Mental State Examination Flashcards
You expand the mental state examination according to the diagnosis you’re moving towards. Which area would you expand on with depression, schizophrenia, dementia?
Depression - mood
Schizophrenia - mood, abnormal beliefs and abnormal experiences
Dementia - mood, cognitive state
What are the 7 parts of a mental state examination?
Appearance and behaviour Speech Mood Thought content Abnormal beliefs and experiences of events Cognitive state Insight
What are you looking for in the general appearance?
Signs of self neglect, poorly fitting clothes (indicating weight loss), inappropriate or very flamboyant clothes.
What are you looking for in facial appearance?
Downcast eyes, vertical furrow in brow, down turned mouth all indicate depression.
Fixed facial expression from Parkinson’s or Parkinsonism from antipsychotics.
What is echopraxia?
Seen in schizophrenia - automatic imitation of another’s movements.
What is posturing?
Seen in schizophrenia - adopting a bizarre posture for a long period of time.
What is a tic?
A repeated irregular movement involving any muscle group.
What posture is characteristic of depression?
Hunched shoulders and poor eye contact.
What is stupor?
The patient is conscious but mute and immobile.
What is the form of stupor seen in depression?
Depressive retardation (a lesser form of psychomotor retardation) which means a patient takes a long time to complete a movement.
What is obsessional slowness?
Seen in OCD, patient can’t get anything done because of the need to complete compulsive rituals.
What is it called when the patient shows unproductive restlessness?
Psychomotor agitation.
What is compulsion?
A repetitive, seemingly purposeful behaviour is carried out.
What three things are you assessing when looking at speech?
Rate - increased in mania, reduced in depression
Quantity - increased in mania and anxiety, reduced in dementia and schizophrenia and depression
Volume - shouting during normal conversation can indicate hypermania, depression leads to whispering
What is meant by increased pressure of speech?
Increased rate AND quantity of speech
What is meant by poverty of speech?
A restricted amount of speech
What is mutism?
The complete loss of speech
What is dysarthria?
Difficulty articulating speech
What is “flight of ideas”?
Thoughts are sped up so the person jumps form one topic to another.
What is a neologism?
When a patient uses a new word they’ve made up, or uses an everyday word in a way that only has meaning to them.
What is echolalia?
Patient automatically imitating another person’s speech
What is thought blocking and what is it a sign of?
A sudden interruption to the train of thought so the patient can’t remember what they were thinking or saying and their sentence just trails off.
It is a sign of psychosis.
What is Knight’s Move Thinking?
Odd associations between ideas leading to disruptions in the continuity of speech.
What is a thought disorder?
Pattern of disordered language presumed to reflect disordered thinking.
What is psychosis?
When a person loses contact with reality.
What is mood?
Pervasive and sustained emotion which markedly colours the patient’s perception of the world.
What two assessments of mood do you need to carry out?
Objective - based on history, appearance, behaviour and posture of the patient
Subjective - described by the patient, what they say they are feeling at the time
What is a dysphoric mood?
Unpleasant mood where the person doesn’t feel comfortable.
What is anhedonia?
A loss of ability and interest in regular and pleasurable activities.
What are the biological symptoms that it is important to ask about to a depressed patient?
Weight loss, sleep pattern, appetite, constipation
What is elation?
Elevated mood or exaggerated feeling of wellbeing.
What is euphoria?
Personal feeling of unconcern and contentment.
What is an irritable mood?
A tendency to be annoyed or provoked to anger.
What is the difference between phobic anxiety and free-floating anxiety?
Phobic anxiety means the focus of the anxiety has to be avoided. Free-floating anxiety is pervasive and unfocused, and so the situation causing anxiety can’t be avoided.
What is the patient’s affect?
How patient’s convey their mood by their behaviour.
What are two different types of affects?
Inappropriate affect e.g appearing cheerful when talking about bereavement
Flat affect - absence of signs of expression of affect
What is hypochondriasis an example of?
A preoccupation
What four things are you looking for when assessing thought content?
Preoccupations
Obsessions
Phobias
Suicidal and homicidal thoughts
What are overvalued ideas?
An unreasonable and sustained intense preoccupation, but with less than delusional intensity.
What are delusions?
Fixed, false, personal beliefs which are firmly sustained in spite of obvious evidence to the contrary.
What are a few different types of delusions?
Persecutory - someone trying to harm you
Delusions of reference - tv and radio is referring to you
Delusions of grandeur
Delusions of doubles - person has been replaced by a double
Nihilistic - denies they have a body, so refuses to eat
Somatic - sensory delusions
Erotomania - think someone’s in love with you
What is the difference between a primary delusion and a secondary delusion?
A primary delusion arises fully formed without any discernible connection with previous events, but a secondary delusion arises when a person is trying to make sense of their experiences.
What is passivity phenomena, and what are the three types?
A delusion that an external agency is controlling you by putting thoughts in your head.
Thought insertion = putting thoughts in your mind
Thought withdrawal = taking thoughts out of your mind
Thought broadcasting = reading your thoughts
What is delusional perception?
When a patient attaches delusional significance to a real perception with no logical significance.
What is the difference between an illusion and hallucination?
An illusion is a false perception in response to a real external stimulus, a hallucination is a false sensory perception in the absence of a real external stimulus.
What types of hallucinations are there?
Auditory (second person derogatory hallucinations in depression, third person running commentaries in schizophrenia) Visual Olfactory Gustatory Somatic
What is pareidolia?
Vivid imagery occurring without conscious effort while looking at a poorly constructed background e.g a fire
What is depersonalisation?
The patient feels they are not real.
What is derealisation?
The person’s surroundings don’t feel real.
What 4 things should you assess in cognitive state?
Orientation
Attention and concentration
Memory
General knowledge
What is the max score of a mini mental state exam, and what 5 things are assessed?
Max score = 30 Orientation Registration Attention and calculation Recall Language and praxis
Why is insight important?
It’s important for compliance to treatment.
