Mental Health Flashcards
How would you perform an MSE?
Appearance Behaviour Speech Emotion Perception Thoughts Insight Cognition RISK ASSESSMENT
What are you looking for in appearance?
Looking for clues of lifestyle and ability to self care
- distinctive features
- clothing, appropriate?
- posture/gait?
- grooming/hygiene?
- evidence of self harm?
What are you looking for to assess behaviour?
non-verbal communication
- eye contact?
- facial expression?
- psychomotor activity
- body language /gestures/mannerisms
- level of arousal? calm/agitated/aggresive?
- ability to follow requests?
- engagement/ rapport
What are you looking for to assess Speech?
Rate- pressured/ slowed
quantity- minimal/excessive/ complete absence
tone- monotonous/ tremulous
volume of speech- loud/quiet
fluency and rhythm- articulate/clear/slurred
How do you assess emotion?
You are assessing
1)affect (immediately expressed and observed emotion)
quality- sad/agitated/hostile. Euphoric/animated
Range- restricted, normal, expansive
Intensity- normal, blunted, flat
Fluctuations- labile (easily changed between states)
2) mood ( sustained emotion present over a prolonged period of time as reported by the patient) - how have you been feeling lately? eg low/depressed; anxious; angry; apathetic; elated.
Affect is reported as OBJECTIVELY
Mood is SUBJECTIVELY
What are you looking for to assess thoughts?
THOUGHT FORM:
Speed- accelerated, racing,slow
Flow/ Coherence- linear, incoherent, circumstantial (lots of irrelevant/unnecessary detail)
Tangential- moves from one point to the other that are related but never gets to the point
Flight of Ideas- increased no ideas, produced at a rapid pace
Perseveration- repetion of a particular response despite abcense/removal of the stimulus.
THOUGHT CONTENT”
Abnormal beliefs/ delusions
Obsessions- pt aware they are irrational
Overvalued ideas
THOUGHT POSSESSION
Insertion
Withdrawal
Broadcasting
How could you screen for thought content abnormalities?
What has been on your mind recently?
Are you worried about anything?
Do things seem unreal to you?
Are there any thoughts you have a hard time getting out of your head?
Do you think anyone is trying to harm you?
Do you have beliefs that aren’t shared by others you know?
What are you looking for to assess perception?
Hallucinations- sensory perception without any relevant stimulation that the patient believes IS real
Pseudo-hallucination- same as hallucination but the patient is aware that it is not real
Illusions- illusions are misinterpreted perception such as mistaking a shadow for a person.
How could you screen for perception abnormalities?
Do you ever see, hear, smell, feel or taste things that others can’t?
Did you think it was real at the time?
Do you still think it was real?
What are you looking for to assess insight?
Is the patient able to recognise they have a problem or recognise what they’re experiencing is abnormal?
What does the patient think is the cause of the problem?
Does the patient want help with this problem?
How do you test cognition?
Basic:
Orientation
attention and concentration
short term memory
can do a mini-mental stateexam
How do you screen for risk?
Have you ever thought about hurting yourself?
Have you ever hurt yourself?
Have you ever thought about hurting others?
Do you ever feel like life isn’t worth living?
Do you ever think about ending your life?
Have you attempted to end your life?
Have you any plans to end your life?
