Mental State Examination Flashcards
what should be included in a past psychiatric history
Existing diagnosis/diagnoses Timescale / duration Symptoms in previous episodes Effect on function Previous contacts Admissions/detentions
what are the components of the MSE
Appearance and Behaviour Speech Mood and Affect (including suicidality) Thoughts (form and content) Perception Cognition Insight
what should be included in appearance
age physique dress evidence of self neglect effort with appearance signs of ill health posture facial expression Physical Features of Alcoholism or Drug Abuse
what should be included in behaviour
- Psychomotor agitation/ retardation
- Eye contact
- Attitude/Rapport; Cooperative/ uncooperative, hostile, guarded, suspicious
- appropriateness of behaviour in patient
what should be included in speech
form of speech rate volume tone articulation sudden silences stammer
what are the names of types of speech that can be comment on in MSE
pressure or poverty of speech
how does mood compare to affect
mood = how the patient thinks they are
affect = how you think they are
what should be included in mood
Neutral, euthymic, dysphoric, euphoric, anxious, angry, apathetic, irritable
what should be included in affect
Congruent/ incongruent
Intensity – normal, blunted, exaggerated, flat, heightened
Extent to which affect changes – restricted, labile, reactive
what must be included in mood and affect
suicidality
what needs to be asked in relation to suicidality
Suicidal ideation – active or passive
Thoughts of life not worth living
Thoughts of wanting to harm self, methods, plans
what is psychosis
mental health problem that causes people to perceive or interpret things differently from those around them.
This might involve hallucinations or delusions.
how can you understand the patients thought form
Inferred from patients speech or described
what are conditions that can be seen in thought of MSE
Flight of ideas
Poverty of thought
what are formal thought disorder
thought blocking loosening of associations knights move thinking tangential thinking circumstantiality neologisms
what are problems in thought content
preoccupations
overvalued idea
obsessions
delusion
how does the different types of thought content differ
preoccupations
- not fixed, false or intrusive but have an undue prominence in person mind
overvalued idea
- An unreasonable, sustained belief that is held with less than delusional intensity
obsessions - An undesired, unpleasant intrusive thought that cannot be suppressed
delusion - next flash card
what is the definition of delusion
- Fixed, false belief
- Inappropriate to the patient’s socio-cultural background
- Firmly held in the face of logical argument or evidence to the contrary
- Not modified by experience or reason
- Usually very individualised / of great personal significance
what are the themes of delusions
Grandiose
Paranoid
Nihilistic
Bizarre
what is included in the perception part of MSE
Derealisation/ depersonalisation, déjà vu
Illusions
Hallucinations
what is definition of hallucination and how can they present
Perception in the absence of an external stimulus
visual, auditory, olfactory, gustatory, tactile
what information is vital to find out in an auditory hallucination
2nd or 3rd person? Number of voices? Gender? Content? Running commentary Thoughts spoken aloud? Do the voices command the patient? Do they feel compelled to act on them?
what is looked for in cognition in MSE
Attention and concentration Orientation Memory Calculation Language (name + repeating objects) Visuospatial functioning Executive functioning
what are the options for formal cognitive testing
MMSE (out of 30)
ACE-R (out of 100)
MOCA (out of 30)
what are the 4A’s of insight
Awareness of one’s own symptoms (absence - anautognosia)
Attribution of symptoms to mental disorder appropriately (absence –dysautognosia)
Appraisal or analysis of consequences of such symptoms
Acceptance of treatment
what is the way thought works in formal thought disorders; normal, tangential, circumstantiality
normal
A»_space; B
Tangential
A»_space; F»_space; C
Circumstantiality
A»_space; A1»_space; A2»_space; A3»_space; B
what is a neologisms
abnormality of speech in which the patient makes up a new word or phrase or uses existing words which have no generally accepted meaning but which have idiosyncratic meaning to the patient.
e.g. headshoe for hat
