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Psychiatry > Mental State Exam and Histories > Flashcards

Mental State Exam and Histories Flashcards

1
Q

what is a personal history

A

expanded social history, gives an idea of premorbid function/ difficulties/ personality

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2
Q

do you assess sleep in MSE

A

no, MSE is observations, dont observe someone sleeping unless they fall asleep during exam

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3
Q

what is the difference between MSE and a history

A

MSE is:

  • based on observation by doctor
  • objective assessment
  • technical description
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4
Q

what is this patients mood and affect:
A previously depressed patient says that generally they are feeling a lot better but today they feel “very low” and at interview looks unhappy but is able to laugh at jokes. What would be the best description of their mood and affect at interview?

A

Mood “very low”, affect low but reactive

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5
Q

what is a perception without a stimulus

A

hallucination

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6
Q

which of the following is an example of passivity experience:

  • Persecutory delusion
  • Self-referential thought
  • Thought blocking
  • Thought broadcasting
  • Threatening Auditory Hallucination
A

thought broadcasting- dont have control over own thoughts

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7
Q

A patient on their own at home hears a voice say “Get out of the house or we will bomb the house”. What abnormality of mental state is this is an example of?

  • Auditory Hallucination
  • Auditory Illusion
  • Persecutory Delusion
  • Reduced insight
  • Thought insertion
A

auditory hallucinations

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8
Q

The patient says that the threatening voice came from an RAF plane flying over her house. What abnormality of mental state is this is an example of?

  • Auditory Hallucination
  • Persecutory Delusion
  • Nihilistic Delusion
  • Reduced insight
  • Thought broadcasting
A 
persecutory delusion 
(persecutory as about other people doing harmful things)
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9
Q

what is included in the MSE

A 
appearance and behaviour 
speech 
affect and mood
thoughts: control & content 
perception 
cognition 
insight
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10
Q

what do you look for in appearance in MSE

A 
age, gender, race
body habitus 
grooming
attire
posture
gait, odd movements (tics, tremors, stereotypes, mannerisms)
evidence of injuries of illness (self harm, abuse, fights, drug use: pupils, bruising) 
smell
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11
Q

what do you look for in behaviour is MSE

A 
eye contact
rapport
open/ guarded/ suspicious 
agitation/ psychomotor retardation 
disinhibition/ overfamiliarity
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12
Q

what do you look for in speech in MSE

A 
rate 
amount (increased -> pressured. decreased -> monosyllabic -> mute)
variation in tone (prosody)
speech delay 
volume
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13
Q

what is mood

A

how does the patient feel today (not how they have been feeling over the past few months)
subjective- record in patients own words

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14
Q

what is affect

A

your observation of how the patient appears through the interview, how reactive they are during conversation

consider their baseline affect and to what extend this varies

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15
Q

what are the terms for how an affect can vary/ stay the same

A

appropriately reactive
labile (varies too much and too often)
unreactive (stays emotionally low)
flattened (reaches low emotions (sad) reactions but not high ones (happy))
blunted (neutral- unreactive to both happy and say)
incongruent (inappropriate reactions)

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16
Q

how do you assess cognitive function in MSE

A

orientation to time, place and person
concentration (months of year backwards)
memory (autobiographical, retrograde (past events), anteriorgrade (new memories- remember 3 things, name and address))

17
Q

what is insight

A

self awareness
does the patient recognise that they are unwell
do the attribute it to a mental health problem
do they accept the need for treatment/ hospitalisation

18
Q

what is a hallucination

A

a perception which occurs in the absence of an external stimulus

is experienced as originating in real space not just in thoughts

same qualities as a normal perception

is not subject to conscious manipulation

can occur in any sensory modality, can be simple (formless sound) or complex

=a misrepresentation of inner experience as having an external origin

19
Q

when are hallucinations significant

A

only when in the context of other relevant symptoms

20
Q

where in brain is abnormally active during auditory hallucinations

A

supplementary motor area (monitors self generated actions)

hippocampus - parahippocampal gyrus (detects mismatch between perceived & expected activity)

21
Q

what are the types of auditory hallucinations

A

second person- voices which directly address the patient

third person- voices which discuss the patient or provide a running commentary on their actions

thought echo- patient experiences his own thoughts spoken or repeated out loud

22
Q

what are the types of visual hallucinations

A

(often associated with altered consciouness/ organic impairment)

simple- flashes of light
complex- face or figure

23
Q

what other senses can experience hallucinations

A

olfactory
gustatory
somatic (body sensations e.g. being touches, bugs crawling under skin)

24
Q

what is passivity phenomena

A

behaviour is experienced as being controlled by an external agency rather than by the individual

can affect:
thoughts (insertion, withdrawal, broadcasting), actions and feelings (made actions and feelings)

25
Q

where are the abnormalities on a PET scan in passivity phenomena

A

parietal and cingulate cortices
these areas are involved in interpretation of sensory information
abnormalities may lead to internal actions being misinterpreted as being caused by external agency

26
Q

what is disorder of form of thought

A

when there is evidence from the patients speech or writing that there is an abnormality in the way their thoughts are linked together

  • disturbance in organisation, control and processing of thoughts
  • the abnormality id the the form of their speech rather than its content
27
Q

give two examples of disorders of the form of though

A

flight of ideas

loosening of associations

28
Q

what is flight of ideas

A

when words are associated together inappropriately because because of their meaning or rhyme so that speech loses its aim and the patients wanders far from original theme

-patient will jump from topic to topic with with recognisable links such as rhyming, punning or environmental distractions

29
Q

describe loosening of associations

A

the patients speech is muddled, illogical, difficult to follow and cannot be clarified
patient will talk freely but so vaguely that no information is given in spite of the number of words used
may be jumps from topic to topic but with no logical connection

30
Q

describe neologism

A

an abnormality of speech in which the patient makes up a new word or phrase/ uses existing words or phrases in bizarre ways (will have an idiosyncratic meaning to the patient)

31
Q

what is a delusion

A

a false belief/ belief held on false grounds
inappropriate to the patients socio-cultural background
is firmly held in the face of logical argument or evidence to the contrary
not modified by reason or experience
usually very individualised/ of great personal significance

32
Q

what are themes of delusions

A

what it is about

33
Q

what themes of delusion are common in depression, schizophrenia and mania

A

depression- disease, nihilism, poverty, sin, guilt
schizophrenia- control, persecution, reference, religion, love
mania- grandiosity, persecution, religion

34
Q

what usually determines the content of a delusion

A

the specific content is usually culturally defined

-a persecutor is often recognisable to society/ culture as a danger threat

35
Q

what is the origin of most delusions

A

they are often attempts to explain anomalous experiences (e.g. hallucinations, passivity experiences, depression)

Psychiatry (27 decks)

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