Mental State Examination

Question 1

When conducting and presenting the findings of a mental state examination, in what order should this be approached?

Answer 1

Appearance and behaviour

Speech

Mood

Affect

Thought

Perceptions

Cognition

Insight

Risk

Question 2

How should appearance and behaviour be examined?

Answer 2

Describe the patient

Question 3

What aspects of a patients appearance and behaviour should be described?

Answer 3

Well kempt?

Clothing

Eye contact

Level of rapport

Psychomotor retardation

Other psychomotor signs

Question 4

What types of eye contact may be particularly relevant?

Answer 4

Inappropriate eye contact

Reduced eye contact

Question 5

How can level of rapport differ between psychiatric patients?

Answer 5

Can be easy to develop

Patient can be guarded

Question 6

What other psychomotor signs could be commented on?

Answer 6

Parkinsonism

Question 7

What aspects of speech should be analysed during a mental state examination?

Answer 7

Rate

Tone

Volume

Difficulty speaking?

Formal thought disorder?

Question 8

How can rate of speech vary?

Answer 8

Delayed start

Slow

Fast

Question 9

How can tone of speech vary?

Answer 9

Monotonous

Overly variable

Question 10

How can volume of speech vary?

Answer 10

Quiet/loud

Question 11

What types of difficulty speaking may a patient have?

Answer 11

Dysphasia

Dysarthria

Question 12

What are some different types of formal thought disorder?

Answer 12

Loosening of associations

Flight of ideas

Circumstantiality

Tangentiality

Neologisms

Question 13

What is loosening of associations?

Answer 13

A loss of connection between thoughts presenting as changing of topic between sentences or words with obvious links between topics.

Question 14

At its wort how can loosening of ideas present?

Answer 14

Word salad

Question 15

What condition does loosening of associations typically present in?

Answer 15

Schizophrenia

Question 16

What is flight of ideas?

Answer 16

Rapid changing of topic between sentences with some identifiable link between topics

Question 17

What condition does flight of ideas typically present in?

Answer 17

Mania

Question 18

What is the major difference between loosening of associations and flight of ideas?

Answer 18

There is an identifiable link between topic changes in flight of ideas if speech is written down and analysed

Question 19

What is circumstantiality?

Answer 19

Patient will go over the top with detail and move on to seemingly irrelevant topics before bringing the conversation back to answer the question

Question 20

What is tangentiality?

Answer 20

The patient will move the conversation on to another topic and never return to answer the original question

Question 21

What are neologisms?

Answer 21

Words made up by the patient with a specifically assigned meaning

Question 22

In what two ways should a patients mood be assess in a mental state examination?

Answer 22

Subjectively

Objectively

Question 23

How is a patient’s mood described subjectively?

Answer 23

Ask the patient to describe their mood

Can use a scale of 1-10

How has it changed from premorbid mood

Question 24

How is a patient’s mood describe objectively?

Answer 24

The assessor gives their view on the patient’s current mood

Question 25

In what ways may an assessor describe a patient’s mood?

Answer 25

Depressed Manic Anxious Irritable Euthymic (normal)

Question 26

What is affect?

Answer 26

How a patient appears to respond emotionally in certain situations

Question 27

In what ways may a patients affect be altered?

Answer 27

Blunt Flat Inappropriate Labile Reactive (normal)

Question 28

What is a blunt affect?

Answer 28

A decrease in the variation of emotional response displayed by a patient

Question 29

What is a flat affect?

Answer 29

Absence of any emotional response

Question 30

How may a patient’s affect be inappropriate?

Answer 30

May have the typically wrong response to a certain situation E.g. finding a sad situation funny

Question 31

What is meant by a labile affect?

Answer 31

Rapid changes in emotional state

Question 32

What aspects of thought should be considered in a mental state examination?

Answer 32

Form Content

Question 33

How can psychiatric pathology affect form of thought?

Answer 33

Delusions Obsessions Phobias Intrusive thoughts Paranoia

Question 34

How can content of thought be recorded?

Answer 34

Write exactly what the patient says in answer to some questions/some statements

Question 35

In what ways may a persons perception be altered?

Answer 35

Illusions Hallucinations

Question 36

What is an illusion?

Answer 36

A misinterpretation of a stimulus that can occur in any modality

Question 37

Is an illusion a sign of pathology?

Answer 37

No - it is normal to sometimes see illusions

Question 38

What is a hallucination?

Answer 38

The perception of something (e.g. taste, smell etc.) in the absence of an external stimulus

Question 39

What type of hallucination is most common in functional psychiatry?

Answer 39

Auditory hallucination

Question 40

What type of hallucination is more common in organic psychiatry?

Answer 40

Visual hallucinations

Question 41

What conditions can 2nd person auditory hallucinations occur in?

Answer 41

Severe depression Schizophrenia (some times)

Question 42

What condition are 3rd person auditory hallucinations more common in?

Answer 42

Schizophrenia

Question 43

How does a third person auditory hallucination often present in schizophrenia?

Answer 43

As a running commentary

Question 44

What is an important indicator of cognition?

Answer 44

Awareness of orientation of in time, place and person

Question 45

What can be used to assess cognition?

Answer 45

MMSE

Question 46

What is meant by insight?

Answer 46

A patient’s understanding of their experience/illness

Question 47

What must be considered when assessing a patient’s insight?

Answer 47

Do the believe they’re well? Does their view differ from professional opinion? Do they understand their condition?

Question 48

What risks must be considered when assessing psychiatric disease?

Answer 48

Risk to self Risk to others Risk to health

Question 49

How can a patient be a risk to themselves?

Answer 49

Self-harm Suicide Neglect

Question 50

How can a patient be a risk to others?

Answer 50

Protection of self Command hallucinations Aggression and irritability

Question 51

How may a psychiatric patient be a risk to their own health?

Answer 51

Not taking medication causing deterioration of mental/physical health Not exercising Eating disorders