Mental State Examination

Question 1

List the components of a mental state examination (ASEPTIC)

Answer 1

Appearance + behaviour
Speech
Emotion (mood + affect)
Thought (control, content)
Perception (hallucinations)
Cognition
Insight

Question 2

What is the difference between viewing a patient objectively and subjectively?

Answer 2

Objectively: without emotions or feelings, just purely what’s there in front of you (fact)
Subjectively: taking into account emotions and wider interpretation

Question 3

List aspects of behaviour in a patient you should look out for

Answer 3

Appropriate to situation (disinhibition/over-familiarity)
Agitation/psychomotor retardation (slowness)
Cooperation (open/guarded/suspicious)
Eye contact
Rapport and attitude

Question 4

List aspects of speech in a patient you should look out for

Answer 4

Pace/rate
Volume
Amount (increased/ pressuring or decreased/ monosyllabic)
Tone (prosody - variation, monotomous, flat)
Speech delay
Volume

Question 5

What is the difference between observing mood and affect?

Answer 5

Mood is subjective - how does the patient feel just NOW and record in patient’s own words

Affect is subjective - your observation of how the patient appears in interview, establish a baseline (‘euthymic’) and look for variation

Question 6

List the different types of affect seen in patients

Answer 6

Reactive (changes as normal)
Labile (exaggerated)
Unreactive (stays low)
Flattened (no emotion)
Blunted (doesn't vary)
Incongruent (doesn't match with mood)

Question 7

How is a patient’s insight assessed?

Answer 7

Awareness of one’s own symptoms
Attribution of symptoms to mental illness
Acceptance of treatment/ hospitalisation

Question 8

List aspects of appearance in a patient you should look out for

Answer 8

Age, gender, race
Body habitus (weight)
Grooming (neat, unkempt)
Attire
Posture
Gait, odd movements (tics, tremors, stereotypes, mannerisms)
Evidence of injuries or illness (e.g. from self-harm, abuse, fights, drug use (pupil size, bruising))
Smell (alcohol, urine, vomit, body odour)

Question 9

List ways in which cognitive function in a patient can be assessed

Answer 9

Orientation to time (date, day, month, year, time of day), place (name, what ward, what floor), person (name, age, DOB)

Concentration (months of year backwards, digit span, spelling a word backwards)

Memory (autobiographical = personal events, retrograde = past events, historical dates, TV shows, anterograde = new memories, remember 3 things, name, address)

Question 10

What is classes as an abnormal MSE?

Answer 10

24/30

But each patient should be judged subjectively

Question 11

What is a schema?

Answer 11

Pattern of thought or behaviour, the way we organise information/ rules about the world