Mental State Examination Flashcards
Why is the MSE important:
Provides a snap shot in time
information for the diagnosis and response to treatment
Helpful for communication to other profesionals
describes change over time
What should the MSE always be taking in context with?
Education
Cultural
Developmental
Social Factors
*what are the factors
What does the MSE consist off:
Appearance and Behaviour
Mood and Effect
Speech and Language
Thought
Perception
Cognition
Insight and Judgement
Appearance and Behaviour:
Descriptive of physical appearance
- sex
- build
- level of grooming
- washing themselves
- cloths suitable? cultural and sociable acceptable
- evidence of self neglect?
Rapport:
- how was established
Level of Alertness:
- Drowsy
- alert
Attitude:
- co-operative
- aggressive
- abusive
Eye contact
- lack of contact - autism
- intense - manic
Psychomotor activity
- retardation movement
- agitation
Movements:
- Tremor
Mood and Effect
Mood is the predominant mood over a period of time
- communicated by the patient “climate”
Affect: Objective - made by clinician
- congruence (is it fitting with what they are saying)
- reactive (is there is blunted, flat, normal)
- reactivity
- Stability (changing between emotions)
Name some common abnormalities seen with the mood and effect:
Schizophrenia:
Incongruent/ blunted restricted
Mania:
Euphoric/ Ecstatic / Expansive/ Labile
Major Depressive Disorder:
Sad/ Low/ Restricted
Speech and Language
Quantity
- talkative
- spontaneous
- Expansive
Rate
- Fast
- slow
- pressured
Volume
- loud
- soft
- monotone
Fluency and Rhythm
- slurred
- clear
- hesitant
Thought and speech
Goal Directed flow of ideas
Verbal Output of flow of ideas
Speech is a measure of thought
Give some examples of common abnormalities seen in thought and speech:
Manic:
Form:
- Flight of ideas - connected ideas but speech moves quickly
Content:
- delusions of grandeur
Stream and Flow:
- Pressure of speech
Possession:
- Patients own thoughts - recognise they are their own thoughts
Formal thought disorder: Thought form descriptors:
Clanging and Punning
Flight of ideas
Loosening of associations
Circumstantial
Tangentiality
List some disorders of flow in thought content:
Retardation of thinking
- train is slowed down
Pressure of speech:
- excessive thoughts
Perseverations
- response continues despite stimulus has changed
- seen in dementia
Thought content:
Overvalued Ideas
- ideas that people hold with a lot of thought but is shakable
Delusions
- fixed false belief
- held in spite of evidence to contrary
- Not in keeping with Cultural and educational setting
Paranoid
Define Delusions
Delusions
- fixed false belief
- held in spite of evidence to contrary
- Not in keeping with Cultural and educational setting
Name the different types of delusions:
Delusions of persecutions
Delusions of reference
- messages through the TV
Delusions of grandeur
- Mood disorders
- special roles in society
Nihilistic delusions
- severe depressive disorders
Hypochondriacal delusions
- certain illness
Delusions of jealousy
- 100% believe despite evidence
Disorders of possession of thoughts:
this is more common in psychosis
Thought insertion
thought withdrawal
- thoughts taken away
Thought broadcast
- people can hearing their thoughts
Thought blocking
- just completely stop
Obsessions
Obsessions:
recurrent
persistent
Intrusive
causes marked anxiety
attempts to ignore are unsuccessful
**are recognised as person’s own thoughts
usually ego-dystonic
Compulsions:
Repetitive behaviours
Risk:
Can be included anywhere. but usually in thought content.
Asking about particular anxieties
Risk to self
- Self harm
- plans
- intends
Risk to others
- harming others
- driving
- children
**risk must be commented on
Perception:
the perception from any of the 5 modalities
Define Hallucination:
Where there is perception of something without a stimulus. This can occur in any of the senses
Perceptions disturbances:
Distortion
- where an object is perceived but the quality of it is altered.
Illusion:
- stimulus present but different object perceived
Negative Hallucination:
- where a stimulus is there but no object is percieved
Pseudo Hallucination:
Located within a subjective space
- so within their head
Not the same quality as that of normal perception
Insight is often much greater
More common in personality disorders
VS
- hears voice outside their head
- quality of voice is greater is as real as a voice
- seen in psychosis
Auditory Hallucinations:
Elementary
- hear noises
First person
Second person
- talking to them
Third person
- people here two voices talking about them
Visual Hallucinations:
Consider an underlying organic cause.
other causes:
- alcohol withdrawal
- Charles Bonnet Syndrome
- Hypnagogic Hypnopompic (when waking up)
Tactile Hallucinations:
Superficial - formication
Visceral
- deep feeling
Cognition:
Can either do the:
- MMSE
- Addenbrooke’s
MMSE consists of:
Attention
- serial of 7’s
- spell world backwards
Orientation
- times, place, date etc
Memory
- ability to retain info - retain 3 words
Executive function - plan complex - abstract thinking - inhibiting "what do you do if you loose your keys" "what do you do if there is a fire"
Language and praxis
***these can be formatively tests
Insight and Judgement:
Awareness of one’s own symptoms
Attribution of symptoms
Appraisal or analysis of consequence of the disorder
Acceptance of treatment
What are the points of insight and awareness
- Complete denial
- Slight awareness of being sick and needing help but denying it at the same time
- Ambivalence - Awareness of being sick but blaming it on others
- Awareness that the illness is caused by something unknown in the patient
- Intellectual insight
- True emotional insight
