Mapping the Mental Status Examination: Insights from a Scoping Review of Popular Psychiatry Textbooks.

Abstract

Objective: This review aims to critically examine the Mental Status Examination (MSE) as presented in contemporary textbooks used for psychiatry training and identify areas of convergence and variability.

Methods: The authors conducted a comprehensive scoping review comprising expert sampling from top-ranked universities and a gray literature web search. Recommended textbooks available in English and published within the last decade were included. Data extraction focused on the MSE's conceptualization, structure, and definitions. Variability in the hierarchical organization and terminology was documented, internal and external consistency assessed, and a qualitative synthesis of the data performed.

Results: An analysis of 12 authoritative psychiatry textbooks revealed substantial variability in the MSE's conceptualization, hierarchies, and definitions across domains, subdomains, and features. Despite agreement on the importance and purpose of the MSE, the sources lacked consensus on the MSE's fundamental nature, objectivity, and temporal scope, and did not provide explicit theoretical frameworks for their proposed structures. Problematic definitions of key terms and an absence of references to empirical literature were identified. Despite the variability, nine core MSE domains consistently emerged: Appearance, Behavior, Speech, Emotional State, Perception, Thought Process, Thought Content, Cognition, and Insight.

Conclusions: The findings underscore the need for consensus-building efforts to standardize the MSE, supported by philosophical research and empirical validation of its components. Addressing inconsistencies is crucial to ensure reliable, valid assessments in clinical practice and provide a coherent pedagogical framework for psychiatric training. A standardized MSE would enhance communication among healthcare providers, improve diagnostic accuracy, and facilitate patient care.