Mental Health Assessment/Mental State Examination (MSE)

Question 1

Why do an MSE?

Answer 1

• Identify signs & symptoms
• Monitor change or improvement
• May inform treatment or interventions
• Provides a standardised form of documentation

Question 2

When to conduct an MSE?

Answer 2

• During admission
• In the course of taking history
• If there is any change in clinical presentation
• On one to one interaction
• Informally: MH nurses conduct MSE constantly

Question 3

What is included in history taking in addition to MSE?

Answer 3

• Individual details
• Identifying the presenting problems
• History of presenting illness
• Personal history
• Previous medical/surgical history
• Family history
• Premorbid personality
• Prescribed/non-prescribed substance use

Question 4

Overview of mental state examination

Answer 4

1. Appearance & Behaviour
2. Speech
3. Mood & Affect
4. Form of thought
5. Content of thought
6. Perceptual disturbances
7. Sensorium & cognition
8. Insight / Judgement / Memory

Question 5

Appearance & Behaviour

Answer 5

• The persons appearance in relation to their mental health
• Eye contact
• Individuals reaction to present situation…is it appropriate?
• Individuals motor activity/inactivity
• Expressive gestures

Question 6

Speech

Answer 6

• Articulation disturbances
• Rate (rapid, pressured, slow)
• Volume
• Quantity

Question 7

Mood and Affect

Answer 7

Mood

• subjective/ internal feeling state
• use patients own words

Affect

• objective/observable emotions
  
  • Range & intensity
  • Stability
  • Appropriateness & congruity

Question 8

Range and intensity of affect

Answer 8

Variations may range from lack of emotional expression to emotional expressiveness e.g sadness, anger, happiness etc

• Normal affect - variations in facial expressions, use hands, body movements or laughter
• Restricted affect - decrease in intensity & range of emotional expressions
• Blunted affect - severe decrease in intensity & range of emotional expressions
• Flat affect - total or near absence emotional expressions

Question 9

Stability of affect

Answer 9

Rate at which affect changes

• Stable - no fluctuation in affect
• Labile - excessively rapid changes in affect
• Diurnal variation

Question 10

Appropriateness & congruity of affect

Answer 10

• Appropriate & congruent to topic of conversation or situation e.g. sadness at funeral, laughter at joke
• A person may claim to be blind, paralysed yet show no concern for his fate, or for the impact of symptoms on his life

Question 11

Thought form/process

Answer 11

Thought form/process refers to organisation, flow & production of thought & include:

• Amount of thought & its rate of production
• Continuity of ideas
• Disturbances of language
• Logical / linear or irrational

Question 12

Amount of thought & its rate of production

Answer 12

• Poverty of ideas - absence or near absence of spontaneous speech or talk
• Flight of ideas - abrupt changes in conversation, where there is no common connection in the ideas expressed
• Slow or hesitant thinking - reduced amount of thoughts

Question 13

Continuity of ideas

Answer 13

• Perseveration- persistent repetition of the same words or themes
• Thought blocking - abrupt interruption to the flow of thinking where thoughts are completely absent for a period of time
• Distractible speech - repeated changes of topic in response to nearby stimuli
• Irrelevance - replies to questions are not related to main topic of discussion

Question 14

Disturbances of language

Answer 14

Refers to use of language or words that do not exist & include:

• Neologisms - creation of new words that have no significance or meaning to others
• “Word Salads” and incoherence’s - communication is disorganised & senseless

Question 15

Thought content

Answer 15

• What is going through the persons head?
• delusions
• obsessions/intrusive thoughts
• compulsions
• Suicidal thoughts?
• Thoughts to harm others?
• What’s for dinner?

Question 16

Perceptual disturbances

Answer 16

• Hallucinations (all senses)
• Delusions
• Derealisation
• Depersonalisation
• Logical / linear or irrational thoughts?

Question 17

Sensorium & Cognition

Answer 17

• Level of consciousness
• Memory
• Orientation
• Concentration or focus
• Judgement (should be separate category, very specific)

Question 18

Insight

Answer 18

• Capacity to recognise own problems & symptoms
• One of the most important measures which often influences treatment.
• Often recorded as absent, partial, limited or full.
• very important to assess/record as will strongly impact the care given

Question 19

Elements of a mental health assessment

Answer 19

• MSE
• Background
  
  • recent and relevant past life events
  • personality
  • family
• strengths/resources
  
  • social connectedness
  • access to resources
• challenges/threats
  
  • risk to self / to others
  • social isolation
  • few resources

Question 20

types of delusions

Answer 20

• persecutory delusions
• grandiose delusions
• delusions of reference (ordinary events are specifically significant to them)
• delusions of influence (others are controlling them)
• religious delusions
• thought insertion (others are placing thoughts in their head)
• thought broadcasting (others can hear what they are thinking)
• thought withdrawal (others can take their thoughts away)

Question 21

Types of thought processes

Answer 21

• logical
• loose associations
• word salad
• echolalia (repeats what is said to them)
• clang association (similar sounds/rhyming)
• perseveration (continual repetition of a word, phrase, idea)

Question 22

types of hallucinations

Answer 22

• auditory
• visual
• olfactory
• tactile
• gustatory

Question 23

levels of consciousness

Answer 23

• alert
• lethargic
• stuperous
• coma