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OSCE - histories > Mental state examination > Flashcards

Mental state examination Flashcards

1
Q

What is the mental state examination?

A

A structured way of observing and describing a patient’s current state of mind

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2
Q

What are the domains of the mental state examination?

A
  1. Appearance
  2. Behaviour
  3. Speech
  4. Mood and Affect
  5. Thought
  6. Perception
  7. Cognition
  8. Insight and judgement
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3
Q

What would you take into consideration as part of appearance for a mental state examination?

A
  1. Distinguishing features: these may include scars (e.g. self-harm), tattoos and signs of intravenous drug use.
  2. Weight: note if they appear significantly underweight or overweight.
  3. Stigmata of disease: note any stigmata of disease (e.g. jaundice).
  4. Personal hygiene: this can provide insight into the patient’s current ability to care for themselves.
  5. Clothing: note if this is appropriate for the weather/circumstances and if the clothes have been put on correctly.
  6. Objects: look around to see if the patient has brought any objects with them and note what they are.
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4
Q

What would you take into consideration as part of behaviour for a mental state examination?

A
  1. Engagement and rapport (e.g. replying to auditory hallucinations)
  2. Eye contact
  3. Facial expressions (e.g. relaxed, angry, disengaged)
  4. Body language (e.g. threatening or withdrawn)
  5. Psychomotor activity (psychomotor retardation or restlessness)
  6. Abnormal movements or postures
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5
Q

What abnormal movements or postures can potentially be seen?

A 
Involuntary movements
Tremors
Tics
Lip-smacking
Akathisias
Rocking
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6
Q

What would you take into consideration as part of speech for a mental state examination?

A
  1. Rate of speech
  2. Quantity of speech
  3. Tone of speech
  4. Volume of speech
  5. Fluency and rhythm of speech
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7
Q

What is pressure of speech?

A

A tendency to speak rapidly, motivated by an urgency that may not be apparent to the listener (often a manifestation of thought abnormalities such as flight of ideas)

Slow speech: may occur due to psychomotor retardation which is typically associated with major depression.

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8
Q

What would you say about quantity of speech?

A

Minimal or absent speech: associated with depression.

Excessive speech: associated with mania and schizophrenia.

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9
Q

What would you say about tone of speech?

A

Monotonous speech: associated with conditions such as depression, schizophrenia and autism.

Tremulous speech: associated with anxiety.

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10
Q

What would you say about fluency and rhythm of speech?

A

Slurred speech: may occur in major depression due to psychomotor retardation.

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11
Q

What would you take into consideration as part of mood and affect for a mental state examination?

A

Mood:
“How are you feeling?”
“What is your current mood?”
“Have you been feeling low/depressed/anxious lately?”

Affect:

  1. Apparent emotion
  2. Range and mobility of affect
  3. Intensity of affect
  4. Congruency of affect
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12
Q

How would you distinguish mood from affect?

A

Affect represents an immediately expressed and observed emotion (e.g. the patient’s facial expression or overall demeanour).

Mood represents a patient’s predominant subjective internal state at any one time as described by them.

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13
Q

What would you say about the range and mobility of affect?

A

Fixed affect: the patient’s affect remains the same throughout the interview, regardless of the topic.

Restricted affect: the patient’s affect changes slightly throughout the interview, but doesn’t demonstrate the normal range of emotional expression that would be expected.

Labile affect: characterised by exaggerated changes in emotion which may or may not relate to external triggers. Patients typically feel like they have no control over their emotions.

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14
Q

What would you say about the intensity of affect?

A

Heightened: associated with mania and some personality disorders.

Blunted or flat: associated with schizophrenia, depression and post-traumatic stress disorder.

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15
Q

What would you take into consideration as part of thought for a mental state examination?

A
  1. Thought form
    a. Speed of thought (racing, abnormally slow)
    b. Flow and coherence of thoughts
  2. Thought content
  3. Thought possession
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16
Q

What would you say about the flow and coherence of thoughts?

A
  1. Loose associations: moving rapidly from one topic to another with no apparent connection between the topics.
  2. Circumstantial thoughts: these are thoughts which include lots of irrelevant and unnecessary details.
  3. Tangential thoughts: digressions from the main conversation subject, introducing thoughts that seem unrelated, oblique, and irrelevant.
  4. Flight of ideas (pressure of speech and many associations)
  5. Thought blocking
  6. Perseveration (e.g. a patient is asked what their name is and they then continue to repeat their name as the answer to all further questions).
  7. Neologisms
17
Q

What would you consider about thought content?

A
  1. Delusions
  2. Obsessions
  3. Compulsions
  4. Overvalued ideas
  5. Suicidal thoughts
  6. Homicidal/violent thoughts
18
Q

What would you consider about thought possession?

A

Thought insertion: a belief that thoughts can be inserted into the patient’s mind.

Thought withdrawal: a belief that thoughts can be removed from the patient’s mind.

Thought broadcasting: a belief that others can hear the patient’s thoughts.

19
Q

What would you take into consideration as part of perception for a mental state examination?

A
  1. Hallucinations
  2. Pseudo-hallucinations: the same as a hallucination but the patient is aware that it is not real.
  3. Illusions
  4. Depersonalisation
  5. Derealisation
20
Q

What would you take into consideration as part of cognition for a mental state examination?

A

Cognition refers to “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses”. Cognition can be impaired as a result of mental health conditions and their treatments.

Assess whether they are orientated in time, place and person what their attention span and concentration levels are like what their short-term memory is like

Could use MMSE, AMTS or 4AT

21
Q

What would you take into consideration as part of insight and judgement for a mental state examination?

A

Insight, in a mental state examination context, refers to the ability of a patient to understand that they have a mental health problem and that what they’re experiencing is abnormal

Judgement refers to the ability to make considered decisions or come to a sensible conclusion when presented with information
“What would you do if you could smell smoke in your house?”

OSCE - histories (20 decks)

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