Estimation of Appearance, Behaviour and Sensorium (Mental State Examination — Part 1)

1. Overview & Where This Sits in the MSE

The Mental State Examination (MSE) is the psychiatric equivalent of the physical examination: a structured snapshot of the patient's mental functioning at the moment of the interview. The UD Department of Psychiatry teaches the mental state around three core elements — cognition, behaviour, and emotions — preceded by the things you record before the patient says a word: appearance, behaviour, and speech.

This topic covers Part 1 of the MSE — the parts you assess by observation rather than by questioning:

• Appearance — what the patient looks like.
• Behaviour / psychomotor activity — how the patient moves and acts.
• Attitude toward the examiner.
• Sensorium / level of consciousness — the platform on which every other MSE finding rests.

Why it comes first: consciousness and attention are the gatekeepers of cognition. If the patient is somnolent, clouded, or delirious, then orientation, memory, perception, and thinking (Topics 23–31) cannot be validly assessed — the abnormalities you find downstream may simply be artefacts of a clouded sensorium. The golden rule taught in the source lecture: record what you observe (signs), not your interpretation. Write "unshaven, malodorous, slouched, minimal eye contact," not "depressed."

Signs vs symptoms (TOK lecture): Signs = the clinician's objective observations (this whole topic). Symptoms = the patient's subjective reports. A syndrome is a recognisable cluster of both.

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