7.2.2 Mental state examination
The mental state examination (MSE) can be usefully applied in identifying areas of impairment that may affect fitness to drive:
- Appearance. Appearance is suggestive of general functioning (e.g. attention to personal hygiene, grooming, sedation, indications of substance use).
- Attitude. This may, for example, be described as cooperative, uncooperative, hostile, guarded or suspicious. While subjective, it helps to evaluate the quality of information gained in the rest of the assessment and may reflect personality attributes.
- Behaviour. This may include observation of specific behaviours or general functioning including ability to function in normal work and social environments.
- Mood and affect. This includes elevated mood (increase in risk taking) and low mood (suicidal ideation, particularly if past attempts, current ideation or future plans involve driving vehicles). Suicide involving motor vehicles is relatively common.
- Thought form, stream and content. This relates to the logic, quantity, flow and subject of thoughts that may be affected by mania, depression, schizophrenia or dementia. Delusions with specific related content may impact on driving ability.
- Perception. This relates to the presence of disturbances, such as hallucinations, that may interfere with attention or concentration, or may influence behaviour.
- Cognition. This relates to alertness, orientation, attention, memory, visuospatial functioning, language functions and executive functions. Evidence from formal testing, screening tests and observations related to adaptive functioning may be sought to determine if a psychiatric disorder is associated with deficits in these areas that are relevant to driving.
- Insight. Insight relates to self-awareness of the effects of the condition on behaviour and thinking. Assessment requires exploration of the person’s awareness of the nature and impacts of their condition and has major implications for management.
- Judgement. The person’s ability to make sound and responsible decisions has obvious implications for road safety. As judgement may vary, it should not be assessed in a single consultation.