Mental state Examination Flashcards
Appearance
General elements such as attire and sign of self neglect Facial expression Tatoos and scars Evidence of substance misuse Possibly relevant physical disease
Behviour
Cooperation, rapport, eye contact Social behaviour Apparent responses to possible hallucination or unobserved stimuli Over activity Under activity Abnormal activirty
Agitiation
Combination of pyshic anxiery and excessive, ouorose less motor activity
Compulsion
Sterotyped action that the patient cannot resist performing repeatedlt
Disinhibiton
Loss of control over normal social behaiour
Motor retardation
Decreased motor activity, usually a combination of fewer and slower movements
Posturing
Maintainence of bizarre gait or limb positions for no valid reasons
Speech
Articulation (stammering, dysarthria) Quantiity (mutism, garrulosness) Rate (pressured, slowed) Volume (whispering, shooting) Tone and quality (accent emotionality) Fluency (staccato, monotonous) Abnormal language (neologism, dysphasia, clanging
Clang associations
Thoughts connected by their similar sound rahte than by meaning
Echolalia
Sensless repetition of the interviwer’s words
Mutism
Absence of speech without impaired conciousness
Neologism
Invented word, or a new meaning for an established word
Pressure of speech
Rapid, excessive, continious speech
Word salad
Meaningless string of words, often with loss of grammatical construction
Mood
Variabke iver time
How has your mood been lately
Blunting
Loos of normal emothional sensitivty to expierneces
Catastrophic reaction
An extreme emotional and behavioural over-reaction to trivial stimulus
Flattening
Loss of range of normal emotional responses
Incongruity
Mismatch between the emotional expressiona dn the associated thoguh
Lability
Superficial, rapidley changing and poorly controlled emotions
Thought form
As with speech this is not an assessment of what the patient is thinking about but how they think about it
Circumstantiality
Trivia and digressions impairing the flow but not direction of thought
Cenrete thinking
Inability to think abstractly
Fliught of ideas
rAPID SHIFTS FROM ONE IDEA TO ANOTHER, RETAINING SEQUENCING
Loosening of associations
Logical sequence of ideas impaired. Subtypes include knight’s move thinking, derailment, thought blocking and in its extreme form word salad
Perseveration
Inability to shift from one idea to the next
Pressure of thought
Increased rate and quantitiy of thoughts
Thought content
Main themens and subjects occupying the patient’s mond
Hypochondriasis
Unjustified belief in suffering from a particular disease in spite of appropriate examination and reasssurance
Morbid thinking
Depressive ideas
Phobia
Senslesss avoidance of situation, objecr or activity stemming from a belief that has caused an irrational fear
Preoccupation
Beliefs that are not inhertly abdnormal but which have come to dominate the patient’s thinking
Ruminations
Repeptivie, intrusive, senseless thoughts or preoccupations
Obsessions
Ruminations that persist despite resistance
Delusion
An abnornal belief held with total conviction which is maintained in spite of proof or ligcal argument to the contrary and is not shared by others from the same culture
Delusional perception
Delusion that arises fully formed the false interpretation of a real perception
Magical thinking
An irrational belief that certain actions and outcomes are linked, often culturally determined by folklore or custom
Overvalued ideas
Beliefs that are held, valued, expressed and acted on beyond the normn fro the culture to which the person belongs
Thought broadcastin
Belief that the patients thoughts are heard by others
Thoguht insertion
elief that thoughts are being placed in the patients head from outisde
Thought withdrawl
Belief that thoughts are being removed from the patients head
Depersonalisation
Subjective expeiirence of feeling unreal
Derealisation
Subjective experience that the surrounding environent is unreal
Hallucination
False perception that is an understandable misinterpreation of a real stimulus in the external world
Pseudohallucination
A flase perception that is percieved as part of one’s internal expiernce
Cognition
If the hsitory and observation suggest a cognitive deficit it must be evaluated by standard tests Level of consciousness Orientation Memory Attention and concentration Intelligence
Level of concioussness
Mental disorders are rarely associared with areduced level of consciousness such as drowsiness stupor or coma. The exception is delerium
Oritentation
Key aspect of cognitive function being particular sensivie to impairment
Check orientation to time, place and person by evaluating their knowledge of the current time and date, recognition of where they are and identification of familiar people
Memory
Divided into 3 elements
Registration is tested by asking the patient to repeat after you the names fo 3 unrelated objects
Short term memory
Long term memory
Insight
Degree to which a patient agrees that they are ill
Recognition that abnormal mental expiericnes are in fact abnormal
Agreement that. these abnormalities amount to a mental illness and acceptance of the need for treatment
Risk assessment
Who is at risk
Nature of the risk
Lieklihood of the risk
Collateral hisotry
IMportant whnever assessment is limited by: Physical illness, acute confusional state or dementia
Severe learning disability or other mental disorder imparing communication
Disturbed, aggressive or otherwise uncooperative behaviour
Abberviated mental test
Age DOB Time Year Hospital name Recognition of 2 people Recall address Dates of first world war Name of the monarch Count backwards 20-1
General morbitidity has
General health questionnaire
Mood dirsorders
Hospital anxiety and depression scale
Beck Depression Inventroy
Alcohol
CAGE questionnaire
CAGE
Cut down: Have you ever felt you should cut down on your drinking
Annoyed: Have people annoyed you by criticising your drinking
Guilty: Have you ever felt bad or guilty about driving
Ever: Do you ever have a drink first thing in the morning to steady you or help your hangover
FAST
1- Men: How often do you ahve eight or more drinks on one occasion
Women: How often do you have six or more drinks on one occasion
2- How often during the last year have you been unable to remember what happened the night before because you had been drinking
3- How often during the last year have you failed to do what was normally expected of you because of drinking
4- In the last year, has a relative or friend, or a doctor or other heath worker been concerned about you drinking or suggested you cut down
