History and Mental State Examination

Question 1

List the domains of the mental state examination?

Answer 1

1) Appearance and Behaviour
2) Speech
3) Mood and Affect
4) Perceptions
5) Thoughts
6) Cognition
7) Insight

Question 2

Describe what you may look for in appearance in MSE?

Answer 2

Colour and state of clothes, facial appearance, eye contact, posture, movement, agitation. Startle response, sweating, tremor, restlessness, fidgeting, visual scanning (for danger), distractibility

Question 3

Describe what you may look for in behaviour in MSE?

Answer 3

Eye contact
Rapport
Open / Guarded / Suspicious
Agitation / Psychomotor Retardation
Disinhibition / overfamiliarity

Question 4

Describe what you may look for in speech in MSE?

Answer 4

Rate
Abnormally fast or slow
Amount- Increased pressured or Decreased monosyllabic or mute
Variation in tone (prosody)
Speech delay
Volume

Question 5

Define pressured speech and give an example of when it may occur?

Answer 5

Rapid rate, increased volume, difficult to interrupt

Mania

Question 6

Define poverty of speech and give an example of when it may occur?

Answer 6

Lengthy pauses between brief utterances

Depressive illnesses and schizophrenia

Question 7

Define thought block and give an example of when it may occur?

Answer 7

A sentence is suddenly stopped for no obvious reason

Schizophrenia

Question 8

Define what is meant by flight of ideas and give an example of when it may occur?

Answer 8

Thoughts rapidly jump from one topic to another

Mania

Question 9

Define what is meant by word salad or schizophasia and give an example of when it may occur?

Answer 9

The connection between themes, sentences and even words is lost, resulting in unintelligible speech, although words are still identifiable

Schizophrenia and Receptive Aphasia (Wernicke’s)

Question 10

Define what is meant by perseveration and give an example of when it may occur?

Answer 10

Persistent, inappropriate repetition of the same thought or action

Schizophrenia, OCD and frontal lobe lesions

Question 11

Explain the difference between mood and affect?

Answer 11

Mood is subjective, this is how the patient is feeling that day and should be recorded in their own words.

Affect is objective and is your observation of how the patient appears through the interview.

Question 12

A patient’s intensity of affect may be described as?

Answer 12

heightened or blunted or flattened

Question 13

What is a heightened intensity of affect associated with?

Answer 13

mania and some personality disorders

Question 14

What is a blunted or flattened intensity of affect associated with?

Answer 14

schizophrenia, depression and post-traumatic stress disorder

Question 15

Explain what is meant by congruency of affect?

Answer 15

Congruency- is the patient’s affect appears in keeping with the content of their thoughts. A patient sharing distressing thoughts whilst demonstrating a flat affect or laughing would be described as showing incongruent affect. Incongruent affect is typically associated with schizophrenia.

Question 16

Define cognition and how it used in the MSE?

Answer 16

Cognition refers to “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses”. Cognition can be impaired as a result of mental health conditions and their treatments.

Question 17

What things can you use to test cognition?

Answer 17

Orientation to Time, Place and Person
What is today’s date? What day? What month? What year? What time of day is it?
Where are we just now? What is it called? What ward number? What floor?
What is your name? Age? Date of birth?

Concentration
Can you go through the Months of the Year but in reverse order?
(Digit span, Spelling a word backwards e.g. World)

Memory
Autobiographical memory: i.e. personal events: coherent history?
Retrograde memory i.e. past events: dates of 2nd world war, things on TV
Anterograde memory i.e. new memories: remember 3 things, name and address

Question 18

What are the aspects of insight in the MSE?

Answer 18

Does the patient recognise that they are unwell?
Do they attribute it to a mental health problem?
Do they accept the need for treatment?

4As- awareness, attribution (to a mental illness), appraisal (understand the consequence of your symptoms), acceptance (of treatment)

Question 19

List some abnormalities of perception?

Answer 19

Hallucinations
Pseudo-hallucinations
Illusions
Depersonalisation 
Derealisation

Question 20

Define a hallucination?

Answer 20

A perception which occurs in the absence of an external stimulus.

is experienced as originating in real space, not just in thoughts (e.g. is not like inner speech).
same qualities as a normal perception i.e. is vivid, solid and compelling.
is not subject to conscious manipulation
can occur in any sensory modality

Question 21

Define pseudo-hallucinations

Answer 21

The same as a hallucination but the patient is aware that it is not real. (usually auditory: “i heard a voice in my head”)

Question 22

Define illusions?

Answer 22

the misinterpretation of an external stimulus (e.g. mistaking a shadow for a person)

Question 23

Define depersonalisation?

Answer 23

A change in self-awareness such that the patient feels unreal or detached from their body. The patient is aware, however, of the subjective nature of this alteration.

Question 24

Define derealisation?

Answer 24

The unpleasant feeling that the external environment has become unreal and/or remote; patients may describe themselves as though they are in a dream-like state.

Question 25

Explain the difference between second and third person auditory hallucinations?

Answer 25

second person voices directly address the patient

third person voices discuss the patient or provide a running commentary on his actions

Question 26

What are the two categories considered in the thought domain?

Answer 26

thought content and thought possession

Question 27

List some abnormalities of thought content?

Answer 27

Delusions, overvalued ideas, obsessions

Question 28

Explain what is meant by a delusion?

Answer 28

false belief / belief held on false grounds
inappropriate to the patient’s socio-cultural background
firmly held in the face of logical argument or evidence to the contrary
not modified by experience or reason
usually very individualised / of great personal significance

Question 29

Explain what is meant by overvalued ideas?

Answer 29

Deeply held personal convictions that are understandable when the individual’s background is known

Question 30

Explain what is meant by obsessions?

Answer 30

Recurrent, persistent thought, impulse, image or musical theme occurring despite the patient’s effort to resist it. May be accompanied by compulsions (repetitive, seemingly purposeful action performed stereotypically)

Question 31

Explain what is meant by thought broadcast?

Answer 31

The patient experiences their thoughts as being understood by others without talking

Question 32

List some abnormalities of thought possession?

Answer 32

thought broadcast, thought insertion, thought withdrawal

Question 33

Abnormalities of thought possession usually occur in what condition?

Answer 33

schizophrenia

Question 34

Explain what is meant by thought insertion?

Answer 34

The patient’s thought is perceived as being planted in their mind by someone else

Question 35

Explain what is meant by thought withdrawal?

Answer 35

The patient experiences their thoughts being taken away from them, without their control.