Mental State Examination

Question 1

how do you test concentration/attention

Answer 1

say months of the year backwards

Question 2

what is mental state examination the equivalent to in general medicine

Answer 2

physical examination

Question 3

what is the difference between mood and affect

Answer 3

mood - subjective at time of interview - how to they say they are feeling

affect - what do you observe, do they look happy/sad etc. eg. how does their mood appear to you

Question 4

true or false: mood is constantly changing

Answer 4

false
mood usually stays the same

affect changes all the time. People look unhappy when you talk about a sad subject, or look happy when u talk about something happy eg. face lights up, affect gets brighter

Question 5

what is reactivity

Answer 5

how much the affect can vary

Question 6

what is euthymic affect

Answer 6

normal/fine affect

Question 7

what is a flattened/blunted affect

Answer 7

when the affect doesn’t vary much

Question 8

what is an unreactive affect

Answer 8

when the affect doesn’t change

Question 9

what is incongruent affect

Answer 9

opposite affect eg. when talking about something happy they look sad/ when talking about something sad they look happy

Question 10

what is a perception without stimulus

Answer 10

hallucination

Question 11

what is an illusion

Answer 11

a misperception of a REAL stimulus eg. thinking nurses shoes are ferrets lol

Question 12

what is passivity

Answer 12

things that are normally under the patients control but when unwell are not under their control

eg. though broadcasting - feelings like you don’t have control of your thoughts eg. other people can access your thoughts, take them away, here them etc

Question 13

what is a persecutory delusion

Answer 13

belief that you are being persecuted, with no real evidence

Question 14

what is insight

Answer 14

self awareness in relation to the illness - do they know they have an illness

Question 15

what is looked at in a mental state examination

Answer 15

Appearance and behaviour 
Speech 
Affect and mood 
Thoughts: control&content 
perception 
cognition 
insight

Question 16

what to look for in behaviour

Answer 16

eye contact 
rapport 
open/guarded/suspicious 
agitation/psychomotor retardation 
disinhibition/overfamiliarity

Question 17

what to look for in speech

Answer 17

rate 
amount 
variation in tone 
speech delay 
volume

Question 18

what to look for in mood

Answer 18

subjective
how does the patient feel today (currently not over past few weeks)

response is usually “fine, tired, down, worried, pretty good’ etc

Question 19

what to look for in affect

Answer 19

objective assessment - how the patient appears through the interview

what is the baseline affect eg. low, anxious, elated - and to what extent it varies eg. appropriately reactive, labile unreactive, flattened, blunted, incongruent

Question 20

how to asses cognitive function

Answer 20

look at orientation to time, place and person

asses concentration

asses memory

Question 21

how to determine a patient’s insight

Answer 21

do they recognise they re unwell?

do they attribute it to a mental health problem?

do they accept the need for treatment? hospitalisation?

Question 22

when are hallucinations significant

Answer 22

in context of other relative symptoms- can otherwise be induced in most people eg. by sensory deprivation

Question 23

what are types of auditory hallucination

Answer 23

Second person - voices directly address the patient
Third person - voices discuss the patient or provide a running commentary on his actions
Though echo - the patient experiences his own thoughts spoken or repeated out loud

Question 24

what are somatic hallucinations

Answer 24

bodily sensations eg. insects crawling under skin or being touched

Question 25

what are visual hallucinations

Answer 25

hallucinations associated with altered consciousness/organic impairment

simple. eg- flashes of light
complex eg. face or figure

Question 26

what other sensory hallucinations can you have

Answer 26

olfactory

gustatory

Question 27

what is the passivity phenomena

Answer 27

when behaviour is experienced as being controlled by an external agency rather than by the individual

Question 28

what can passivity affect

Answer 28

thoughts
-though insertion, withdrawal, broadcasting

actions - made actions

feelings - made feelings

Question 29

where are brain abnormalities seen in the passivity phenomena

Answer 29

in the parietal and cingulate cortices which are involved in interpretation of sensory information

Question 30

what is a thought disorder

Answer 30

disorder of the form of thought - an abnormality in the way their thoughts are linked together.

2 types:
flight of ideas
loosening of associations

Question 31

what is a flight of ideas thought disorder

Answer 31

words are associated together inappropriately because of their meaning or rhyme so that speech then looses its name and the patient wanders far from the topic of conversation

jump from topic to topic but with recognisable links such as rhyming, punning or environmental distractions

Question 32

what is loosening of associations thought disorder

Answer 32

patient’s speech is muddled, illogical and difficult to follow and cannot be clarified

speak so vaguely that no information is given in spite of the number of words used

Question 33

what is neologism thought disorder

Answer 33

an abnormality of speech in which the patient makes up a new word or phrase or uses existing words or phrases in bizarre ways with no accepted meaning

Question 34

what is a delusion

Answer 34

false belief firmly held in the face of logical argument or evidence to the contrary

not modified by experience or reason

usually very individualised or of great personal significance

Question 35

how are delusions identified

Answer 35

by their form, but described by its content or theme

‘not what you believe, how you believe it’

Question 36

what is the theme of a delusion

Answer 36

in general terms, what it is about

Question 37

where do delusions originate from

Answer 37

from an attempt to explain anomalous experiences eg. hallucinations, passivity experiences, depression