Mental State Exam Flashcards
What is the purpose of a mental state exam?
- an assessment of a person’s current state of mind
- sescribes a dnapshot of their presentation during your interaction with them
- also includes relevant negative findings
- used to assess progress during/after treatment
What is the format of a mental state exam?
- appearance and behaviour
- speech
- mood and affect
- thought form and content
- perception
- cognition
- insight
What aspects of a patients appearance is assessed in a mental state exam?
Description of the person
- ethnicity
- build
- hairl colour
- clothing (appropriate for weather?)
- biological vs chronical age
- well kempt
- evidence of self neglect
- appear physically unwell or intoxicated?
- any distinguishing features
What aspects of a patient’s behaviour is assessed in a mental state exam?
how the person acts:
- level of motor activity (agitation or retardation)
- eye contact
- rapport and engagement with interview
- body language and posture
- any unusual or socially inappropriate behaviour
What aspects of a patients speech is assessed in a mental state exam?
how the person talks:
- rate and quantity
- rhythm
- volume
- tone
- spontaneity
What is the difference between mood and affect?
Mood: a persons emotional state overall
Affect: changes in the persons emotions that you observe moment-to-moment during the interview
How is a patients mood assessed in a mental state exam?
- subjectively: how the person tells you they feel in their own words
- objective: your impression of the person's mood during the interview > euthymic (normal) > elevated/elated > low/depressed > anxious
How is a patients affect assessed in a mental state exam?
- reactive: appropriate reaction to the situation or topic being discussed
- flattened: limited emotional reaction
- blunted: no observed emotional reactions (specifically associated with psychosis)
- labile: excessive emotional fluctuations
What is thought form?
the pattern of the persons thoughts
- are they logical connections between the things they are saying?
How is a patient’s thought form assessed?
include specific quotes if possible
- flight of ideas: rapid flow of speech, moving from topic to topic with logical connections (e.g. mania)
- loosening of associations/Knight’s move thinking: little or no logical connections between thoughts (e.g. schizophrenia)
What is thought content?
What the person is saying
any topics that are discussed more than others
What are examples of abnormal thought content?
- delusion
- over-valued idea
- obsessions
What is a delusion?
a fixed false belief that is out of keeping with the person’s religious and cultural background (e.g. psychosis)
Describe different types of delusions
- persecutory: perceived threat from others
- grandiose: considerable overestimate of abilities or possession of special powers
- nihilistic: belie that they are dead or do not exist
- delusions of reference: belief that external events/objects are directly related to them
- thought interference: insertion, withdrawal or broadcast
What is an over-valued idea?
a false belief, not totally
fixed but causing great disability (e.g.
anorexia, hypochondriasis)
What is an obsession?
recurrent, intrusive, distressing
ideas, impulses or images that the patient
recognises as their own (e.g. OCD)
How is a patient’s risk assessed during a mental state exam?
Any thoughts of harm to self or others,
including the degree of planning and intent
Always document, even if negative
What is perception?
What the patient tells you and what you observe
What are examples of abnormal perception?
- hallucination: perception without external stimulus
> auditory - associated with psychosis
> visual, olfactory, gustatory, tactile - more often oganic states - illusion: false perception of a real stimulus
What is cognition in relation to the mental state exam?
- is the person alert and orientated?
- how is their concentration and memory
- can use mini mental state examination if necessary
How is cognition assessed in a mental state exam?
- alertness: do they seem fully awake
- orientation: to time, place and person
- attention/concentration: are they able to maintain focus during the interview, are they easily distracted?
- memory: 3 objects, ask to repeat, then spell world backwards and then ask what the objects were
What is insight?
The patient’s understanding of their presentation and their need for treatment
How is insight assessed in a mental state exam?
Do they believe their experience is unusual?
Is it part of an illness? A mental illness?
Do they require treatment?
What type of treatment?
Do they need to be admitted to hospital?
