Psychopathology and Psychiatric Interviewing/Mental State Examination
What the exam tests
Psychopathology and the mental state examination test whether you can describe abnormal experience precisely and elicit it without leading the patient. Marks are lost by using psychiatric jargon without evidence.
Core rules
- Sequence the MSE: appearance and behaviour, speech, mood and affect, thought form and content, perception, cognition, insight and judgment, then risk.
- Mood is the patient's sustained subjective state; affect is the observed, fluctuating emotional expression.
- A delusion is a fixed false belief held with conviction despite evidence; an overvalued idea is understandable and less rigid.
- Hallucination is perception without external stimulus; illusion is misperception of a real stimulus; pseudohallucination is experienced as inner, not external.
- Obsessions are intrusive, unwanted and resisted; delusions are egosyntonic and not resisted.
- Record risk explicitly: self-harm, suicide, violence, neglect, safeguarding.
Worked example
A patient says, 'The radio in my head is my neighbour's transmitter; they put thoughts into me.' The precise description is thought insertion and a passivity phenomenon, with a likely auditory experience described as outside the self. The reasoning is that the patient experiences thoughts as generated by another agency, not merely as unusual beliefs. This belongs to a schizophrenia-spectrum formulation, but diagnosis still requires duration, functional change and exclusion of mood, substance and medical causes.
Traps that cost marks
Do not write 'paranoid' without quoting the belief. Do not call vivid mental imagery a hallucination. Do not equate insight with agreeing with the doctor; insight includes recognising illness and accepting treatment. Avoid leading questions such as 'Do you hear voices?' before asking open questions.