Mental State Examination

Question 1

What aspects of appearance should be noted in the MSE?

Answer 1

Apparent age and gender
Grooming (hair, beard, make-up, fingernails)
Clothing (style, colours, cleanliness, odour)
Distinguishing physical features (scars, tattoos, deformities, teeth)
Accent when speaking if relevant

Question 2

What aspects of behaviour should be noted in the MSE?

Answer 2

Gait on entry, posture on sitting
Increased/decreased general activity
Extraneous movement, tremors, tics
Facial expressions (grimacing, smiling, frowning, poverty of expression, furtive)
Eye contact (with interviewer, other parts of the room, open/closed, downcast)
Limb movements (dramatic, odd/manneristic)
Tearfulness, laughing, etc

Question 3

Why is it important to evaluate the patient’s attitude to the interview?

Answer 3

May influence reliability and quality of history obtained

Question 4

What aspects of speech and language should be noted in the MSE?

Answer 4

Volume
Dysarthria
Dysphonia
Dysphasia (receptive, expressive)
Prosody (speech rhythm, monotone, variability)

Question 5

Dysarthria covers what aspects of speech?

Answer 5

Diction and articulation

Question 6

Dysphonia covers what aspects of speech?

Answer 6

Audibility of voice

Question 7

Define mood

Answer 7

Internal feeling state of the patient (subjective)

Question 8

Define affect

Answer 8

Affect is the outward emotional state (more objectively observed)

Question 9

What is the difference between mood and affect?

Answer 9

Affect - weather outside right now
Mood - the season; sustained and elicited indirectly from many signs
OR subjective vs objective, internal feeling vs outwards emotional state

Question 10

What methods should be used to assess mood in the MSE?

Answer 10

Ask patient directly to describe mood
Can infer likely mood through themes patient returns to repeatedly
NB Should use both

Question 11

What mood changes are characteristic of schizophrenia?

Answer 11

Patient may appear to lack feeling (non-communication of mood or “blunted affect”)

Question 12

What aspects of affect should be assessed?

Answer 12

Form (variety of feeling states observed - range, capacity/rapidity of change - reactivity, appropriateness to though content/situation)
Content (what are the feeling states observed - quality, how much feeling

Question 13

Content of affect

Answer 13

Quality: observable feeling state

Strength/depth/quantity

Question 14

Euthymic

Answer 14

Normal feeling

Question 15

Flat

Answer 15

Unchanging affect (most commonly depressed)

Question 16

Blunted

Answer 16

Impoverished affect

??

Question 17

Perplexity

Answer 17

Bewildered, puzzled
Often co-occurs with severe thinking abnormalities
Seen in organic and psychotic states

Question 18

Fatuous

Answer 18

Vacant silly, superficial
Often incongruent with thought/situation
Seen in acute psychotic states

Question 19

Form of affect

Answer 19

Reactivity: dynamic aspects of changes in affect during the interview (lability, irritabiity, flatness)
Appropriateness: relationship between the quality/depth of an affect and content of thought/situation

Question 20

Appropriateness of affect in affective disorders

Answer 20

Usually associated with appropriate affect

Question 21

Inappropriateness of affect in psychotic disorders

Answer 21

Mismatch affect and thought

Question 22

What aspects of thought process and form should be noted in the MSE?

Answer 22

Thought process: stream and form

Content: content and possession

Question 23

Stream (pace of thought generation)

Answer 23

Slow: depression, organic states
Fast: anxious states
“Pressured”: manic states
Increased latency: slowness to respond to question (some psychotic states)

Question 24

Form (connectivity of ideas)

Answer 24

??

Question 25

"Flight of ideas"

Answer 25

Increased number of ideas, produced at rapid pace (characteristic of mania) Tangentiality (but does link back to point)

Question 26

Retardation

Answer 26

Relative poverty of ideas produced at slow pace (characteristic of depression, some psychotic disorders)

Question 27

Circumstantiality

Answer 27

Over-inclusion of ideas, overly detailed train of thought, in time returns to the point (characteristic of some anxious and obsessional states)

Question 28

Loosening of associations/tangentiality

Answer 28

Logical connections between thoughts tenuous

Question 29

Derailment

Answer 29

Un-understandable disconnection between thoughts

Question 30

Blocking

Answer 30

Sudden interruption of thought resulting in loss of thought

Question 31

Word salad

Answer 31

Complete disruption of goal-directed thought even within an idea Synactical, grammatical, semantic structure of conversation lost

Question 32

Be careful to distinguish between thought blocking and perplexity

Answer 32

??

Question 33

Thought withdrawal

Answer 33

Delusion that someone has "plucked the thought away"

Question 34

Other abnormal thought forms

Answer 34

"Wooly", imprecise, vague thinking (approximate language) Neologisms (new words) Rhyming speech (often in mania - clang associations) Idiosyncratic use of words Echolalia (repetition of interviewer's words repeatedly)

Question 35

Echopraxia

Answer 35

Mirroring of interviewer's posture

Question 36

What aspects of thought content are important to assess in the MSE?

Answer 36

Inherent themes Overvalued ideas Delusions Obsessions

Question 37

What is an overvalued idea?

Answer 37

Comprehensible idea pursued beyond the bounds of reason; it preoccupies the patient and there is often strong emotional investment Passionately held but (to some extent) amenable to reasons

Question 38

Delusional thinking

Answer 38

Fixed, unshakeable beliefs Absolute conviction Great personal significance/investment Regarded as false/inherently unlikely by others Out of keeping with educational, cultural and social background

Question 39

Bizarre delusions

Answer 39

Obviously delusional, highly improbable

Question 40

Non-bizarre delusions

Answer 40

Hypochondriasis, delusions of jealous, delusions of poverty, etc

Question 41

Most common type of delusion

Answer 41

Delusion of persecution

Question 42

Mood incongruent delusions more possible in schizophrenia

Answer 42

E.g. describe one kind of belief, affective state is different

Question 43

Passivity phenomena

Answer 43

Related phenomena in which patient feels influenced or controlled by other agencies ("made" thoughts, feelings and actions) Seen mainly in psychotic states

Question 44

+thought broadcast

Answer 44

in addition

Question 45

Maintain "as if" function

Answer 45

"I feel as if..." (suggests insight?)

Question 46

Define illusion

Answer 46

True perception, transformed by a prevailing affect

Question 47

Most common type of hallucinations in schizophrenia and mood disorders

Answer 47

Auditory (visual more common in organic e.g. dementias)

Question 48

Pseudohallucinations

Answer 48

Images product of own mind and thoughts but not under voluntary control

Question 49

Judgement

Answer 49

Whether patient is making the right judgement calls given the circumstances they are in

Question 50

Disorder higher up the hierarchy, the symptoms of which would account for a disorder lower down the hierarchy - you get the superordinate diagnosis, not both (e.g. schizophrenia, not schizophrenia and personality disorder)

Answer 50

...

Question 51

Personality diagnoses made over a period of time - cross-sectional assessment can be affected by their situation, axis 1 (?) diagnosis

Answer 51

...