Mental state exam Flashcards
What are the components of the MSE?
Appearance
Behaviour
Speech
Mood
Thoughts
Perception
Cognition
Insight
(Risk assessment)
Components of thoughts?
content
delusions
overvalued ideas
focus of discussion
Perception?
sensations
auditory
visual
smells
tastes
movement
How to assess cognition?
MMSE
Addenbrooke’s Orientation
How to assess insight?
do they feel unwell?
do they feel that they need help?
How to assess appearance/behaviour?
make up
clothes
carrying objects
hygiene
eye contact
agitated
What is most important for speech?
rate and rhythm
How to distinguish between elated and being normally cheerful?
elation becomes annoying after a while…you laugh with them initially but you then stop
How to document mood?
not depressed
not elated
(comment on absence!! like with xrays…no fracture, no fluid, normal joint space, no osteophytes)
What is another word for knight’s move thinking?
=derailment
What are the two most important thought forms
flight of ideas and knight’s move
Which condition is associated with knight’s move thinking
schizophrenia
How to define delusion?
fixed false belief outwith social cultural and religious norms
What to do if patient comes in with delusions about their wife who is cheating on them?
wife’s safety is the paramount. Only time you can break confidentiality. Ask nurse or someone else to stay with patient whilst you phone the wife to tell her to go somewhere safe whilst you sort out admission, whether it is voluntary or under detention. Very interesting…you can explore the patient’s delusions but due to the nature, it is likely that they will think that you are crazy
Who gets visual hallucinations??
organic brain disease! super rare in psychiatry, almost always auditory
Who gets visual hallucinations??
organic brain disease! super rare in psychiatry, almost always auditory
Who gets olfactory hallucinations?
temporal lobe
Psychosis of touch?
cocaine use
Do you experience the voice inside or outside your head?
Is the voice talking to you or about you?
Which is the most serious
external talking about you (third person)
What is normal auditory hallucinations?
internal talking to you
What are the four domains of cognition that you need to assess?
memory
concentration/attention
orientation
intellectual capability
How to assess memory
give patient name and address to remember
ask them to repeat after you. then at the end of your assessment, e.g. after orientation, then ask them to repeat the address. 70% is fine, less than that then not so good…
How to assess concentration/attention
take 7 away from 100
I’m not going to tell you if you’re right or wrong, you just carry on
If patient makes lots of mistakes taking 7 away from 100, do they pass the test?
yes!
