Mental state examination Flashcards
What is the purpose of the mental state examination (MSE)?
To assess state of mind at the time of interview
What are the 7 things assessed in a mental state examination ?
- Appearance and behaviour
- Speech
- Mood and Affect
- Thoughts/beliefs
- Perception - usual experiences or hallucinations
- Cognition - orientation, short and long-term memory and concentration
- Insight
ASEPTIC mneumonic to remember (E= emtion (mood & affect)
What are the aspects of a persons appearance which you are looking at ?
- Age, Gender, Race
- Body Habitus
- Grooming (neat? unkempt?), Attire
- Posture
- Gait,
- odd movements* e.g. tic stereotypy
- evidence of injuries (from self-harm or from abuse or fights)
- illness
- Signs of drug use (pinpoint pupils / bruises on arms)
- Smell can also be mentioned here (alcohol? urine? vomit? body odour?)
What aspects of someone behaviour are you looking out for in the mental state examination ?
- Eye contact
- Rapport
- Manners
- Open / Guarded
- Agitation / Psychomotor Retardation (compulsions?)
What aspects of someones speech are you assessing in the mental state examination?
Rate – slow, fast, pressured, garrulous
Rhythm – spontaneous, taciturn, stammering, stuttering, slurring, staccato
Tone – accent, pitch, coprolalia, inflection
Volume:
- Loudness – shouting, whispering
- Amount – mute, paucity, verbose
What is the difference between objective and subjective opinions ?
If a patient says they are 0/10 for mood, have pervasive low mood, and are sad to the point of wanting to kill themselves, this would be recorded as “Subjectively Mr X says that his mood is 0/10
If you feel that talking with Mr X, his report does not fit with what you observe / encounter during assessment you would then write “Objectively, Mr X did not appear to be low in mood: he appeared euthymic / elated” (Euthymic means balanced / good mood – one that’s neither depressed or significantly elated).
What aspects should you cover about someones mood in the mental state examination ?
- Thoughts about self-harming or harming others - ties in with depression like mood
- May notice laughter and grand ideas such as in a manic patient
- Inlcude both subjective and objective opinions on patients mood
- Assess someones affect
Something like “On a scale of One to Ten, with 1 being the saddest / lowest you could possibly feel, and 10 being bouncing off the walls happy, where would you say your mood has been sitting on average over the last two weeks?” can be helpful.
when assessing mood what is meant by a patients affect ?
- Affect is how ‘reactive’ someone is to during conversation. When someone without a mood or social/communicaton disorder (or a disorder that restricts their facial muscles such as parkinson’s disease) is – for example – given a genuine compliment during a conversation, normally they will smile and their face will ‘light up’. Noticing these changes in your patient is essential to be able to comment on affect.
- Affect is important to note and comment on because it can be affected in different mental disorders. For example, someone with a significant depressive disorder might not respond to humour or complements – or the way that they respond might be toned down / flattened down from what you might expect it to be if they did not have that condition.
Define each of the following:
- Tic
- Stereotypy
- Tardive / Orofacial Dyskinesia
- Tremor
- Mannerism
Tic = A regular spasmodic contraction of the muscles, most often in the face
Stereotypy = the persistent repetition of an act
Orofacial dyskineasia = are involuntary repetitive movements of the mouth and face. In most cases, they occur in older psychotic patients (similar to tics but not spasmodic)
Tremor = an involuntary quivering movement.
Mannerism = a regular gesture or way of speaking or behaving
When assessing someones beliefs what should you cover ?
About the patient and their own body
Beliefs about other people and the future
Note abnormal beliefs e.g. delusions - such as thoughts that are overheard, also ideas - persecutory, grandiose
What should be assessed when covering someones thoughts
If they have had any unusual experiences or hallucinations
What should be covered when assessing someones cognition ?
Orientation - whats their name, where are they?, what time is it ?, what day is it ?
Short-term memory - recall a name and address 5 min after learning it
Concentration - get them to say the months of the year backwards
Long-term memory - e.g. who is the monarch/head of state ?
Some good questions to use when carrying out mental state examination
- Any odd thoughts?
- Might your thoughts be interfered with?
- Do you feel anyone is controlling you?
- Is anyone putting thoughts into your head ?
- Do other people access or hear your thoughts ?
- Is anyone harming you ?
- Any plots against you ?
- Do you hear voices when there is no-one nearby? What do they say ?
- Do you see things others cannot see ?
- Are you feeling low/depressed?
- Is life worth living ?
- Can anything give you pleasure?
- Do you have trouble sleeping or eating ?
- Are your energy levels increased or decreased?
- Can you concentration ok?
- Are you feeling guilty ?
- Are you wanting to harm yourself or others ?
- Any worries/anxieties ?
What are some of the signs of anxious behaviour you may see when carrying out a consultation ?
- Fidgeting, trembling
- Nail-bitting
- Shuffling feet
- squirming in the chair
- Sits on the edge of the chair
What are some of the signs of a depressed mood you may see when in a consultation ?
- Hunched, self-hugging posture
- Little eye contact
- Downcast eyes, tears
- Slow thought, speech and movement
