MSE Generator - Smart Paramedics

Appearance

Physical presentation, grooming, clothing, and hygiene. Note neglect, agitation, or unusual attire.

Neatly dressed / groomed Dishevelled / unkempt Appears older/younger than age Poor hygiene / odour Weather-inappropriate clothing

Behaviour

Observed actions, movements, engagement. Look for cooperation, restlessness, agitation, guardedness, eye contact, psychomotor change.

Calm and cooperative Agitated / restless Guarded / withdrawn Appropriate eye contact Poor / fleeting eye contact Psychomotor changes

Speech

Rate, rhythm, tone, coherence. Reflects thought speed, emotional state, sometimes neurological status.

Mood / Affect

Subjective mood and observed affect/visible emotion (range, congruence). Incongruence or restriction can indicate psychopathology.

Euthymic (normal) mood Depressed / low Elated / euphoric (excessive cheerfulness or optimism that appears disproportionate to the situation) Anxious / tense Irritable / angry Labile (fluctuating rapidly between emotions such as laughter and tearfulness without clear triggers) Restricted / flat affect Affect congruent (visible emotion matches what they are talking about or how they say they feel) Affect incongruent (visible emotion is different to what they are talking about or how they say they feel)

Thought Form

Structure/flow of thoughts. Disorganisation, tangentiality, flight of ideas may suggest mania or psychosis.

Logical / coherent Flight of ideas / tangential Circumstantial / over-inclusive (excessive amount of unnecessary detail, side points, or irrelevant information before eventually returning to the main idea or answering a question Thought blocking (sudden interruption in the train of thought or speech before a thought or idea is completed) Disorganised / incoherent

Thought Content

Themes, beliefs, abnormal thoughts (delusions, obsessions, suicidality). Important for risk and diagnosis.

No delusional content Preoccupied with themes Suicidal ideation Homicidal ideation Paranoid beliefs Grandiose / bizarre delusions

Perception

Sensory experience. Hallucinations/illusions can indicate psychosis, intoxication, or organic dysfunction.

No perceptual disturbance Auditory hallucinations Visual hallucinations Illusions / misperceptions Responding to internal stimuli

Cognition

Orientation, attention, memory, concentration. Abnormalities may indicate delirium, dementia, intoxication.

Alert / oriented to time, place and person Mild disorientation Impaired concentration Memory intact Memory impaired

Insight & Judgment

Awareness of illness and decision-making capacity. Poor insight affects adherence/safety; judgment informs risk.

Good insight Poor / limited insight Judgment intact Judgment impaired

Mental Status Examination (MSE)