Mental state examination Flashcards
define the mental state examination
used in every patient consultation in psychiatry
and psych patients in ED
how does a hisotry and mental state examination differ
hisotry
-records ptx experience of syx UP TO the time of interview
MSE
-descibre the behaviour and syx AT THE TIME. of the interview
purpose of mental state examination
evalutte if ptx has psych problem
-if so how severe
-what are the risks
-do they meet criteria for emergency detention
first component of mental state examination
appearance and behaviour
aspects of appearance and behaviour of mental state examination 5
well/kempt/scruffy
eye contact- yes or no
reactive to stimuli
figeting/appera nervous or distracted
responding to unseen stimuli
aspects of speech for mental state examination 5
how much
-too little- (poverty)
making sense
volume
rate
rhythm
aspects of mood for mental state examination 2
mood
-defined as emotional tone prevailing ar any given time
affect
-meaning a short-lived feeling state
examples of speech syx 6
alogia-poverty of speech
dysarthria
stuttering
logoclinia- repeates last syllable
mutism
pressure of speech (or pressure of thought)
examples of mood and affect syx 5
depressed mood
elevated mood
reactive affect
flattened or blunted affect
anxiety
two important ways to assess risk behaviours in a mental state examination
for suicide:
-Sometimes when people feel low in mood, they might feel life is not worth living. Do you feel like that? Do you ever self harm?
for mania:
-When your mood is high, do you ever spend a lot of money, have unprotected sex, drink excessively…..
what to ask in a mood history 3
rate mood 0-10
better or worse at particular time of day
periods of elated/depressed mood
examples of thought form 4
word salad-a mixture of words or phrases that is confused and difficult to understand:
disjointed; tangential
rambling
knights move thinking
examples of thought content
overvalued ideas
obessions
delusions
suicidal
thought withdrawal, insertion, broadcasting,
thoughts of reference
difference between knights move thinking and flight of ideas
Flight of thought – this is where the patient moves quickly from one idea to another, often half-way through a sentence, with no apparent association between ideas. Knight’s move thinking (aka Derailment)- patient moves from one idea to another with strage illogical associations between the ideas.
deinfe a delusion
fixed (usually) flase or fantasic idea
held in face of evidence to the contrary
and
out of keeping with the patients social milieu
4 criteria for a delusion
held unshakably
not modified by experience or reason
content often bizarre
can be found in any psychotic presentation
define ideas of reference as a form of thought contnetn
ambiguous events in outside world whose interpretations are without foundation wholly or mainly self-centred
define overvauled idea
idea which in itself may be comprehensible or socially acceptable
but which has come to dominate the patients life and is pursed beyond bounds of reason
some types of delusison and overvalued ideas
persecution
reference
dysmorphobobia
jealous
love
guilt, unworhtiness, poverty
gradniosity
define an obession and compulsiosn
obsession- refers to impulses and thougths
Compulsion- confined to motor acts
important characterisitc of obessions and complulsions
thought of carrying out act is not in itself pleasurable
-simple relief of anxiety or tension is no pleasurable
thouths, images and impulses must be unpleasantly repetitive
NO PLEAUSRE OR ENJOYMENT
aspects of perception in mental state exam 3
hallucinations
pseudo-hallucinaitinos
illusions
define hallucinations
false perception which is not in any way a distortion of a real perception
criteria for hallucinations 3
unwilled and not subject to conscious manipulation
has the same qualities of a real perception
-ie vivd and solid
perceived as being located in external world
two categories for halluciantions 2
auditory
visual
auditory types of hallucinations 3
simple- sounds
complex- voices
musicle- (brain/ear disease)
visual types of hallucinations 3
simple (flashses of light)
-ORGANIC DISEASE
complex- objects, animals, people
panoramic/experiental -ORGANIC DISEASE
define pseudohallucinations
’ voice inside my head ‘
-‘i know its not real’
how gets pseudohallucinations 5
depression
obsessional states
hysteria
personality disorder
times of life crisis eg bereavment
aspects of cognition in a mental state exam 5
alterness
orientation
attention
memory
(time place person)
define cognitive function
sum of all the patients higher mental functions
-how did the patient cope with the interview
do they have history of poor function
define insight
correct attidue to morbid changes in oneself
types of insight 3
1-awarenes of disease
2-correct labelling of abnormality
3- willingness to take treatment
