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4th year psychiatry placement > Mental State Exam > Flashcards

Mental State Exam Flashcards

1
Q

What are the 7 domains of the mental state exam?

A
  1. Appearance and behaviour
  2. Speech
  3. Mood and Affect
  4. Perceptions
  5. Thought
  6. Cognition
  7. Insight
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2
Q

Define pressured speech?

A

rapid rate, increased volume, difficult to interpret

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3
Q

Define poverty of speech?

A

lengthy pauses between brief utterances

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4
Q

Define flight of ideas?

A

thoughts in speech jump rapidly from one to another

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5
Q

Define clanging?

A

words put together because of how they sound not how they mean

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6
Q

Define punning?

A

associating words that sound the same e.g. sole the fish and soulful

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7
Q

Define schizophasia/ word salad?

A

the connection between themes, sentences and even words is lost, resulting in unintelligible speech, although words are still identifiable

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8
Q

What is the difference between mood and affect?

A
  • Mood is subjective and this is how the patient says they are 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
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9
Q

What are the 2 categories considered under thought?

A

thought content and thought possession

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10
Q

What may you look for under appearance and behaviour?

A
  • Do they look and act their chronological age
  • Colour and state of clothes
  • Facial appearance
  • Eye contact
  • Posture
  • Movement
  • Agitation
  • Startle response
  • Tremor
  • Restlessness
  • Scanning for danger
  • Distractibility
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11
Q

What may you look for under speech?

A
  • Rate (is it abnormally slow or fast)
  • Pressured speech
  • Poverty of speech
  • Variation in tone
  • Volume of speech
  • Flight of ideas
  • Clanging
  • Punning
  • Schizophasia/ word salad
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12
Q

What may you look for under mood and affect?

A

what patient says their mood is
how they appear today (affect)
intensity of affect (can be heightened or bluttened/ flattened)
Congruency

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13
Q

What is meant by congruency of affect?

A

Congruency of affect refers to whether the patient’s affect appears to be in keeping with the content of their thoughts e.g. a patient sharing distressing thoughts and laughing would be described as showing incongruent affect

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14
Q

What are some abnormalities of perception?

A

hallucinations, pseudohallucinations, illusions, depersonalization and derealization

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15
Q

What may you look for under cognition?

A
  • Orientation to time, place and person
  • Concentration
  • Confusion
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16
Q

What may you look for under insight?

A
  • Aspects of insight can be remembered with the 4As
  • Awareness: Does the patient recognise that they are unwell?
  • Attribution: Do they attribute it to a mental health problem?
  • Appraisal: Do they understand the consequences of their symptoms
  • Acceptance: Do they accept the need for treatment?
17
Q

Parts of psychiatric history?

A
  • presenting complaint
  • history of presenting complaint
  • past medical history
  • past psychiatric history (have they ever been detained, do they have other psychiatric conditions, have they ever had an episode of this condition, ever been to hospital with physical consequences e.g. DSH)
  • medications (inc OTC and illicit drug use)
  • family history
  • social history (smoking, alcohol, occupation, support, do they have children they care for)
  • systematic enquiry
  • forensic history
  • childhood/ life events
  • risk assessment / suicide risk
18
Q

What 3 aspects of risk are you assessing in a psychiatric history?

A

Risk to themselves - are they thinking of harming themselves
Risk to others - are they thinking of harming others
Are they vulnerable to others because of their mental health condition?

19
Q

Define circumstantiality?

A

the inability to answer a question without giving excessive unnecessary detail

20
Q

Explain flight of ideas and knights move thinking?

A

knights move thinking are illogical leaps from one idea to another, flight of ideas is discernible links between ideas

21
Q

What is perseveration?

A

when a patient repeats a phrase or word despite moving on from the initial question e.g. being asked what day it was, then answering wednesday to every question there after

22
Q

Define tangentiality?

A

when patient’s wander away from a topic without returning to it

4th year psychiatry placement (13 decks)

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