Talk:Mental status examination/GA1

GA Review
This review is transcluded from Talk:Mental status examination/GA1. The edit link for this section can be used to add comments to the review.

Lots of good things about this article, but I'm not sure it's complete. It's clearly written by a professional and includes lots of information. The writing is good, not much awkward phrasing.
 * Too many uses of "patient": See WP:MEDMOS. Also per this guideline, beware of wording like "The clinician should take into account", as it sounds like the article is written for the clinician.
 * It's hard NOT to use patient, as the article describes an interaction between a clinician and a patient, but I have removed lots of uses of "patient" and tried to make the wording more neutral.
 * ✅First sentence: Why is Mental state examination capitalized and italicized? Why not bolded?
 * Fixed
 * ✅Looks pretty well referenced overall, but the last parts of the Appearance, Attitude, and Speech sections are not sourced.
 * Fixed
 * The lead does not summarize the article, though it does provide some good context. It does not address the Domains section, which is really the only major section.
 * Fixed
 * I think you could get away with a little more detail, check out WP:LEAD. You could explain what each concept means, for example (though I don't know how you'd manage that without a really long list).
 * How about a history section? Who developed the test?  Was it Karl Jaspers, or was the test just based on his work?  When did it become widely used?
 * I don't know if this information is available. I have included a sentence on controversy around current usage.
 * When did it come into use? Maybe you could find the original papers.  I bet you could find a review paper that would have this info.  delldot   talk  05:12, 30 June 2008 (UTC)
 * ✅If it's received any wider attention, this would be good to include in another section. Has there been any controversy about the test?  Any coverage in the mainstream media?
 * There was an unreferenced section entitled 'controversy' in earlier edits of the article (which I have deleted). I'm not aware of any controversy - I did a google search and all I came up with were several copies on other websites of the earlier version of the wikipedia article. It doesn't seem to be a topic that attracts much non-professional interest.
 * ✅How about an applications section? When is the test used, what situations would this test be useful for?  I'm still not totally clear what role this plays in the overall process of caring for a patient.
 * Done.
 * Beautifully done!  delldot   talk  05:12, 30 June 2008 (UTC)
 * No images. Not a deal breaker, but too bad.  How about an image of a clinician with a patient, interacting in some way that they might during this test?  Also, in appearance, you could have a picture of someone in the colorful or bizarre clothes mentioned, or any of the other things about appearance mentioned.
 * Tricky. I haven't been able to find any suitable free-access images on the web, might need to take one myself.
 * One trick I use is to check the blue links and see if there's anything that would be relevant in them. It might also help to do a read through just looking for concepts that it's possible to take a picture of (I'd say the nicotine stains, but that's just gross).  delldot   talk  05:12, 30 June 2008 (UTC)
 * ✅The notes use "Trzepacz & Baker ", but it's listed in the references as "Baker, Robert; Trzepacz, Paula T".
 * Former is correct (I have it in front of me) Fixed.
 * ✅I recommend making each of the subsections under Domains into two paragraphs (at least): one for a description of the domain and how it is measured, and another for examples of conditions that the clinician can be alerted about. The first paragraph may need to be expanded in some of the sections; e.g. in Behavior, the first paragraph would be only one sentence, the rest is examples.
 * Done -- except for a couple of the shorter Domains, and also Thought Content where I thought it would become too fragmented it we were to break it down any further. There really isn't much more tso say about how to assess behaviour, so I didn't expand that part.
 * Yes, this is excellent.
 * ✅The subsections of Domains should be made consistent with regard to the first mention of the name of the subsection in the text. Sometimes it's bolded, sometimes italicized, sometimes not.
 * ✅It may be worth looking at WP:ITALICS and other MOS guidelines for use on bold and italics. Their use isn't very consistent within the article.  For example, I'm not sure why overvalued idea is bolded.
 * Thanks. To follow the advice on WP:ITALICS, do you think I should have "Appearance, Attitude, Behavior, Speech, Mood and Affect, Thought Process, Thought Content, Perception, Cognition, Insight and Judgement" in the lead section in Boldface? I did this, but I'm not sure it's right.
 * It doesn't look right to me, what part of the MOS made you think you should? Guess you'll have to ask a more clueful copy editor.  delldot   talk  05:12, 30 June 2008 (UTC)
 * To answer your question:under "Thought content", delusions, overvalued ideas, obsessions, phobias and preoccupations are bolded because they are the main categories of thought content abnormalities. To follow WP:ITALICS I guess I should use bold if I regard this as a "defintion list" or "sub-topic redirect", and get rid of all the italics. Use bold for first use, then normal font thereafter. Do you agree? These key terms will get a bit lost in all the other terms - so maybe a sub-paragraph for each term. I've changed this but the paragraph looks a bit messy now - what do you think?
 * I think do away with the bold unless it's really necessary, but maybe you'd have to ask a better copy editor than me. Those words don't redirect here, so they wouldn't be subtopic redirects.   delldot   talk  05:12, 30 June 2008 (UTC)
 * ✅Under Perceptions, I would include a lead sentence like those in some other sections explaining what a  perception is.
 * Done
 * ✅Some subsections explain how the characteristic is measured and some don't, I think it was a good idea to include and each section should have such an explanation.
 * Done

I'm gonna stop here for now, so we can work on these issues. If they're dealt with within the time allotted for the hold (a week), I'll continue reviewing and bring up more (so I'm not guaranteeing the article will be passed even if these are fixed, unfortunately). I'm glad to allow more time if more is needed, just let me know. Also definitely let me know if you need any clarification, help, or further advice. If the issues can't be dealt with within a week, the article can be renominated for GAN at a later date once they have been addressed. delldot  talk  00:10, 27 June 2008 (UTC)


 * Thanks for the comments, I will try to address them. Could you make that a couple of weeks? Thanks also to the folks who've fixed the typos and referencing over the last couple of days. --Anonymaus (talk) 00:33, 27 June 2008 (UTC)


 * No problem, two weeks it is. Keep up your good work Anonymaus.  Definitely let me know if you have any questions or would like any feedback while you're working, and give me a poke when you're ready for me to continue with the review.   delldot   talk  01:46, 27 June 2008 (UTC)

Further feedback and comments on the loose ends indicated above would be appreciated. --Anonymaus (talk) 11:48, 29 June 2008 (UTC)

Next installment
Wow Anonymaus! Excellent work. Well you know what the Wikipedia reward is for that, don't you? More work:
 * The lead does not summarize the article, though it does provide some good context. It does not address the Domains section, which is really the only major section.
 * Fixed --Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * I think you could get away with a little more detail, check out WP:LEAD. You could explain what each concept means, for example (though I don't know how you'd manage that without a really long list).
 * I don't think we can explain each concept without making the introduction very dull and off-putting, or else very long.--Anonymaus (talk) 15:36, 30 June 2008 (UTC)
 * Yeah, maybe that wouldn't work. Is there a way to broadly categorize the domains, e.g. "the way the patient acts, feels, communicates, and thinks" or something to that effect?  delldot   talk  04:37, 3 July 2008 (UTC)
 * Like in brackets? I still think it would reduce the flow and readability of the intro. Most of the words are self-explanatory. --Anonymaus (talk) 17:25, 3 July 2008 (UTC)
 * How about a history section? Who developed the test?  Was it Karl Jaspers, or was the test just based on his work?  When did it become widely used?
 * I don't know if this information is available. I have included a sentence on controversy around current usage.
 * When did it come into use? Maybe you could find the original papers.  I bet you could find a review paper that would have this info.  delldot   talk  05:12, 30 June 2008 (UTC)
 * I bet you I can't. --Anonymaus (talk) 15:28, 30 June 2008 (UTC)
 * No images. Not a deal breaker, but too bad.  How about an image of a clinician with a patient, interacting in some way that they might during this test?  Also, in appearance, you could have a picture of someone in the colorful or bizarre clothes mentioned, or any of the other things about appearance mentioned.
 * Tricky. I haven't been able to find any suitable free-access images on the web, might need to take one myself.
 * One trick I use is to check the blue links and see if there's anything that would be relevant in them. It might also help to do a read through just looking for concepts that it's possible to take a picture of (I'd say the nicotine stains, but that's just gross).  delldot   talk  05:12, 30 June 2008 (UTC)
 * Still looking. --Anonymaus (talk) 15:36, 30 June 2008 (UTC)
 * ✅It may be worth looking at WP:ITALICS and other MOS guidelines for use on bold and italics. Their use isn't very consistent within the article.  For example, I'm not sure why overvalued idea is bolded.
 * To answer your question:under "Thought content", delusions, overvalued ideas, obsessions, phobias and preoccupations are bolded because they are the main categories of thought content abnormalities. To follow WP:ITALICS I guess I should use bold if I regard this as a "defintion list" or "sub-topic redirect", and get rid of all the italics. Use bold for first use, then normal font thereafter. Do you agree? These key terms will get a bit lost in all the other terms - so maybe a sub-paragraph for each term. I've changed this but the paragraph looks a bit messy now - what do you think?
 * I think do away with the bold unless it's really necessary, but maybe you'd have to ask a better copy editor than me. Those words don't redirect here, so they wouldn't be subtopic redirects.   delldot   talk  05:12, 30 June 2008 (UTC)
 * Ok. I guess I have to remember this is for an encyclopedia, not for some lecture notes. De-bolded throughout except for the key words in the intro.--Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * ✅is Mini-Mental State Examination supposed to be capitalized?
 * Sometimes it is but I know the WP style so I've changed it.--Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * Whichever way is fine in that case, so long as it's consistent throughout.  delldot   talk  04:07, 3 July 2008 (UTC)
 * ✅In references, journal and publication titles should be italicized.
 * Done --Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * ✅under the Cognition heading  -- is that how they say it? This is found under a heading?
 * Yes, we actually use these headings when we write case-notes. But maybe this sentence is a bit too "how to"? I've taken out "heading".--Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * ✅Echolalia and palilalia -- maybe should define these in the text even though they're wikilinked.
 * Done
 * ✅I noticed a few instances of the same word being wikilinked multiple times. This has a few uses but should generally be avoided.
 * Removed lots of redundant wikilinks. --Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * ✅Delusions of control, or passivity experiences, are typical of schizophrenia: for example experiences of thought withdrawal, thought insertion, thought broadcasting, and somatic passivity (also called alien penetration).  -- not clear what passivity experiences, somatic passivity, or alien penetration are (presumably Fox Mulder would know about that last).
 * I added an explanation in parentheses and removed the "alien penetration" thing, which is amusing but anachronistic. --Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * ✅Patients can also describe obsessional doubt, with intrusive worries about whether they have made the wrong decision, or forgotten to do something.  -- Maybe add a 'for example' if these aren't the only two.
 * Done --Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * ✅Is it pseudohallucination or pseudo-hallucination?
 * Pseudohallucination in Sims. Fixed. --Anonymaus (talk) 12:56, 30 June 2008 (UTC)
 * ✅Mild impairment of attention and memory may be a feature of any mental illness -- is this true?
 * Yes but I guess I was indulging in Original Research. I've re-worded it to keep it within the scope of the citation.--Anonymaus (talk) 15:11, 30 June 2008 (UTC)
 * ✅Avoid the word should, it makes it read like you're writing for clinicians.
 * I think I've removed all the offending "shoulds", and most of the offending "patients" except where I thought the sense would suffer. --Anonymaus (talk) 15:26, 30 June 2008 (UTC)
 * Good, though I have the same problem with "would take care to" and other rewordings that still sound like advice to clinicians.  delldot   talk  04:07, 3 July 2008 (UTC)
 * Took out the 'take care to' and also a 'have to'. --Anonymaus (talk) 17:25, 3 July 2008 (UTC)
 * ✅I'm not sure what to do about it, but I don't really like the use of his/her or their for third person singular. Maybe some of these can be reworded.  I've been changing some of them to his or her, still not perfect.
 * Yes, it's a perennial problem. I think your edits are ok. --Anonymaus (talk) 15:44, 30 June 2008 (UTC)
 * ✅The clinical significance of impaired judgment is that it is taken into account in clinical risk assessment and risk management -- unclear
 * Re-phrased --Anonymaus (talk) 12:56, 30 June 2008 (UTC)


 * The spelling of "behavior"/"behaviour" is used inconsistently throughout the article. Axl (talk) 14:17, 7 July 2008 (UTC)
 * I'll have a look and fix it--Anonymaus (talk) 00:51, 8 July 2008 (UTC)
 * From "Domains", "Behavior": "The patient may have tics, involuntary but quasi-purposeful movements or vocalizations which may be a symptom of Tourette's syndrome." I'm not sure if this means that tics are involuntary quasi-purposeful movements? Axl (talk) 14:20, 7 July 2008 (UTC)
 * Yes, see . I'll put it in brackets to make it clearer that it is a definition--Anonymaus (talk) 00:51, 8 July 2008 (UTC)

More
✅Another great set of edits Anonymaus. It looks like separating out the examples into separate paragraphs brought up other problems; now some of the sections have one- or two-sentence paragraphs for the assessment or examples sections. Ideally these would be fleshed out, but you may choose to leave them or merge them back into one again.
 * I re-merged 'appearance' and 'behavior' --Anonymaus (talk) 17:32, 3 July 2008 (UTC)

delldot  talk  04:37, 3 July 2008 (UTC)
 * The emedicine article also has domains for Reliability and Impulsivity, are these sometimes a part of the exam and sometimes not? Or sometimes part of another domain?  Maybe this could be explained in the article.
 * I referred to this article more for their account of how the MSE is carried out (footnote 8) and eMedicine's inclusion of these two sections of the MSE is pretty idiosyncratic. Impulsivity would usually be considered part of judgment, and reliability would be subsumed under attitude. I think it might be superfluous to go into this in the article, but maybe I should include a line in the intro that the domains are subject to some variability but that I am using the structure in Trzepacz & Baker's book. I've done this in footnote [1] - do you agree? I'm tempted to take eMedicine out of the external links, but aside from this confusing difference it is still a pretty good resource. --Anonymaus (talk) 17:11, 3 July 2008 (UTC)
 * I think the emedicine link should stay, we actually add them to infoboxes and the like. I would explain what the "minor variations" are in the text; this way leaves the reader curious.  However, this doesn't need to be done in the lead.  I would discuss it in judgement and attitude respectively (which are both stubby sections anyway), just explaining that these may be split off.  On the other hand, I do think the footnote is good as it is to explain what standard the article's using, that was a good idea.
 * ✅Is there a reason why the domains are capitalized in the lead? Do your sources capitalize them in the text?
 * No, I guess not. Fixed (also some re-wording of the intro)--Anonymaus (talk) 17:11, 3 July 2008 (UTC)

Looks like it's coming along well. No need to copy my content, feel free to reply right under my points to keep the material together and easier to follow. delldot  talk  04:39, 3 July 2008 (UTC)
 * Are we there yet? I know there are a couple of points still outstanding (images, and a history section) but to be honest I don't think I'm going to do them.--Anonymaus (talk) 17:32, 3 July 2008 (UTC)


 * I'm still not convinced the article covers the topic in enough depth. Is there really little more to say about the exam other than to describe it?  That may be the case if not much has been written on it.  This is why I was asking for a history section; I wanted to see some more on the real-world implications of the subject, to expand the article beyond just a description of the exam itself (though of course that should be the bulk).   I also still don't think the lead goes into enough depth in summarizing the article, check out WP:LEAD. Perhaps I made a mistake in thinking I knew enough to evaluate the article.  I've asked Jfdwolff for a second opinion.  If you'd like me to officially request a second opinion at GAN and step back myself, I can do that; I may be a more difficult reviewer than others.   delldot   talk  05:16, 4 July 2008 (UTC)


 * Y'know... this is what we had before I came along: it wasn't very good -- and I think it's better now than it was then, and that's good enough for me, I've decided. The present version is "neither defiled nor immaculate, nether deficient nor complete", as they say but translations differ Shanti ... :) --Anonymaus (talk) 11:55, 4 July 2008 (UTC)


 * OK, as I said in my note on your talk, I'm not sure I'm familiar enough with the subject to determine whether the article covers it in enough breadth, so I'm requesting a second opinion for the GA review, and stepping back myself.  delldot   talk  04:13, 5 July 2008 (UTC)


 * Alright, the cavalry's coming, since this is something I do every day at work. Give me a bit of time. :) Cheers, Casliber (talk · contribs) 14:26, 25 July 2008 (UTC)

Comments from Stevenfruitsmaak
Hi, overall this article on a though subject reads great. Here are some ideas how to improve this article: --Steven Fruitsmaak (Reply) 21:24, 21 July 2008 (UTC)
 * Don't know if an infobox could be found for these kind of articles? Could we get a picture from one of the wikilinked articles? For example from autism or depression? Images would ideally illustrate domains like appearance, behaviour and perhaps also perceptions.
 * The intro: is the MSE an assessment or a structured way of describing the mental state? This should be rephrased imho.
 * Wikilinks: some words might be overlinked while others are not, this might require a thorough read-through and maybe someone could pass by with Autowikibrowser.
 * Thanks for that. I've put in some images, re-worded the intro and removed some links. Anonymaus (talk) 10:57, 22 July 2008 (UTC)

I really dislike "for clarity and consistency this article follows Trzepacz & Baker (1993)" in the intro, I'm removing it. --Steven Fruitsmaak (Reply) 15:48, 27 July 2008 (UTC)

Comments from Casliber
Looking good. I can see delldot's query about more detail and I can see some material to add...Cheers, Casliber (talk · contribs) 14:33, 25 July 2008 (UTC)


 * OK, both of us know why we use Trzepacz very very useful book on MSE, and the statement has been made a couple of times that it is being used in hte article. What is lacking is why most of us psychiatrists use it (can't recall myself, other than it always being regarded as the key text for reading aout MSE). The book and its importance needs to be touched upon in the lead and elaborated upon in application. Take the info out of ref #1 and put into text. Would make a good start to second para. Other landmark article which should possibly e mentioned is Andreasens work on disordered speech.
 * I don't see how we can discuss the importance of Trzepacz without coming over all POV and OR. Why do we use it? because there's nothing else? (I included Sims and Hamilton for completeness but they're not very good really). Do you have the reference for the Andreasen article to hand? Anonymaus (talk) 20:19, 30 July 2008 (UTC)
 * I was wondering, there must be something whic at least mentions it as widely used though...I'll muse on this one.Cheers, Casliber (talk · contribs) 20:47, 30 July 2008 (UTC)


 * Should mention dentition (psych drugs (and heroin for that matter)--> dry mouth, less antibacterial saliva --> tooth decay, as well as junk food and not brushing) and stigmata such as needlemarks (IVDU) in Appearance.
 * OK Anonymaus (talk) 20:19, 30 July 2008 (UTC)


 * Erm, idiosyncratic word usage and neologisms for schizophrenia somewhere?
 * Absolutely Anonymaus (talk) 20:19, 30 July 2008 (UTC)


 * I always put mood and affect before speech, so as speech then flows into thought form and content - but am aware many others do it this way. Haven't looked in Trzepacz for a looong time..is it really this way in it, oh well...
 * Mm you're right. I've changed it. Anonymaus (talk) 20:19, 30 July 2008 (UTC)


 * Need to emphasise suicidality a bit more - eg rating it by lethality of mode and extent of planning, plus accompnaying hopelessness or whether situation causing suicidal ideation has resolved or is likely to resolve. Safety cannot be overempasised.
 * Ive added a bit on suicide under "application" and "thought content". Anonymaus (talk) 20:19, 30 July 2008 (UTC)


 * Similarly, WRT delusions and AH, whether someone is likely to act upon them (helps in assessing dangerousness)
 * I have some references on that somewhere ... Anonymaus (talk) 20:38, 30 July 2008 (UTC)


 * Finally, the importance needs more emphasis, and how structured interviews have not and are unlikely to replace this exam in a clinical setting.
 * Yes but how does one support that assertion? Do you know of any citations that say that? Anonymaus (talk) 20:19, 30 July 2008 (UTC)
 * I know. tricky this one and I was pondering it myself. I was looking at various scales etc. and all I have seen have a modest note that they are not diagnostic but an adjunct to an interview by a clinician, or research tool. There must be a textbook or something which says it...Cheers, Casliber (talk · contribs) 20:45, 30 July 2008 (UTC)

Other than that, I think we're over the line. Cheers, Casliber (talk · contribs) 14:47, 25 July 2008 (UTC)


 * Great work, my congratulations to all who helped out, especially Anonymaus. Thanks for all the hard work that went into this.  My apologies for being so slow to promote, I kind of forgot it was my responsibility.  At any rate, all my concerns have been addressed, so here it is: [[Image:Symbol support vote.svg|18px]]  delldot   talk  09:18, 3 August 2008 (UTC)


 * Woohoo! (Anonymaus jumps up from swivel chair and punches fist in the air, does a silly little dance) Thank you delldot ! And thanks also to Casliber and all the other folk! A luta continua! --12:35, 3 August 2008 (UTC)Anonymaus (talk)

Ideas for more info on real-world implications
Just some ideas that can hopefully serve as a springboard for more development. No need to use them, just thought they might be helpful. delldot  talk  05:43, 4 July 2008 (UTC)
 * The Merck manual] says "Mental status examinations can help a court establish a person's legal competence for making a will or for giving informed consent for procedures."
 * This book has a little info on history and its use in practice.
 * This book, like the above one, makes the analogy to the physical exam, and appears to give a little history. However, frustratingly, the rest of that section is not available from Google books!  The "major systems of psychiatric functioning" might be a good way to summarize in the lead.
 * This book mentions the results of the exam being used to justify hospitalization. It looks from some of these sources there could be legal aspects or medicolegal issues that could be explored.  The info "probably the most widely used" in mental health could be a valuable addition to the lead.
 * This chapter discusses differences between psychiatric and neurologic MSEs.
 * This book discusses the hierarchical nature of the exam.
 * Restoring accidentally removed content. delldot   talk  04:22, 5 July 2008 (UTC)

Update on Trzepacz
I just talked to a colleague who trained in Great Britain and she said she'd never heard ot Trzepacz, so I guess I will eat my words. My thoughts are now to just use it as a reference without highlighting what it is - thuse I'd take this line out:

This article will use the Trzepacz and Baker (1993) definitions - and just use it as as reference.

Still thinking about other ref thingy. I reckon this now meets GA criteria really. Cheers, Casliber (talk · contribs) 01:30, 31 July 2008 (UTC)