Mental State Examination Flashcards
When would you assess them
Assess them for the time that you are with them
Appearance
Distinguishing features
-self harm scars, tattoos, IVDU use?
Weight
-significantly overweigh/underweight - clothes fitting?
Disease stigmata - contributing to mental state
Personal hygiene - self care ability?
-unshaven?
Clothing - appropriate for circumstances, are they on correctly?
-makeup
Speech
Rate
- pressure of speech - can you interrupt them? (mania, schizoaffective)
- slow speech - psychomotor retardation (depression?)
Quantity
- minimal/absent - depression?
- excessive - mania, schizophrenia
Tone
-monotonous - depression, schizophrenia, autism?
Fluency, rhythm
- stammer, stutter
- slurred - psychomotor retardation in depression?
- tremulous - anxiety?
Flight of ideas - mania (many ideas but can see connections)
Word salad - schizophrenia (cannot see the connections between ideas)
Pressure of speech - are they interruptable?
Clanging - schizophrenia (words are used based on similar sounds, lack of connection)
Do you feel confused => schizophrenia?
Do you feel amused, see connections => mania?
Volume - depression (low), loud
Length of answers - depression (short), lengthy
Mood - patient’s description of their emotions
Affect - objective emotion
Subjective experience vs objective experience
-ask how they think they’re feeling
Apparent emotion
- sad
- anger
- hostility
- euphoric
Range and mobility
- fixed - no change in affect regardless of topic discussed
- restricted - affect changes but not the normal range of emotional expression expected
- labile - highly changeable, may feel like they have no control over emotions
Intensity
- heightened - personality disorder, mania
- blunted/flat - schizophrenia, depression, PTSD
Congruency - affect does not match thoughts
-incongruent - schizophrenia, bipolar v changeable
Somatic symptoms of mood disorder
- concentration, enjoyment
- weight, appetite
- energy levels, libido
Thought form - processing, organisation
Thought form - organisation of their thinking
- Knights move thinking - loose connections between ideas
- Word salad - lose grammar and
- New words
Speed - racing/abnormally slow processing
Flow and coherence
- loose associations - rapid mv between topics with no clear connection
- circumstancial thoughts - irrelevant, unnecassery details included
- tangential thoughts - digressions
- flight of ideas - no connection between ideas
- thought block - sudden cessation of speech, cannot continue
- perseveration - repetition of a particular response to further questions
- neologisms - new words
Thought content
Delusions - false, fixed belief that is not consistent with their cultural background
- persecutory
- grandiose
- nihilistic - feels like the world, their life has ended
- guilt - committed a crime they haven’t done
- passivity experiences - made actions, made feelings
- somatic passivity - ext influences are acting on your body
Obsessions, compulsions - own thoughts that come but make them uncomfortable
-how do they manage it? => rituals, strict patterns of behaviour, ask for extra reassurance
Flashbacks
Negative beliefs and cognitions - low self esteem, failure, no good
How to screen for thought content
What’s been on your mind recently
Do you have any beliefs that people around you don’t have?
Do you ever feel that people are out to harm you
Do you ever have thoughts that make you uncomfortable, how do you manage these situations?
Have you ever thought that your life is not worth living, wanted to harm yourself, take your own life?
Do you ever think about harming others?
Risk assessment
Risk to self - feeling hopeless, hurting yourself, taking your life?
- can you ignore them, how intrusive are they?
- have you planned, dates, times, reasons?
- past attempts and outcomes
- ideation, intent and planning
- protective factors?
- social factors?
Risk to others - children, family?
-try to normalise the question so it feels less interrogative
Thought posession
- thought broadcasting
- thought withdrawal - someone else is removing their thoughts
- thought insertion
How to screen for thought possession
Do you ever feel like people can put ideas into your head without your control
Have you ever felt like people have removed thoughts from your mind
Do you ever feel like others can hear your thoughts?
Behaviour
Engagement, rapport
-distracted, engaging with hallucinations - schizophrenia?
Eye contact
-reduced/excessive?
Body language
- threatening/withdrawn - distance from you
- exaggerated mannerisms, gestures?
Psychomotor symptoms
- psychomotor retardation (paucity of movement, delayed responses to questions)
- restlessness, pacing?
Abnormal movements/postures
- involuntary mv, tics
- akathisias - restlessness due to antipsychotic meds
- rocking
Perception - organisation, identification, interpretation of sensory info
Hallucination - sensory perception without ext stimulation
- auditory - MOST COMMON, sound is coming from somewhere
- 2nd (more mood), 3rd person (more schizophrenia)
- visual - organic disorders likely (drug withdrawal/intoxication, dementia, infection)
- tactile - crawling insects (alcohol withdrawal)
- olfactory - smell of poisoning, burning gas
- gustatory - taste of poisoning, may often match other beliefs
Pseudohallucinations - hallucinations but patient is aware they are not real
Depersonalisation - no longer feel like you’re in your own body
Derealisation - world feels fake
Illusion - misinterpretation of ext stimulus
How to screen for perception
Do you ever see, hear, smell, feel, taste things that others cannot?
Did you believe this was a real experience
Do you ever feel disconnected from your body
Do you ever feel like the world isn’t real
Cognitions
Orientated in place, person and time
- attention span, concentration
- short term memory
Can be assessed throughout the exam
Insight - ability to understand that they have a mental health problem
How to screen
What do you think the problem is?
Do you think you need help with your problem
