Mental State Examination Flashcards
When conducting and presenting the findings of a mental state examination, in what order should this be approached?
Appearance and behaviour
Speech
Mood
Affect
Thought
Perceptions
Cognition
Insight
Risk
How should appearance and behaviour be examined?
Describe the patient
What aspects of a patients appearance and behaviour should be described?
Well kempt?
Clothing
Eye contact
Level of rapport
Psychomotor retardation
Other psychomotor signs
What types of eye contact may be particularly relevant?
Inappropriate eye contact
Reduced eye contact
How can level of rapport differ between psychiatric patients?
Can be easy to develop
Patient can be guarded
What other psychomotor signs could be commented on?
Parkinsonism
What aspects of speech should be analysed during a mental state examination?
Rate
Tone
Volume
Difficulty speaking?
Formal thought disorder?
How can rate of speech vary?
Delayed start
Slow
Fast
How can tone of speech vary?
Monotonous
Overly variable
How can volume of speech vary?
Quiet/loud
What types of difficulty speaking may a patient have?
Dysphasia
Dysarthria
What are some different types of formal thought disorder?
Loosening of associations
Flight of ideas
Circumstantiality
Tangentiality
Neologisms
What is loosening of associations?
A loss of connection between thoughts presenting as changing of topic between sentences or words with obvious links between topics.
At its wort how can loosening of ideas present?
Word salad
What condition does loosening of associations typically present in?
Schizophrenia
What is flight of ideas?
Rapid changing of topic between sentences with some identifiable link between topics
What condition does flight of ideas typically present in?
Mania
What is the major difference between loosening of associations and flight of ideas?
There is an identifiable link between topic changes in flight of ideas if speech is written down and analysed
What is circumstantiality?
Patient will go over the top with detail and move on to seemingly irrelevant topics before bringing the conversation back to answer the question
What is tangentiality?
The patient will move the conversation on to another topic and never return to answer the original question
What are neologisms?
Words made up by the patient with a specifically assigned meaning
In what two ways should a patients mood be assess in a mental state examination?
Subjectively
Objectively
How is a patient’s mood described subjectively?
Ask the patient to describe their mood
Can use a scale of 1-10
How has it changed from premorbid mood
How is a patient’s mood describe objectively?
The assessor gives their view on the patient’s current mood
In what ways may an assessor describe a patient’s mood?
Depressed
Manic
Anxious
Irritable
Euthymic (normal)
What is affect?
How a patient appears to respond emotionally in certain situations
In what ways may a patients affect be altered?
Blunt
Flat
Inappropriate
Labile
Reactive (normal)
What is a blunt affect?
A decrease in the variation of emotional response displayed by a patient
What is a flat affect?
Absence of any emotional response
How may a patient’s affect be inappropriate?
May have the typically wrong response to a certain situation
E.g. finding a sad situation funny
What is meant by a labile affect?
Rapid changes in emotional state
What aspects of thought should be considered in a mental state examination?
Form
Content
How can psychiatric pathology affect form of thought?
Delusions
Obsessions
Phobias
Intrusive thoughts
Paranoia
How can content of thought be recorded?
Write exactly what the patient says in answer to some questions/some statements
In what ways may a persons perception be altered?
Illusions
Hallucinations
What is an illusion?
A misinterpretation of a stimulus that can occur in any modality
Is an illusion a sign of pathology?
No - it is normal to sometimes see illusions
What is a hallucination?
The perception of something (e.g. taste, smell etc.) in the absence of an external stimulus
What type of hallucination is most common in functional psychiatry?
Auditory hallucination
What type of hallucination is more common in organic psychiatry?
Visual hallucinations
What conditions can 2nd person auditory hallucinations occur in?
Severe depression
Schizophrenia (some times)
What condition are 3rd person auditory hallucinations more common in?
Schizophrenia
How does a third person auditory hallucination often present in schizophrenia?
As a running commentary
What is an important indicator of cognition?
Awareness of orientation of in time, place and person
What can be used to assess cognition?
MMSE
What is meant by insight?
A patient’s understanding of their experience/illness
What must be considered when assessing a patient’s insight?
Do the believe they’re well?
Does their view differ from professional opinion?
Do they understand their condition?
What risks must be considered when assessing psychiatric disease?
Risk to self
Risk to others
Risk to health
How can a patient be a risk to themselves?
Self-harm
Suicide
Neglect
How can a patient be a risk to others?
Protection of self
Command hallucinations
Aggression and irritability
How may a psychiatric patient be a risk to their own health?
Not taking medication causing deterioration of mental/physical health
Not exercising
Eating disorders
