Mental Health Assessment/Mental State Examination (MSE) Flashcards
Why do an MSE?
- Identify signs & symptoms
- Monitor change or improvement
- May inform treatment or interventions
- Provides a standardised form of documentation
When to conduct an MSE?
- 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
What is included in history taking in addition to MSE?
- 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
Overview of mental state examination
- Appearance & Behaviour
- Speech
- Mood & Affect
- Form of thought
- Content of thought
- Perceptual disturbances
- Sensorium & cognition
- Insight / Judgement / Memory
Appearance & Behaviour
- 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
Speech
- Articulation disturbances
- Rate (rapid, pressured, slow)
- Volume
- Quantity
Mood and Affect
Mood
- subjective/ internal feeling state
- use patients own words
Affect
- objective/observable emotions
- Range & intensity
- Stability
- Appropriateness & congruity
Range and intensity of affect
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
Stability of affect
Rate at which affect changes
- Stable - no fluctuation in affect
- Labile - excessively rapid changes in affect
- Diurnal variation
Appropriateness & congruity of affect
- 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
Thought form/process
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
Amount of thought & its rate of production
- 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
Continuity of ideas
- 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
Disturbances of language
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
Thought content
- What is going through the persons head?
- delusions
- obsessions/intrusive thoughts
- compulsions
- Suicidal thoughts?
- Thoughts to harm others?
- What’s for dinner?
Perceptual disturbances
- Hallucinations (all senses)
- Delusions
- Derealisation
- Depersonalisation
- Logical / linear or irrational thoughts?
Sensorium & Cognition
- Level of consciousness
- Memory
- Orientation
- Concentration or focus
- Judgement (should be separate category, very specific)
Insight
- 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
Elements of a mental health assessment
- 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
types of delusions
- 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)
Types of thought processes
- 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)
types of hallucinations
- auditory
- visual
- olfactory
- tactile
- gustatory
levels of consciousness
- alert
- lethargic
- stuperous
- coma