Mental State Exam and Histories Flashcards
what is a personal history
expanded social history, gives an idea of premorbid function/ difficulties/ personality
do you assess sleep in MSE
no, MSE is observations, dont observe someone sleeping unless they fall asleep during exam
what is the difference between MSE and a history
MSE is:
- based on observation by doctor
- objective assessment
- technical description
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?
Mood “very low”, affect low but reactive
what is a perception without a stimulus
hallucination
which of the following is an example of passivity experience:
- Persecutory delusion
- Self-referential thought
- Thought blocking
- Thought broadcasting
- Threatening Auditory Hallucination
thought broadcasting- dont have control over own thoughts
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
auditory hallucinations
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
persecutory delusion (persecutory as about other people doing harmful things)
what is included in the MSE
appearance and behaviour speech affect and mood thoughts: control & content perception cognition insight
what do you look for in appearance in MSE
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
what do you look for in behaviour is MSE
eye contact rapport open/ guarded/ suspicious agitation/ psychomotor retardation disinhibition/ overfamiliarity
what do you look for in speech in MSE
rate amount (increased -> pressured. decreased -> monosyllabic -> mute) variation in tone (prosody) speech delay volume
what is mood
how does the patient feel today (not how they have been feeling over the past few months)
subjective- record in patients own words
what is affect
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
what are the terms for how an affect can vary/ stay the same
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)
how do you assess cognitive function in MSE
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))
what is insight
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
what is a hallucination
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
when are hallucinations significant
only when in the context of other relevant symptoms
where in brain is abnormally active during auditory hallucinations
supplementary motor area (monitors self generated actions)
hippocampus - parahippocampal gyrus (detects mismatch between perceived & expected activity)
what are the types of auditory hallucinations
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
what are the types of visual hallucinations
(often associated with altered consciouness/ organic impairment)
simple- flashes of light
complex- face or figure
what other senses can experience hallucinations
olfactory
gustatory
somatic (body sensations e.g. being touches, bugs crawling under skin)
what is passivity phenomena
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)
where are the abnormalities on a PET scan in passivity phenomena
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
what is disorder of form of thought
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
give two examples of disorders of the form of though
flight of ideas
loosening of associations
what is flight of ideas
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
describe loosening of associations
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
describe neologism
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)
what is a delusion
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
what are themes of delusions
what it is about
what themes of delusion are common in depression, schizophrenia and mania
depression- disease, nihilism, poverty, sin, guilt
schizophrenia- control, persecution, reference, religion, love
mania- grandiosity, persecution, religion
what usually determines the content of a delusion
the specific content is usually culturally defined
-a persecutor is often recognisable to society/ culture as a danger threat
what is the origin of most delusions
they are often attempts to explain anomalous experiences (e.g. hallucinations, passivity experiences, depression)
