Mental State Examination Flashcards
What is the sequence of the MSE?
Appearance Behaviour Speech Affect Thought Perception Cognition Insight
What about the appearance do you evaluate?
Age, gender
Grooming - hair, beard, make-up
Clothing - style, colours, cleanliness, odour
Distinguishing physical features - scars, tattoos, deformities, teeth
What about the behaviour do you evaluate?
Gait Posture Facial expression Extraneous movements Increased/decreased general activity Eye contact Tearfulness, laughing Limb movements
What about the speech/language do you evaluate?
Form - Volume - Prosody - speech rhythm - monotone/variability - Pressure - Dysarthria Language - Dysphagia - receptive or expressive
What about the mood and affect do you evaluate?
Mood - sustain feeling state
Affect - observable feeling state of patient during interview
Quality eg sad, anxious, euphoria
Intensity of quality ie mild/mod/severe
Range - the way the affect changes
Reactivity - nature of the change eg labile affect
Congruence, appropriateness eg sad thought > sad affect
Communication - empathy of the feeling state of the patient eg feeling sad in the presence of a depressed person
How does a perplexed affect appear and what does it reflect?
Bewildered, puzzled
Think - organic or psychotic disorder
How does a fatuous affect appear and what does it reflect?
Vacant, silly, superficial
Think - psychosis
What might a restricted affect reflect?
A depressed patient
A euphoric patient
What is blunting of affect?
A loss of sensitivity to the emotional import of an event
Or loss of empathy for an emotional event
Cardinal symptom of schizophrenia
What about the thought do you evaluate?
Stream - pace of thought generation
Form - connectivity of ideas eg flight of ideas
Content
Possession
What are over-valued ideas?
Ideas that preoccupies a patient, are passionately held but are amenable to some reason
Can be logical
What makes a delusion a delusion?
Fixed, unshakeable belief
Absolute conviction, non amenable to challenge
Great personal significance/investment
Regarded as false/inherently unlikely by other
Out of keeping with educational, cultural, social background
Should useful
- Emerge in a pathological manner
- Extend to contaminate other beliefs
- Evolve persistent idiosyncratic behaviour
What are Jasper’s four common primary delusions?
Sudden, autochthonous delusion
Delusional atmosphere - feeling of something happening
Delusional perception - delusion associated with a normal event
Delusional memory - new memory that is delusional
What are Jasper’s secondary delusions?
Those that are more understandable to other psychic event
Maybe traced to primary delusions, affects, drivers, fears, hallucinations
More amenable to psychiatric treatment
What are the first rank auditory hallucinations of schizophrenia?
One thoughts heard out loud
Running commentary of actions
Discussion of self in the third person
