M.S.E.

Gurvinder Kalra, MD, DPM

Psychiatrist
LRH-MHS
MSE in un-cooperative patient
 MSE in un-cooperative patient
1) General reaction / posture
2) Facial movement / expression
• Spontaneous acts
• Voluntary postures
• Constancy?
• Behaviour towards examiner

3) Eyes / pupils

4) Reaction to what is said / done

5) Muscular reactions

6) Emotional responsiveness

7) Speech

8) Writing

9) Vitals
 General reaction and posture

Spontaneous acts

• Any occasional show of activities/assaultiveness.

• Is the patient neat or untidy?
• Does the patient eat voluntarily or should be fed.
• Does the patient dress himself /require assistance.
• Does the actions show initial retardation or consistent
slowness throughout?
 General reaction and posture

Voluntary postures

• Comfortable
• Natural
• Constrained
• Awkward
• What does the patient do when placed in awkward
position?
 General reaction and posture

Behavior towards examiner

• Resistive
• Evasive
• Irritable
• Apathetic
• Compliant

Is the behaviour constant or variable with time?

Do any special occurrences influence patient’s behaviour?
 Facial movements / expression
• Alert / Attentive
• Smiling
• Placid
• Mask-like
• Stolid, sulky, scowling
• Anxious / Perplexed
• Distressed
• Tearful
• Grimacing

Is the facial expression constant or variable with time?

 Eyes & pupils
• Eyes open / closed: resistance?
• Attention to examiner & movement of eyes?
• Response to sudden movement of hand towards eyes?
• Gaze: fixed / evasive (furtive glances)
• Blinking of eyes / flickering of eye lids?
• Rolling of eyeballs upwards?
• Sensory reaction of pupils
• Is there corneal irritability (+ tears)
 Reaction to what is said / done
• Response to commands
• Are motions slow / sudden / natural
• Reaction to pin pricks
• Automatic obedience?
• Echopraxia repeat
• Echolalia
 Muscular reactions
• Test for
• Rigidity (lead-pipe / cog-wheel)
• Waxy flexibility
• Reflexes
• Flexibility of neck muscles, muscles of jaw / shoulders / elbows /
fingers / LLs.
• Gegenhalten / mitgehen / mitmachen
• Does distraction / command influence the reactions?
• Mouth usually open / closed? Resistance to opening /
closing mouth?
• Protrusion of lips……?
• Holding / drooling of saliva.
• Retention of urine / feces or soiling & wetting?
• Does indicate when wants to go to toilet?
 Emotional responsivness
• When family members speak / personal facts
mentioned.
• Humor / jokes/ reference to family / sad news
• Unexpected stimuli like clapping sound / flash of
lights.

Note whether there is ↑/↓ HR / RR / flushing / perspiration,

tears?
 Speech
• Spontaneous speech?
• Mute: consistent or periods when speaks?
• Any effort to talk?

Note exact utterances with accompanying emo-reaction.

 Writing
Offer paper / pencil
 Vitals
• T, P, R, BP
 MSE in un-cooperative patient
1) General reaction / posture
2) Facial movement / expression
• Spontaneous acts
• Voluntary postures
• Constancy?
• Behaviour towards examiner

3) Eyes / pupils

4) Reaction to what is said / done

5) Muscular reactions

6) Emotional responsiveness

7) Speech

8) Writing

9) Vitals