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Mental Health Nursing · Chapter 4

Build the Mental Status Exam

The MSE is the psychiatric head-to-toe: a structured, cross-sectional description of how a person is presenting right now. Twenty-three entries from one 0800 assessment are waiting below. File each one into the domain it belongs to — and watch for the three that are not findings at all, but verdicts wearing a finding's clothes.

The findings deck

Observed

0 of 23 filed

Which domain does this belong to?

Why it lives there

File a finding to beginEvery placement is explained, right or wrong, and the note on the right grows as you go. Two whole domains — mood and affect — are the ones examiners separate and students blur, so read those explanations twice.

The note, assembling

Mood is what they say; affect is what you see. Chart mood in quotation marks, affect in clinical adjectives, and the two will never blur. When they disagree — “I’m fine” through tears, or a cheerful account of a plan to die — the incongruence is itself one of the most important findings you can record, and it earns a direct follow-up question, not just a line in the note.
Never write a conclusion where a description belongs. Judgement words follow a person from chart to chart and change how much explanation, analgesia and benefit of the doubt the next clinician offers. Write the behaviour and what it may be communicating.