiasm, anxiety, rage and jealousy, are all within everyone’s normal experience.
Affect is assessed by observing patients’ posture, facial expression, emotional reactivity and speech (e.g. smiling at a joke, or crying at a sad memory).
Questions Part 10 of 11
Summary Part 11 of 11