Mental State Examination

Question 1

What are the main components to an MSE?

Answer 1

Appearance and behaviour 
Speech 
Mood and Affect - incl. suicidality 
Thoughts (form and content)
Perception 
Cognition 
Insight

Question 2

What aspects of Appearance are worthy of note?

Answer 2

Age 
Physique 
clothing 
effort with appearance 
tattoos 
posture 
facial expressions 
physical features of alcohol/drug abuse

Question 3

What aspects of behaviour should be commented on?

Answer 3

What the patient is doing and the appropriateness for the situation
psychomotor agitation/retardation
eye contact
attitude/rapport

Question 4

Name aspects of speech in an MSE

Answer 4

form of speech 
pressure or poverty 
spontaneous speech 
latency 
rate 
volume 
tone 
articulation 
vocabulary 
stammer/dysarthria

Question 5

What is mood?

Answer 5

patients subjective description of their emotional state

Question 6

Describe aspects of a patients affect in MSE?

Answer 6

congruent/incongruent

intensity - normal, blunted, exaggerated, flat, heightened

extent of change - restricted, labile, reactive

Question 7

Is suicidality important to ask about in an MSE?

Answer 7

Yes - your questions will not make anyone feel suicidal

Question 8

What kind of thoughts can indicate intentions of self-harm?

Answer 8

life not worth living
wanting to self harm
methods
plans

Question 9

What is psychosis?

Answer 9

a mental health problem that causes people to perceive or interpret things differently from those around them - may involved hallucinations or delusions

Question 10

What is flight of ideas?

Answer 10

words associated together inappropriately because of their meaning or rhyme so that speech loses its aim and the patient wanders from the original theme.

the patient jumps from topic to topic but with a recognisable theme

Question 11

What is Formal Thought Disorder?

Answer 11

There is evidence from the patient’s speech or writing that there is an abnormality in the way their thoughts are linked together.
Disturbance in organisation, control and processing of thoughts.

Question 12

Loosening of associations?

Answer 12

Patients speech is muddled, illogical, difficult to follow and cannot be clarified.

the patient talks freely but so vaguely that no information is given despite how many words

Question 13

Knights move thinking?

Answer 13

jumps from topic to topic with no connection between them.

Question 14

What is tangential thinking?

Answer 14

wandering from topic and never returning to it or providing the information requested

Question 15

What is circumstantiality?

Answer 15

inability to answer a question without giving excessive, unnecessary detail

Question 16

how does circumstantiality differ from tangential thinking?

Answer 16

in circumstantiality the patient will eventually return to the original point

Question 17

What are neologisms?

Answer 17

An abnormality of speech where a patient makes up a new word or uses existing words in bizarre ways which have idiosyncratic meaning to the patient - e.g. hat = headshoe

Question 18

What is a preoccupation?

Answer 18

not fixed, false or intrusive but have an undue prominence in the persons mind

Question 19

What is an overvalued idea?

Answer 19

an unreasonable, sustained belief that is held with less than delusional intensity

Question 20

What is an obsession?

Answer 20

an undesired, unpleasant intrusive thought that cannot be suppressed

Question 21

What is a delusional ideation?

Answer 21

fixed, false belief inappropriate in the patients socio-cultural background

firmly held in the face of logical evidence to the contrary

not modified by experience or reason

Question 22

What are common themes in delusions?

Answer 22

grandiose
paranoid
nihilistic
bizarre

Question 23

What is contained within the component of perception?

Answer 23

derealisation/depersonalisation
illusions
hallucinations

Question 24

What is a hallucination?

Answer 24

perception in the absence of an external stimulus

Question 25

What kinds of hallucinations are there?

Answer 25

visual 
auditory 
olfactory 
gustatory 
tactile - tangible feeling

Question 26

What is involved in orientation?

Answer 26

time
place
person

Question 27

What aspects of cognition can be tested?

Answer 27

orientation 
memory 
calculation 
language 
visuospatial function 
executive function - verbal fluency, similarities

Question 28

What tools can be used for formal cognitive testing?

Answer 28

MMSE

Addenbrookes cognitive examination

montreal cognitive assessment (MOCA)

Question 29

What are the 4A’s of insight?

Answer 29

AWARENESS of ones own symptoms

ATTRIBUTION of symptoms to mental disorder

APPRAISAL or analysis of consequences of such symptoms

ACCEPTANCE of treatment