Block 6Mental State examination Flashcards
what does a mental state examination show
Covers the psychiatric symptomatology (“signs” of illness”) shown at interview
what should the mental state examination also include
information obtained by others e.g..nursing staff
Different areas are expanded on according to
diagnosis - in depression expand on mood
- in schizophrenia expand on mood, abnormal beliefs and abnormal experiences
- in dementia expand on mood and cognitive state
how to start the examination
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
overview of mental state exam
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
what facia;l features would you see in a depressed patient
vertical furrow forehead and downturned mouth
what facia;l features would you see in a manic patient
euphoric +/- irritable.
what facia;l features would you see in a parkinsons patient and why
Relatively fixed facies may be parkinsonian side-effects from medication or Parkinson’s disease itself
what posture or movement would you see in schizophrenia
you may see abnormal movements e.g. Echopraxia, automatic imitation of another’s movements, posturing where patient adopts bizarre posture for long time
what are tics
tics are repeated irregular movements involving a muscle group
what posture or movement would you see in depression
poor eye contact and hunched shoulders may indicate depression
what posture or movement would you see in mania
Increased movements and inability to sit down
what posture or movement would you see in anxiety
Restlessness
desscirbe overactivity giving examples and where its seen
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
desscirbe underactivity giving examples and where its seen
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
when is rate increased
increased in mania
when is rate reduced
reduced in depression
when is quantity increased
may be increased in mania and anxiety
when is quantity decreased
reduced in dementia, schizophrenia and depression.
what is pressure of speech
increased rate and quantity.
what is povety of speech and mutism
restricted amount of speech. Mutism = complete loss of speech.
what is Dysarthria
difficulty in articulation of speech
what is a flight of idea
accelerated thoughts, abrupt changes of topic, no central direction
• Neologism
a new word constructed by patient or everyday word used in special way
Echolalia-
automatic imitation by patient of another person’s speech even when they don’t understand it
Thought blocking –
sudden interruption in train of thought leaving a “blank” and the patient cannot recall what he had been saying or thinking
Knight’s move thinking
– odd associations between ideas leading to disruptions in continuity of speech
what is a thought disorder?
a pattern of disordered language presumed to reflect disordered thinking
what is psychosis
is an abnormal condition of the mind with a loss of contact with reality
what is mood
“ a pervasive and sustained emotion that, in the extreme, markedly colours the person’s perception of the world”
how do we assess modd
Objective assessment based on history, appearance, behaviour and posture of patient
Subjective assessment as described by the patient
what is dysphoric mood
unpleasant mood
what is anhedonia?
loss of ability and interest in regular and pleasurable activities. may accompany low mood
what is Euphoria
is a personal feeling of unconcern and contentment
what is elevation
is an elevated mood or exaggerated feeling of well-being
how does irritable mood present?
tendency to be annoyed and provoked to anger
what is anxiety?
Feeling of apprehension, tension or uneasiness owing to anticipation of an external or internal danger
what is phobic anxiety?
focus of anxiety avoided
what is free floating anxiety?
pervasive and unfocussed
what is a panic attack
acute intense episodic attacks
what is an affect?
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
what is an Inappropriate affect
to the thought or speech expressed e.g. Appearing cheerful when talking about recent bereavement
what is a Flat affect
total or almost total absence of signs of expression of affect
what is the preoccupation in hypochondriacs
a preoccupation with the fear of having a serious illness
what are obsessions
repetitive senseless thoughts that are recognised as irrational by patient and usually resisted
what is a phobia
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
what are overvalued ideas
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
what are delusions
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)
what are the diferent types of delusions and give examples
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)
Primary delusion arises
fully formed without any discernible connection with previous events
Secondary delusion arises when
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
Passivity phenomena
belief an external agency controlling oneself including
Thought insertion
thoughts being put into mind by external agency
Thought withdrawl
thoughts removed from mind by external agency
Thought broadcastin
thoughts being
“read” by others
Delusional perception
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”
depersonalisation
patient feels altered or not real
Derealisation
surroundings do not seem real
Types of hallucination
- auditory- depression- (second person derogatory)
- schizophrenia- (third person and running commentaries- visual
- olfactory
- gustatory
- somatic – include tactile hallucinations
depressive hallucination
second person derogatory
schizophrenic hallusinations
third person and running commentaries
what type of hallusinations does somatic hallusination include
tactile hallucinations, false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object.
Pareidolia
vivid imagery occurs without conscious effort while looking at a poorly structured background such as a fire aka seeing patterns in random data.
what are the types of sensory delusions and what do they mean
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
