Mental State Exam Flashcards
Appearance?
Do they look ill or well?
Appropriately dressed?
Clean, well groomed?
Behaviour and interaction?
Non verbal communication
- facial expression
- eye contact
- body language and gestures
- posture
- rapport, social engagement
- anxious or aggressive behaviour
- psychomotor activity and movement
- tremors/slowed/repetitive/involuntary mv
- ease of interaction and quality of conversation
Mood
- what are you looking for
- how would you assess this
How are you feeling today?
Underlying emotional state
Happiness
-happy, sad, anxious, depressed, dysphoric, euphoric?
Irritability
-angry, irritable, explosive, suspicious, restless, calm?
Stability
-stable, labile?
Affect
Current expression of emotion
Range - flat, blunt, restricted, expansive
Appropriateness
- congruent with circumstances?
- congruent with speech content
Stability
-does it vary during the interview?
Speech
Quantity - poverty <=> pressure of speech
Tone - monotonous/tremulous
Volume - loud/normal/whisper?
Speed - fast/slow
Thought content
-how would you assess this?
Delusions
- Do you have thoughts or beliefs that others around you don’t seem to share?
- Do you ever feel that people are out to harm you (persecutory - paranoid schizophrenia)
Thought possesion
- Insertion - Do you think people can put thoughts into your head without your control
- Withdrawal - Do you think people can remove thoughts from your head
- Broadcast - Do you think others can hear what you are thinking?
Obsessional, compulsive thoughts
-Do you have thoughts that you know are irrational but are difficult to get out of your head? Do you feel the need to act on these thoughts to get some relief? (OCD)
Anxious thoughts
-Is there anything that you’re worried about? (anxiety)
Low mood, self harm, suicide, violent thoughts
- Have you felt hopeless? Have you felt you don’t get enjoyment out of life? (depression)
- Have you had thoughts of wanting to hurt yourself? (self harm)
- Have you had thoughts of wanting to end your life? (suicide)
- Have you ever thought of harming others (violent thoughts)
Thought process
-what are you looking for?
Speed of thoughts - racing or slow
Connection between thoughts
-Loose associations
-Tangential - normal speed of thoughts but train of thought derails.
-Flight of ideas - similar to tangential but accelerated speed
-Thought block - sudden cessation of thought
-Neologisms - made up words
Perception
-how would you assess for this
Hallucinations, illusions - Do you ever see, hear, smell, feel, taste things that others don’t seem to experience?
-How real did this feel? => very real (hallucination), understands that they are not real (illusions)
Command hallucinations? - Do the voices you hear ever tell you to do things?
2nd, 3rd person? - What do these voices say?
Passivity phenomenon - Do you ever feel that someone is controlling your actions or emotions?
Dissociations
Derealisation - Do you ever feel detached from your surroundings,
Depersonalisation - Do you ever feel detached from your own body, emotions and thoughts
Insight and attribution
-how would you assess this?
What do you think the problem is?
What do you think the cause of the problem is?
You’re on a mental health ward, do you think you need to be here?
What does the patient think about their state
-what is their understanding and attitude of their present state
Can the patient understand possible treatment options and adhere?
Are they aware of their own pathological events (hallucinations, suicidal impulses?)
Judgement
-how would you assess this?
Cognition
-how would you assess this?
Just some routine questions we ask everyone
Assess patient’s general problem solving ability
-what would you do if you found a stamp addressed envelope in the street
TPP assessment
- what is the date
- do you know where you are at the moment
Risk assessment for future suicide/self harm
Suicidal ideation?
- have they thought about this
- is there a real chance of this happening?
- any past attempt? how did they feel?
Planning
- have they decided how they would end their life
- any specific preparations?
Protective factors
-what would stop them from taking their own life (social support, family responsibilities, religious beliefs, fear of outcomes?)
Risk assessment for recent suicide/self harm
Antecedent
- intention?
- duration and degree of planning
- preparation needed/final acts?
- what happened in the last 48hrs
Attempt
- expectation of outcome?
- lethality?
- precautions taken to avoid discovery?
Outcomes
- feelings? guilt or regret?
- discussions with others?
Completion of examination?
To summarise =>
Description of main positive and negative features of case
Differentials in order of likelihood
Predisposing, precipitating, perpetuating factors?
Further investigations?
-collateral history is always useful
Care plan
-medical, psychological, social interventions?
Prognosis if treated/untreated
-risks to others in short=> medium term
