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MD2 Psych > Mental State Examination > Flashcards

Mental State Examination Flashcards

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1
Q

What aspects of appearance should be noted in the MSE?

A

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

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2
Q

What aspects of behaviour should be noted in the MSE?

A

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

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3
Q

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

A

May influence reliability and quality of history obtained

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4
Q

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

A 
Volume
Dysarthria
Dysphonia
Dysphasia (receptive, expressive)
Prosody (speech rhythm, monotone, variability)
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5
Q

Dysarthria covers what aspects of speech?

A

Diction and articulation

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6
Q

Dysphonia covers what aspects of speech?

A

Audibility of voice

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7
Q

Define mood

A

Internal feeling state of the patient (subjective)

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8
Q

Define affect

A

Affect is the outward emotional state (more objectively observed)

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9
Q

What is the difference between mood and affect?

A

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

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10
Q

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

A

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

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11
Q

What mood changes are characteristic of schizophrenia?

A

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

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12
Q

What aspects of affect should be assessed?

A

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

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13
Q

Content of affect

A

Quality: observable feeling state

Strength/depth/quantity

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14
Q

Euthymic

A

Normal feeling

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15
Q

Flat

A

Unchanging affect (most commonly depressed)

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16
Q

Blunted

A

Impoverished affect

??

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17
Q

Perplexity

A

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

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18
Q

Fatuous

A

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

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19
Q

Form of affect

A

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

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20
Q

Appropriateness of affect in affective disorders

A

Usually associated with appropriate affect

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21
Q

Inappropriateness of affect in psychotic disorders

A

Mismatch affect and thought

22
Q

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

A

Thought process: stream and form

Content: content and possession

23
Q

Stream (pace of thought generation)

A

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

24
Q

Form (connectivity of ideas)

A

??

25
Q

“Flight of ideas”

A

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

26
Q

Retardation

A

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

27
Q

Circumstantiality

A

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

28
Q

Loosening of associations/tangentiality

A

Logical connections between thoughts tenuous

29
Q

Derailment

A

Un-understandable disconnection between thoughts

30
Q

Blocking

A

Sudden interruption of thought resulting in loss of thought

31
Q

Word salad

A

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

32
Q

Be careful to distinguish between thought blocking and perplexity

A

??

33
Q

Thought withdrawal

A

Delusion that someone has “plucked the thought away”

34
Q

Other abnormal thought forms

A

“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)

35
Q

Echopraxia

A

Mirroring of interviewer’s posture

36
Q

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

A

Inherent themes
Overvalued ideas
Delusions
Obsessions

37
Q

What is an overvalued idea?

A

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

38
Q

Delusional thinking

A

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

39
Q

Bizarre delusions

A

Obviously delusional, highly improbable

40
Q

Non-bizarre delusions

A

Hypochondriasis, delusions of jealous, delusions of poverty, etc

41
Q

Most common type of delusion

A

Delusion of persecution

42
Q

Mood incongruent delusions more possible in schizophrenia

A

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

43
Q

Passivity phenomena

A

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

44
Q

+thought broadcast

A

in addition

45
Q

Maintain “as if” function

A

“I feel as if…” (suggests insight?)

46
Q

Define illusion

A

True perception, transformed by a prevailing affect

47
Q

Most common type of hallucinations in schizophrenia and mood disorders

A

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

48
Q

Pseudohallucinations

A

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

49
Q

Judgement

A

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

50
Q

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)

A

…

51
Q

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

A

…

MD2 Psych (3 decks)

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