Mental state Examination and mini mental state examination- mnemonic
One of the first things one would be taught while rotating through psychiatry posting as a medical student is mental state examination and mini mental state examination. It may seems overwhelming to learn these topics for those who are being exposed to them for the first time. As for me, it seems daunting and difficult to learn so I was looking for mnemonic to adequately remember these stuffs and thank goodness, I was able to get what I was looking for!
Here I will be presenting the mnemonics for each while giving detail explanation on these mnemonics. Please follow me.
Mental State Examination (MSA) Mnemonic
Remembering the components of MSA might not be easy at first but of course it becomes handy with practice. So, what’s this mnemonic? ASEPTIC, yes ASEPTIC it is. What does it stand for? OK, let’s go
A- Appearance and behaviour
Now let’s discuss each one after the other.
Appearance and Behavior
- Abnormal movement
- Body language
- Eye contact
- Level of cooperation during interview
- Quantity/relevance and spontaneity
- Volume and rate
- Tone, prosody
- Articulation and intelligibility
- The mood: subjective, i.e what the patient says about himself/herself
- The affection: objective, i.e what the interviewer observed about the patient’s emotion
- Illusions and hallucinations (esp. visual, auditory)
- Derealization and depersonalization
- Content-ideas, delusions, obsessions and compulsions
- Possession- thought insertion, withdrawal, broadcast, echo
This asks 5 distinct questions:
Does the patient:
- recognise symptoms experienced as abnormal
- attribute these symptoms to an illness
- believe that it is a mental illness
- realise that he needs to be treated
- appreciate the consequences of the illness e.g. associated disability, concerns of his relatives and need for involuntary treatment.
Here is the last of the MSE, and it examines:
- Judgement: ability make right decision, example is running tap test
- Memory: immediate, short and long term
- Abstraction: similarities, difference and proverb
- Calculation: simple calculations like recognition of amount given and ability to calculate change to be collected
Well, we have briefly considered MSE. I do hope this gives you better understanding of the subject. We will now proceed to talk about MMSE.
Mini Mental State Examination (MMSE)
This examination contains a series of questions which can be used to assess cognitive impairment. It should be noted that this examination can not be used as a diagnostic tool.
The total score in this examination is 30 with 24-30 representing normal cognition, 18- 23 representing mild cognitive impairment and 0-17 representing severe cognitive impairment.
Now what is the mnemonic? ORARL pronounced as ORAL
Both Rs are assigned 3 scores each
L is 9 scores
A is 5 scores
O- has two components with 5 scores assigned to each
Better put O-R-A-R-L : 5-3-5-3-9
Now , what does the mnemonic represent?
- O- Orientation
- R- Registration
- A- Attention/Calculation
- R- Recall
- L- Language
Let’s take this one after the other:
This has two components (TP) with each carries 5 scores
- Time( year, season, month, day of the week and date)- each carries 1 score
- Place(Country, State, City, Hospital and Floor)- each carries 1 score
This involves naming three objects by the examiner and asking the patient to repeat. Each of the objects carries 1 score. You ask the patient to repeat afterwards until s/he gets it.
Attention and Calculation
It involves subtraction of 7 from 100 repeatedly for 5 times eg 100, 93, 86, 79, 72, 65…. Alternatives are spelling WORLD from the back or reading days of the week forward and backward. The total score here is 5
This involves asking the patient to mention the object memorized in recognition phase. The carries 3 scores with 1 awarded to each correct answer
The last in this mini mental state examination is language and there are 9 points in total.
It contains: 2, 3 DR2aW
- 2- Name two objects (it carries 2 marks)
- 3- Three steps command is followed. The examiner gives three step command and asks the patient perform the action, eg take this paper with your right hand, fold it and place it on the table. The examiner should allow the patient to perform this action without repeating this statement. 3 scores are awarded, 1 for each command.
- D- Draw: the patient is asked to draw two intercepted pentagon. 1 score is awarded
- R- Read: the patient is asked to read what is written on the paper and do what it says eg close your eyes. 1 score is awarded
- R- Repeat: the patient is asked to repeat no ifs, and or, buts. 1 score is awarded
- W- Write: the patient is asked to write a complete sentence, must contain subject and verb. 1 mark is awarded.
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Psychiatry Lecture Notes by Gautam Gulati page 2-3