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Phase 3 > Mental State Examination > Flashcards

Mental State Examination Flashcards

1
Q

Why is the MSE important:

A

Provides a snap shot in time

information for the diagnosis and response to treatment

Helpful for communication to other profesionals

describes change over time

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2
Q

What should the MSE always be taking in context with?

A

Education

Cultural

Developmental

Social Factors

*what are the factors

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3
Q

What does the MSE consist off:

A

Appearance and Behaviour

Mood and Effect

Speech and Language

Thought

Perception

Cognition

Insight and Judgement

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4
Q

Appearance and Behaviour:

A

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

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5
Q

Mood and Effect

A

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)
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6
Q

Name some common abnormalities seen with the mood and effect:

A

Schizophrenia:
Incongruent/ blunted restricted

Mania:
Euphoric/ Ecstatic / Expansive/ Labile

Major Depressive Disorder:
Sad/ Low/ Restricted

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7
Q

Speech and Language

A

Quantity

  • talkative
  • spontaneous
  • Expansive

Rate

  • Fast
  • slow
  • pressured

Volume

  • loud
  • soft
  • monotone

Fluency and Rhythm

  • slurred
  • clear
  • hesitant
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8
Q

Thought and speech

A

Goal Directed flow of ideas

Verbal Output of flow of ideas

Speech is a measure of thought

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9
Q

Give some examples of common abnormalities seen in thought and speech:

A

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

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10
Q

Formal thought disorder: Thought form descriptors:

A

Clanging and Punning

Flight of ideas

Loosening of associations

Circumstantial

Tangentiality

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11
Q

List some disorders of flow in thought content:

A

Retardation of thinking
- train is slowed down

Pressure of speech:
- excessive thoughts

Perseverations

  • response continues despite stimulus has changed
  • seen in dementia
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12
Q

Thought content:

A

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

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13
Q

Define Delusions

A

Delusions

  • fixed false belief
  • held in spite of evidence to contrary
  • Not in keeping with Cultural and educational setting
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14
Q

Name the different types of delusions:

A

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

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15
Q

Disorders of possession of thoughts:

A

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

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16
Q

Obsessions:

A

recurrent
persistent

Intrusive
causes marked anxiety

attempts to ignore are unsuccessful

**are recognised as person’s own thoughts

usually ego-dystonic

17
Q

Compulsions:

A

Repetitive behaviours

18
Q

Risk:

A

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

19
Q

Perception:

A

the perception from any of the 5 modalities

20
Q

Define Hallucination:

A

Where there is perception of something without a stimulus. This can occur in any of the senses

21
Q

Perceptions disturbances:

A

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

22
Q

Pseudo Hallucination:

A

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
23
Q

Auditory Hallucinations:

A

Elementary
- hear noises

First person

Second person
- talking to them

Third person
- people here two voices talking about them

24
Q

Visual Hallucinations:

A

Consider an underlying organic cause.

other causes:

  • alcohol withdrawal
  • Charles Bonnet Syndrome
  • Hypnagogic Hypnopompic (when waking up)
25
Q

Tactile Hallucinations:

A

Superficial - formication

Visceral
- deep feeling

26
Q

Cognition:

A

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

27
Q

Insight and Judgement:

A

Awareness of one’s own symptoms

Attribution of symptoms

Appraisal or analysis of consequence of the disorder

Acceptance of treatment

28
Q

What are the points of insight and awareness

A
  1. Complete denial
  2. Slight awareness of being sick and needing help but denying it at the same time
    - Ambivalence
  3. Awareness of being sick but blaming it on others
  4. Awareness that the illness is caused by something unknown in the patient
  5. Intellectual insight
  6. True emotional insight

Phase 3 (50 decks)

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