Mental state examination Flashcards
What factors can be commented on in ‘appearance’ in MSE?
distinguishing features - scars, tattoos, signs of IVDU
weight - under/overweight
stigmata of disease
personal hygiene - gives insight into patient’s current ability to care for themselves
clothing - appropriate for weather
objects - if they’ve brought anything with them
What factors can be commented on in ‘behaviour’ in MSE?
engagement + rapport
eye contact - reduced or excessive
facial expression
body language
psychomotor activity
abnormal movements or postures eg. tremors, rocking, tics
What factors can be commented on in ‘speech’ in MSE?
rate of speech
quantity of speech
tone of speech
volume of speech
fluency + rhythm of speech
What’s the difference between mood and affect?
affect = immediately expressed and observed emotion
mood = predominant subjective internal state at any one time as described by them
affect is what you observe, mood is what the patient tells you
What is meant by loose associations?
moving rapidly from one topic to another with no apparent connection between the topics
What is meant by circumstantial thoughts?
thoughts which include lots of irrelevant and unnecessary details
What is meant by tangential thoughts?
digressions from the main conversation subject, introducing thoughts that seem unrelated, oblique and irrelevant
What is meant by flight of ideas?
accelerated tempo of speech
excited speech wanders off the point following the arbitrary connections, and the coherent progression of ideas tends to become obscured
What is meant by thought blocking?
sudden cessation of thought, typically mid-sentence, with the patient unable to recover what was previously said
What is meant by perseveration?
refers to repetition of a particular response (such as a word, phrase or gesture) despite the absence/removal of the stimulus (eg. a patient is asked what their name is and they continue to repeat their name as the answer to all further questions)
What is meant by clang association?
connected by something other than meaning eg. rhyming
What is meant by neologisms?
words a patient has made up which are unintelligible to another person
What is meant by word salad?
random words without any logic
What is meant by poverty of speech?
little content, not conveying much meaning
What are delusions?
firm, fixed belief based on inadequate grounds, not amenable to a rational argument or evidence to the contrary and not in sync with regional and cultural norms
What are obsessions?
thoughts, images or impulses that occur repeatedly and feel out of the person’s control
the patient is aware these obsessions are irrational, but the thoughts continue to enter their head
What are compulsions?
repetitive behaviours that the patient feels compelled to perform despite recognising the irrationality of the behaviour
What are overvalued ideas?
a solitary, abnormal belief that is neither delusional, nor obsessional in nature, but which is preoccupying to the extent of dominating the sufferer’s life (eg. the perception of being overweight in a patient with AN)
Examples of delusions
paranoid
persecutory
grandiose
love
jealousy
somatic
control/thought possession
reference
guilt
poverty
Examples of obsessions and compulsions
contamination
harm/violence
sexuality/sexual behaviours
making mistakes/causing accidents
washing
cleaning
checking
counting
ordering/arranging
What should you assess in auditory hallucinations?
inside vs outside
2nd vs 3rd person
content
running commentary
commands
level of distress
