History and Mental State Examination Flashcards
List the domains of the mental state examination?
1) Appearance and Behaviour
2) Speech
3) Mood and Affect
4) Perceptions
5) Thoughts
6) Cognition
7) Insight
Describe what you may look for in appearance in MSE?
Colour and state of clothes, facial appearance, eye contact, posture, movement, agitation. Startle response, sweating, tremor, restlessness, fidgeting, visual scanning (for danger), distractibility
Describe what you may look for in behaviour in MSE?
Eye contact Rapport Open / Guarded / Suspicious Agitation / Psychomotor Retardation Disinhibition / overfamiliarity
Describe what you may look for in speech in MSE?
Rate Abnormally fast or slow Amount- Increased pressured or Decreased monosyllabic or mute Variation in tone (prosody) Speech delay Volume
Define pressured speech and give an example of when it may occur?
Rapid rate, increased volume, difficult to interrupt
Mania
Define poverty of speech and give an example of when it may occur?
Lengthy pauses between brief utterances
Depressive illnesses and schizophrenia
Define thought block and give an example of when it may occur?
A sentence is suddenly stopped for no obvious reason
Schizophrenia
Define what is meant by flight of ideas and give an example of when it may occur?
Thoughts rapidly jump from one topic to another
Mania
Define what is meant by word salad or schizophasia and give an example of when it may occur?
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)
Define what is meant by perseveration and give an example of when it may occur?
Persistent, inappropriate repetition of the same thought or action
Schizophrenia, OCD and frontal lobe lesions
Explain the difference between mood and affect?
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.
A patient’s intensity of affect may be described as?
heightened or blunted or flattened
What is a heightened intensity of affect associated with?
mania and some personality disorders
What is a blunted or flattened intensity of affect associated with?
schizophrenia, depression and post-traumatic stress disorder
Explain what is meant by congruency of affect?
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.
Define cognition and how it used in the MSE?
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.
What things can you use to test cognition?
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
What are the aspects of insight in the MSE?
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)
List some abnormalities of perception?
Hallucinations Pseudo-hallucinations Illusions Depersonalisation Derealisation
Define a hallucination?
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
Define pseudo-hallucinations
The same as a hallucination but the patient is aware that it is not real. (usually auditory: “i heard a voice in my head”)
Define illusions?
the misinterpretation of an external stimulus (e.g. mistaking a shadow for a person)
Define depersonalisation?
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.
Define derealisation?
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.
Explain the difference between second and third person auditory hallucinations?
second person voices directly address the patient
third person voices discuss the patient or provide a running commentary on his actions
What are the two categories considered in the thought domain?
thought content and thought possession
List some abnormalities of thought content?
Delusions, overvalued ideas, obsessions
Explain what is meant by a delusion?
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
Explain what is meant by overvalued ideas?
Deeply held personal convictions that are understandable when the individual’s background is known
Explain what is meant by obsessions?
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)
Explain what is meant by thought broadcast?
The patient experiences their thoughts as being understood by others without talking
List some abnormalities of thought possession?
thought broadcast, thought insertion, thought withdrawal
Abnormalities of thought possession usually occur in what condition?
schizophrenia
Explain what is meant by thought insertion?
The patient’s thought is perceived as being planted in their mind by someone else
Explain what is meant by thought withdrawal?
The patient experiences their thoughts being taken away from them, without their control.
