Mental state exam

Question 1

What are the components of the MSE?

Answer 1

Appearance
Behaviour
Speech
Mood
Thoughts
Perception
Cognition
Insight
(Risk assessment)

Question 2

Components of thoughts?

Answer 2

content
delusions
overvalued ideas
focus of discussion

Question 3

Perception?

Answer 3

sensations
auditory
visual
smells
tastes
movement

Question 4

How to assess cognition?

Answer 4

MMSE
Addenbrooke’s Orientation

Question 5

How to assess insight?

Answer 5

do they feel unwell?
do they feel that they need help?

Question 6

How to assess appearance/behaviour?

Answer 6

make up
clothes
carrying objects
hygiene
eye contact
agitated

Question 7

What is most important for speech?

Answer 7

rate and rhythm

Question 8

How to distinguish between elated and being normally cheerful?

Answer 8

elation becomes annoying after a while…you laugh with them initially but you then stop

Question 9

How to document mood?

Answer 9

not depressed
not elated
(comment on absence!! like with xrays…no fracture, no fluid, normal joint space, no osteophytes)

Question 10

What is another word for knight’s move thinking?

Answer 10

=derailment

Question 11

What are the two most important thought forms

Answer 11

flight of ideas and knight’s move

Question 12

Which condition is associated with knight’s move thinking

Answer 12

schizophrenia

Question 13

How to define delusion?

Answer 13

fixed false belief outwith social cultural and religious norms

Question 14

What to do if patient comes in with delusions about their wife who is cheating on them?

Answer 14

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

Question 15

Who gets visual hallucinations??

Answer 15

organic brain disease! super rare in psychiatry, almost always auditory

Question 15

Who gets visual hallucinations??

Answer 15

organic brain disease! super rare in psychiatry, almost always auditory

Question 16

Who gets olfactory hallucinations?

Answer 16

temporal lobe

Question 17

Psychosis of touch?

Answer 17

cocaine use

Question 18

Do you experience the voice inside or outside your head?
Is the voice talking to you or about you?
Which is the most serious

Answer 18

external talking about you (third person)

Question 19

What is normal auditory hallucinations?

Answer 19

internal talking to you

Question 20

What are the four domains of cognition that you need to assess?

Answer 20

memory
concentration/attention
orientation
intellectual capability

Question 21

How to assess memory

Answer 21

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…

Question 22

How to assess concentration/attention

Answer 22

take 7 away from 100
I’m not going to tell you if you’re right or wrong, you just carry on

Question 23

If patient makes lots of mistakes taking 7 away from 100, do they pass the test?

Answer 23

yes!