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Block 6Mental State examination Flashcards

(64 cards)

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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
 Echolalia-
automatic imitation by patient of another person’s speech even when they don’t understand it
26
 Thought blocking –
sudden interruption in train of thought leaving a “blank” and the patient cannot recall what he had been saying or thinking
27
Knight’s move thinking
– odd associations between ideas leading to disruptions in continuity of speech
28
what is a thought disorder?
a pattern of disordered language presumed to reflect disordered thinking
29
what is psychosis
is an abnormal condition of the mind with a loss of contact with reality
30
what is mood
“ a pervasive and sustained emotion that, in the extreme, markedly colours the person’s perception of the world”
31
how do we assess modd
 Objective assessment based on history, appearance, behaviour and posture of patient  Subjective assessment as described by the patient
32
what is dysphoric mood
unpleasant mood
33
what is anhedonia?
loss of ability and interest in regular and pleasurable activities. may accompany low mood
34
what is  Euphoria
is a personal feeling of unconcern and contentment
35
what is elevation
is an elevated mood or exaggerated feeling of well-being
36
how does irritable mood present?
tendency to be annoyed and provoked to anger
37
what is anxiety?
Feeling of apprehension, tension or uneasiness owing to anticipation of an external or internal danger
38
what is phobic anxiety?
focus of anxiety avoided
39
what is free floating anxiety?
pervasive and unfocussed
40
what is a panic attack
acute intense episodic attacks
41
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
42
what is an Inappropriate affect
to the thought or speech expressed e.g. Appearing cheerful when talking about recent bereavement
43
what is a Flat affect
total or almost total absence of signs of expression of affect
44
what is the preoccupation in hypochondriacs
a preoccupation with the fear of having a serious illness
45
what are obsessions
repetitive senseless thoughts that are recognised as irrational by patient and usually resisted
46
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
47
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
48
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)
49
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)
50
Primary delusion arises
fully formed without any discernible connection with previous events
51
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
52
Passivity phenomena
belief an external agency controlling oneself including
53
Thought insertion
thoughts being put into mind by external agency
54
Thought withdrawl
thoughts removed from mind by external agency
55
Thought broadcastin
thoughts being | “read” by others
56
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”
57
depersonalisation
patient feels altered or not real
58
Derealisation
surroundings do not seem real
59
Types of hallucination
- auditory- depression- (second person derogatory) - schizophrenia- (third person and running commentaries - visual - olfactory - gustatory - somatic – include tactile hallucinations
60
depressive hallucination
second person derogatory
61
schizophrenic hallusinations
third person and running commentaries
62
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.
63
 Pareidolia
vivid imagery occurs without conscious effort while looking at a poorly structured background such as a fire aka seeing patterns in random data.
64
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

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