Mental State Examination Flashcards
Appearance?
Colour and state of clothes Facial appearance Posture Ethnicity Physique Tattoos Kempt or unkempt Signs of self-neglect Looks older, younger or as expected for age
Behaviour?
- General: relaxed, agitated, fidgety, restless, anxious, guarded, suspicious, hostile
- Eye contact: able to make and maintain it
- Posture: open and responsive or closed off
- Unusual mannerisms
- Excessive or inadequate amount of movements
- Comment on how these behaviours impacted on ability to build rapport
- Scanning for danger
Speech questions?
Level of articulation Spontaneous or not Variation in tone Rate: slow, normal, rapid Volume: quiet, adequate or increased Quantity: Decreased, adequate, increased Clear abnormalities: Stammer, dysarthria
(Flight of ideas, clanging, punning, schizophrenia/word salad)
Pressured speech is?
Rapid rate
Increased volume
Difficult to interpret
Poverty of speech is?
Lengthy pauses between brief utterances
Mood?
Anxious? Apathetic Dysphoric Depressed Euthymic Elated Euphoric Irritable
Affect:
-Congruent (eg distressing thoughts & laughing)
-Reactive or restricted
-Blunted: expression of emotion is insensitive to situation
-Flattened: outward display of emotion reduced
Labile: Poorly controlled and fluctuating
Thought?
Flow:
- Amount and speed
- Pressure: Rapid, abundant, wide ranging
- Poverty: slow, limited range
- Blocking: abrupt end to chain of thought
Form:
- Any formal thought disorder
- Flight of ideas
- Knights move
- Loosening of associations
- Circumstantiality
- Tangenital
- Preservation
- Neogolisms
Consider what 2 things when assessing thought?
Content of thought
Thought possession
What is involved in possession of thought?
Thought insertion
Broadcasting
Thought withdrawal
Knights move?
Jumps from idea to idea with their being no apparent connection between them
Loosening of associations?
Thought becomes muddled and difficult to follow- word salad is severe form
Circumstantiality?
Questions answered in a very round about way
Tangenital?
Wanders off topic and never returns to it
Preservation?
Involuntary repetition of ideas and thoughts when subject has been changed
Neogolisms?
New words invented for objects with only the patient understanding these
Content of thoughts?
Nature: guilt, shame, worthlessness, homicidal
Pre-occupations: thoughts that are in an individuals mind but not fixed, false or intrusive
Over-valued ideas: nature of thought is unreasonable, irrational, intrusive and cannot be suppressed
Delusions: Foxed, firm belief that is inappropriate to background firmly held in the face of logical argument or contrary evidence and of great significance to the patient
Types of delusional thoughts?
Congruent or incongruent Bizarre Grandiose Paranoid Nilistic Control Thought control: insertion, broadcast, removal Reference: innocuous events held in high significance. Two
Perceptions?
- Depersonalization (body is strange or unreal)
- Derealization (feelibg that object in external world are strange/unreal)
- Illusions (normal sensory stimuli are misinterpreted)
- Hallucinations (perception in absence of sensory stimulus)
Types of hallucinations?
- Visual
- Auditory
- Olfactory
- Tactile
- Gustatory
- Auditory
Questions about auditory hallucinations?
- No of voices
- Do they recognize voices
- Do you hear them inside your head or speaking to you like I am
- Do they talk to you or about you
- What do they say
- Do they tell you to do anything
Cognition
Formal assessment: MMSE
Information assessment:
-Orientation in time, place, and person
-Concentration and level of conciousness
How can aspects of insight be remembered?
4 As
- Awareness: Recognise they are unwell
- Attribution: Attribute it to mental health problem?
- Appraisal: Understand consequence of symptoms
- Acceptance: Accept need of treatment
Questions to ask so patients understand consequences of not getting help?
- Do you think you symptoms are a problem
- What do you think is causing you to think this way/hear these voices
- Would you accept that is due to mental illness
- Do you think you need help
- What do you think would happen if you didn’t get help
Flight of ideas?
Words are associated together inappropriately because of their meaning or rhyme so that speech loses its aim and the patient wanders far from the original theme. The patient jumps from topic to topic but with recognizable links such as rhyming, punning or environmental distractions.
Clanging is?
Words put together because of how they sound not what they mean
What is punning?
Associating words that sound the same (soul the fish and soulful)
What is word salad?
Connection between themes, sentences and even words is lost, resulting in unintelligible speech
