Appearance and Behaviour
The outward appearance can often reflect the inner mental state and observation can give us a useful insight into the patients background, habits, social circumstances and emotional state. To complete the Appearance and Behaviour section of the MSE
objectively record the following:
Physical Appearance
Observe the patients dress style, hair, jewellery, tattoos, scars... Are they clean and well presented or dishevelled? Do their clothes fit properly? Continue to
observe throughout the interview as details can become obvious which may not
initially be obvious. Make a note of where the patient is at the time of observation; wearing a gown in hospital may be acceptable but not
necessary in the local park.
Activity
Activity level can range from semi conscious to hyperactive. Comment on the
subtleties of movement and actions like tremor, walk, posture, gestures, signs and level of alertness observed during the course of the interview.
Interactions
Is the patient friendly or hostile? Do they maintain eye contact? What does their body language say? The way the patient interacts and responds during the interview may or may not reflect their day to day interactions. Comment on attitude, body language, facial expressions and overall impression of how engaged they where.
| Example. Mrs. Jackson |
|
| 'Mrs. Jackson is a 56 year old Caucasian lady, of small build with grey thinning hair; she was dressed in an ironed long sleeved shirt and long pleated skirt and appeared clean. She wore a pair of earrings and no rings. She had an old-fashioned appearance about her.
She wore glasses but frequently took these off and fidgeted with them cleaning them with her shirt. She sat upright throughout the interview and often looked preoccupied or uneasy, a degree of psychomotor agitation was observable by the fidgeting and swaying in the chair.
Eye contact was limited and never longer than 30 seconds with her gaze often shifting to the floor. She has multiple slash scars on both wrists, some looked fresh.
She came across as nervous and building a rapport was difficult.' |
. |
. |
- Small, Caucasian
- Grey, thinning
- Clean shirt, skirt
- Fidgeted with glasses
- Preoccupied |
- Poor eye contact
- Hand rubbing, swaying
- Slashed wrists
- Poor rapport |
|
 Descriptive Word List [psychiatric dictionary] |
| Appearance |
Interactions |
Movements |
Obese
Under weight
Overweight
Emaciated
Unshaven
Unkempt
Neglected
Dishevelled
Underdressed
Overdressed
Scarred
Bizarre |
Aggressive
Attentive
Cooperative
Defensive
Evasive
Exited
Frank
Friendly
Hostile
Indifferent
Integrating
Interested
Playful
Seductive |
Automatism
Ambitendency
Catalepsy
Echopraxia
Limp
Mimicry
Posturing
Psychomotor agitation
Psychomotor retardation
Rigidity
Shuffling
Somnambulism
Stereotypies
Tic
Twitches |
| |
|
... |
