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CSR > Block 6Mental State examination > Flashcards

Block 6Mental State examination Flashcards

1
Q

what does a mental state examination show

A

Covers the psychiatric symptomatology (“signs” of illness”) shown at interview

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2
Q

what should the mental state examination also include

A

information obtained by others e.g..nursing staff

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3
Q

Different areas are expanded on according to

A

diagnosis - in depression expand on mood

                - in schizophrenia expand on mood, abnormal beliefs and abnormal experiences
                - in dementia expand on mood and cognitive state
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4
Q

how to start the examination

A

in a private room or at least in a quiet space

facing your patient but not directly opposite

try to remain relaxed

only need to concentrate on the areas not already covered in history

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5
Q

overview of mental state exam

A 
Appearance and behaviour
Speech
Mood
Thought content
Abnormal beliefs and interpretations of events
Cognitive state
Insight
Andy's brother says many things are coming immediately
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6
Q

what facia;l features would you see in a depressed patient

A

vertical furrow forehead and downturned mouth

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7
Q

what facia;l features would you see in a manic patient

A

euphoric +/- irritable.

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8
Q

what facia;l features would you see in a parkinsons patient and why

A

Relatively fixed facies may be parkinsonian side-effects from medication or Parkinson’s disease itself

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9
Q

what posture or movement would you see in schizophrenia

A

you may see abnormal movements e.g. Echopraxia, automatic imitation of another’s movements, posturing where patient adopts bizarre posture for long time

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10
Q

what are tics

A

tics are repeated irregular movements involving a muscle group

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11
Q

what posture or movement would you see in depression

A

poor eye contact and hunched shoulders may indicate depression

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12
Q

what posture or movement would you see in mania

A

 Increased movements and inability to sit down

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13
Q

what posture or movement would you see in anxiety

A

 Restlessness

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14
Q

desscirbe overactivity giving examples and where its seen

A

Underactivity Stupor- mute, immobile, fully conscious

Depressive retardation- lesser form of psychomotor retardation seen in depression

Obsessional slowness- secondary to repeated doubts and compulsive rituals

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15
Q

desscirbe underactivity giving examples and where its seen

A

Overactivity- Psychomotor agitation- overactivity usually unproductive and restlessness

Compulsion – Repetitive and stereotyped seemingly purposeful behaviour. Motor component of a compulsive thought e.g. checking, cleaning, counting rituals

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16
Q

when is rate increased

A

increased in mania

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17
Q

when is rate reduced

A

reduced in depression

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18
Q

when is quantity increased

A

may be increased in mania and anxiety

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19
Q

when is quantity decreased

A

reduced in dementia, schizophrenia and depression.

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20
Q

what is pressure of speech

A

increased rate and quantity.

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21
Q

what is povety of speech and mutism

A

restricted amount of speech. Mutism = complete loss of speech.

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22
Q

what is Dysarthria

A

difficulty in articulation of speech

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23
Q

what is a flight of idea

A

accelerated thoughts, abrupt changes of topic, no central direction

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24
Q

• Neologism

A

a new word constructed by patient or everyday word used in special way

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25
Q

 Echolalia-

A

automatic imitation by patient of another person’s speech even when they don’t understand it

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26
Q

 Thought blocking –

A

sudden interruption in train of thought leaving a “blank” and the patient cannot recall what he had been saying or thinking

27
Q

Knight’s move thinking

A

– odd associations between ideas leading to disruptions in continuity of speech

28
Q

what is a thought disorder?

A

a pattern of disordered language presumed to reflect disordered thinking

29
Q

what is psychosis

A

is an abnormal condition of the mind with a loss of contact with reality

30
Q

what is mood

A

“ a pervasive and sustained emotion that, in the extreme, markedly colours the person’s perception of the world”

31
Q

how do we assess modd

A

 Objective assessment based on history, appearance, behaviour and posture of patient
 Subjective assessment as described by the patient

32
Q

what is dysphoric mood

A

unpleasant mood

33
Q

what is anhedonia?

A

loss of ability and interest in regular and pleasurable activities. may accompany low mood

34
Q

what is  Euphoria

A

is a personal feeling of unconcern and contentment

35
Q

what is elevation

A

is an elevated mood or exaggerated feeling of well-being

36
Q

how does irritable mood present?

A

tendency to be annoyed and provoked to anger

37
Q

what is anxiety?

A

Feeling of apprehension, tension or uneasiness owing to anticipation of an external or internal danger

38
Q

what is phobic anxiety?

A

focus of anxiety avoided

39
Q

what is free floating anxiety?

A

pervasive and unfocussed

40
Q

what is a panic attack

A

acute intense episodic attacks

41
Q

what is an affect?

A

a pattern of observable behaviours that is the expression of emotion,” variable over time in response to emotions. How patients convey mood by their behaviour

42
Q

what is an Inappropriate affect

A

to the thought or speech expressed e.g. Appearing cheerful when talking about recent bereavement

43
Q

what is a Flat affect

A

total or almost total absence of signs of expression of affect

44
Q

what is the preoccupation in hypochondriacs

A

a preoccupation with the fear of having a serious illness

45
Q

what are obsessions

A

repetitive senseless thoughts that are recognised as irrational by patient and usually resisted

46
Q

what is a phobia

A

Persistent irrational fear of an activity, object or situation, leading to avoidance. Fear out of proportion to real danger and cannot be reasoned away, being out of voluntary control

47
Q

what are overvalued ideas

A

Overvalued ideas
 Unreasonable and sustained intense preoccupation maintained with less than delusional intensity
 The idea or belief is clearly false and not one held by others in the subculture
 Marked associated emotional investment

48
Q

what are delusions

A

 Fixed, false personal belief based on incorrect inference about external reality firmly sustained in spite of what almost everyone else believes and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the culture. (i.e. it is not an article of religious faith)

49
Q

what are the diferent types of delusions and give examples

A

persecutory
of reference ( behaviour of others, events such as tv and radio broadcasts refer to oneself, when these thoughts have less than delusional intensity=ideas of reference)
of grandeur
of doubles (person known to patient replaced by a double)
nihilistic
somatic
erotomania (de Clerambault’s syndrome)

50
Q

Primary delusion arises

A

fully formed without any discernible connection with previous events

51
Q

Secondary delusion arises when

A

a person is trying to make sense of their experiences e.g. if experiencing thought blocking they may ascribe this to aliens taking their thoughts away

52
Q

Passivity phenomena

A

belief an external agency controlling oneself including

53
Q

Thought insertion

A

thoughts being put into mind by external agency

54
Q

Thought withdrawl

A

thoughts removed from mind by external agency

55
Q

Thought broadcastin

A

thoughts being

“read” by others

56
Q

Delusional perception

A

Patient attaches new and delusional significance to a familiar real perception, without any logical reason

e.g. “ I saw the traffic light go to red and I knew straight away I was the queen”

57
Q

depersonalisation

A

patient feels altered or not real

58
Q

Derealisation

A

surroundings do not seem real

59
Q

Types of hallucination

A
  • auditory- depression- (second person derogatory)
    - schizophrenia- (third person and running commentaries
    • visual
    • olfactory
    • gustatory
    • somatic – include tactile hallucinations
60
Q

depressive hallucination

A

second person derogatory

61
Q

schizophrenic hallusinations

A

third person and running commentaries

62
Q

what type of hallusinations does somatic hallusination include

A

tactile hallucinations, false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object.

63
Q

 Pareidolia

A

vivid imagery occurs without conscious effort while looking at a poorly structured background such as a fire aka seeing patterns in random data.

64
Q

what are the types of sensory delusions and what do they mean

A

Illusion – false perception of a real external stimulus
Hallucination – false sensory perception in the absence of a real external stimulus
Perceived as being located in objective space and as having the same realistic qualities as normal perceptions

CSR (1 decks)

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