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Psychiatry Y5 > Mental State Examination > Flashcards

Mental State Examination Flashcards

1
Q

What are the 7 topics in a Mental State Examination?

A 
Appearance and behaviour
Speech and thought form
Mood
Thought content
Perception
Cognition
Insight
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2
Q

Describe the step-wise process you can use to describe the patient’s appearance.

A

Step 1 - anonymous details (age, gender, build)
Step 2 - self care (level of self care + state of clothing)
Step 3 - small physical items (scars, piercings, tattoos)
Step 4 - facial expression, posture

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3
Q

6 components of behaviour?

A 
Facial expression
Posture
Eye contact
Engagement
Level activity
Odd movements (abnormal psychomotor or uncontrolled movements)
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4
Q

4 components of speech? (+ categories)

A

Rate - normal, fast, slow
Volume - normal, soft, loud
Tone - calm, hostile, sarcastic
Flow - spontaneous, hesitant, uninterruptible

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5
Q

What is formal thought disorder?

A

Where a patient’s thoughts (judged by their speech) become muddled, vague, disorganised, disjointed, or abnormal in some way.

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6
Q

What are the 3 types of slow or stopped formal thought disorder?

A 
Poverty of thought (lack of meaningful phrases and spontaneous thought)
Thought block (sudden inability to speak or think)
Thought withdrawal (delusion that a thought has been removed from one's head)
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7
Q

What are 4 overinclusive or excessive thought formal thought disorders?

A

Pressure of speech (rapid and frenzied speech)
Circumstantial (loads of unnecessary detail but maintain train of thought)
Tangential (thought wanders and never returns to original topic)
Over-inclusive (can’t maintain speech/thought to just the 1 topic)

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8
Q

What are 3 formal thought disorders associated with too many thoughts that are linked?

A 
Flight of ideas (series of loosely connected ideas, can be by rhyme or puns etc)
Clang associations (string of words that sound similar, typical of schizophrenia or bipolar)
General distractions (continually distracted by surroundings, typical of mania)
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9
Q

What are 3 formal thought disorders associated with losing train of thought completely? (speech becomes confused and hard to follow)

A 
Derailment (frequent interruption of thoughts and jumping from one idea to an unrelated one)
Knights move thinking (loosening of associations, can be contextual or just the word e.g. "I think someone's infiltrated my copies of the cases. We've got to case the joint. I don't believe in joints, but they do hold your body together.")
Word salad (confused or unintelligible mixture of seemingly random words)
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10
Q

What 4 components do you need to assess someone’s mood?

A

Patient’s subjective report
Your objective observation
Affect
Congruence

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11
Q

What are the 5 biological symptoms of low mood/depression?

A

Reduced sleep, appetite, energy, concentration, libido (ask about these)

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12
Q

What are the 3 negative cognitions of low mood/depression?

A

Hopelessness, worthlessness, guilt

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13
Q

What are 4 key buzzwords for describing low mood/depression?

A

Irritability, sadness, tearfulness, anhedonia

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14
Q

When observing low mood/depression, what 2 ways can it present?

A

May be presenting complaint (low mood/loss of interest)

May be secondary to something else (go find presenting complaint)

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15
Q

What 3 additional symptoms/signs might you hear from someone with severe depression?

A

Psychosis (delusions and hallucinations)
Extreme negative thoughts (I have/am nothing, everyone hates me)
Nihilistic and persecutory delusions (hearing voices with a derogatory content)

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16
Q

What are 3 sensitive topics that are worth discussing with depressed patients?

A

Libido
Alcohol use
Suicidal thoughts

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17
Q

What 3 questions need asked after a suicide/self-harm attempt?

A

Get as much detail as possible
What exactly happened?
What did you think would happen when you did that?
How do you feel now? Has anything changed?

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18
Q

What is mania?

A

A persistent elevation in mood (can be a mix of elation and irritability)

19
Q

What are the biological symptoms of mania?

A

Reduced need for sleep
Increased energy
Increased appetite (but potentially less actual eating)
Subjectively improved concentration, confidence, and sense of wellbeing
Increased libido

20
Q

What behaviour, thoughts, and potential psychosis would you see in mania?

A 
Increased thoughts (reflected in speech as rapid, frenzied)
Increased risk-taking with spending, substance abuse, speeding
Grandiose psychosis (grandiose delusions)
21
Q

What is key to ask in a patient you suspect is manic?

A

“observation”, is this normal for you? (observation can be increased energy, confidence etc)
Do you have any special powers/are you special/different to other people in any way?

22
Q

What 5 things can describe a patient’s thought contents? (other than normal)

A 
Depressive
Anxious
Obsessional thoughts
Overvalued ideas
Delusions
23
Q

What are physical symptoms of anxiety disorders?

A 
Restlessness
Dry mouth
Tremor
Butterflies
Nausea
Shortness of breath
Palpitations
Emotional distress
24
Q

What is the difference between generalised anxiety and phobias?

A

Generalised - excessive worries about anything

Phobias - excessive fear of an object or situation

25
Q

How do you summarise anxiety under thought content in the MSE?

A

State the theme of the anxiety (e.g. fear of humiliation in social situations)

26
Q

3 things to ask about anxious thought content?

A

What - what are you worried about?
How - how does that worry make you feel in your body?
What - what do you do to cope or manage this worry/feeling?

27
Q

What is an ‘overvalued idea’?

A

A reasonable belief/concern that is pursued excessively, dominating their life and causing distress to self/others
KEY - they are socially appropriate

28
Q

What must you exclude when documenting overvalued ideas?

A

Delusions

29
Q

What are ‘delusions’?

A

Fixed, false beliefs, held despite rational argument or evidence to the contrary OUT OF KEEPING with cultural/social background

30
Q

What are primary and secondary delusions?

A

Primary - occur out of the blue

Secondary - develop after another symptom e.g. hearing a voice, smelling something

31
Q

What are the 8 types of delusions?

A 
Persecutory
Grandiose
Nihilistic
Hypochondriacal
Of guilt
Of reference
Erotomania
Of thought interference
32
Q

What are the 2 ways you can elicit delusions?

A

PC - this may be the presenting complaint and they’ll just tell you
Ask screening questions - “is there anything unusual going on that’s been troubling you?” or “have you had an odd experience recently that you can’t explain?”

33
Q

How can you test the strength of a delusional belief?

A

Why do you think this is happening to you?
How do you explain what’s happened?
Sometimes our brain can play tricks on us, do you think this could be happening to you?

(Patients will either know something isn’t right but be unsure or will insist and explain with flawed logic)

34
Q

What is psychosis?

A

The experience of losing touch with reality through delusions, hallucinations, and/or formal thought disorder.

35
Q

What is schizophrenia?

A

A type of psychotic illness.

36
Q

What are the 5 subtypes of schizophrenia?

A 
Paranoid
Catatonic
Hebephrenic
Simple
Residual
37
Q

What are the 5 other types of psychotic illness? (other than schizophrenia)

A 
Acute and Transient Psychotic Disorder
Schizoaffective Disorder
Delusional Disorder
Schizotypal Disorder
Puerperal Psychosis
38
Q

What are the Schneider’s First Rank Symptoms?

A

Delusional perception
Thought interference (insertion, withdrawal, broadcasting)
Passivity (someone/thing else controlling their body)
Auditory hallucinations (voices talking about them, voices running commentary, thought echo)

39
Q

What is the difference between an illusion and a hallucination?

A

Illusion - misperception of a stimulus

Hallucination - perception in ABSENCE of stimulus

40
Q

What are the 5 types of hallucinations that you need to check for?

A 
Auditory
Visual
Olfactory
Gustatory
Tactile
41
Q

Difference in auditory hallucinations between severe depression and schizophrenia?

A

Severe Depression - voice in the head is likely in second person “you are bad”
Schizophrenia - voice in the head is likely in third person “he is bad”

42
Q

What are the 5 areas of cognition you need to assess?

A 
Attention
Concentration
Orientation
Memory
Language
43
Q

What are the 3 components of insight?

A
  • The patient’s awareness that something is wrong or that they are unwell in some way
  • That their problem concerns their mental health
  • That they require treatment

Psychiatry Y5 (22 decks)

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