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Psychiatry > Mental State Examination > Flashcards

Mental State Examination Flashcards

1
Q

What is a MSE assessing?

A

Not history but what they are like at the moment

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2
Q

What is a MSE not assessing?

A

History

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3
Q

What are the seven broad categories in the MSE?

A 
Appearance and behaviour
Mood and affect
Speech
Thought content
Insight and illness beliefs 
Abnormal perceptions
Cognitive state
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4
Q

What kind of things are covered in appearance and behaviour?

A 
Clothing
Gait
Facial appearance
Hair
Eye contact
Posture and movement
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5
Q

What kind of things should you look for in clothing?

A

Dull/flamboyant
Baggy
Socially appropriate
Seasonally appropriate

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6
Q

How does posture normally present in depression?

A

Shoulders hunched
Downward gaze
Immobile

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7
Q

How does posture/movement normally present in anxiety?

A 
Easy to startle
Tremor
Restfulness
Visual scanning
Pacing
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8
Q

How does posture/movement normally present in mania?

A

Overactive

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9
Q

How does posture/movement normally present while hallucinating?

A

Distracted
Stop mid sentence
Stare at nothing

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10
Q

What is mood?

A

What the patient is feeling at this moment in time

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11
Q

What is affect?

A

How the patient comes across

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12
Q

What are the three categories of altered mood?

A

Persistent change in mood
Labile mood
Incongruous mood

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13
Q

Give some examples of persistent changes in mood

A

Depression
Anxiety
Elation
Irritability

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14
Q

What is normal mood called

A

Euthymic

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15
Q

What can cause elation?

A

Mania

Intoxication

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16
Q

What is labile mood?

A

Different emotions rapidly follow one another.

Excessively emotional over trivial events.

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17
Q

What can cause labile mood?

A

Mixed affective states
Mild depression
Pseudobulbar palsy

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18
Q

What is effect blunting?

A

Absence of emotions often seen in schizophrenia

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19
Q

What can speech give insight into?

A

Often help show disorders of thinking/stream of thought.

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20
Q

What are you looking for in their voice?

A 
Monotone or modulated
Rate
Rhythm
Tone
What they are saying
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21
Q

What should you look for in what they are saying?

A

Disorders of stream of thought

DIsorders of form of thought

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22
Q

What are some disorders of thought stream?

A

Pressure of speech
Poverty of speech
Thought block

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23
Q

What is pressure of speech and what is it seen in?

A

Mania
Loud and rapid speech
‘Can’t get a word in edgeways’

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24
Q

What is poverty of speech and what is it seen in?

A

Depression

Absences of thoughts therefore speech

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25
Q

What is thought blocking and what is it seen in?

A

Schizophrenia

Abrupt and complete interruption of thoughts

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26
Q

What are some disorders of form of thought?

A 
Flight of ideas
Perseveration
Thought broadcast
Thought insertion
Thought withdrawal
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27
Q

What is flight of ideas and what is it often seen in?

A

Mania
Thoughts jump rapidly from one topic to another.
Clang association- run through similar sounding but unrelated words
Respond to distracting cues

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28
Q

What is perseveration and what is it seen in?

A

Frontal lobe disorders

Persistent and inappropriate repetition of the same thought

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29
Q

What is thought broadcasting?

A

Thinks others can read their minds

30
Q

What is thought insertion?

A

Thinks others are implanting thoughts into their mind

31
Q

What is thought withdrawal?

A

Thinks thoughts being taken away from them without their control

32
Q

What is thought content?

A

The worries and preoccupations expressed by the patient

33
Q

Give some examples of abnormal thought content?

A

Obsessional rumination
Compulsions
Abnormal beliefs

34
Q

What is obsessional ruminations?

A

A recurrent, persistent thought, impulse, image or musical theme that occurs despite the patient’s effort to resist it. The patient recognizes that the obsessional thought is their own, but it is usually unpleasant and often ‘out of character’.

35
Q

What are compulsions?

A

A repetitive and seemingly purposeful action performed in a stereotypical way, referred to as a compulsive ritual
Patients feel they must carry out the action.
Can be used to counteract ruminations

36
Q

What can compulsions be associated with?

A

Can be used to counteract ruminations

37
Q

What is an example of an abnormal belief?

A

Delusions

38
Q

What is a delusion?

A

An abnormal belief that is:
Held with absolute conviction
Not amenable to reason or modifiable by experience
Not shared by those of a common cultural or social 
background
Experienced as a self-evident truth of great personal 
significance
Usually false.

39
Q

What must a delusion be distinguished from?

A

Overvalued ideas- beliefs in accordance with background.

40
Q

How can delusions be used to diagnose schizophrenia?

A

Can be interpreted as being under control from some other being- diagnostic of schizophrenia

41
Q

What are the two forms of delusions?

A

Primary

Secondary

42
Q

What is a primary delusion?

A

Rare
Sudden
Full conviction
No preceding event

43
Q

What is a secondary delusion?

A

Have preceding event

44
Q

What is an idea of self-reference?

A

Step below delusion- in people who are very self-conscious. Feel people are laughing at them etc

45
Q

What is insight?

A

Degree to which person recognizes they’re ill

46
Q

What is illness belief?

A

Patients explanation for their symptoms

47
Q

What is a good questions to ask for insight?

A

‘Do you think you are well?’

48
Q

What things are needed for insight and illness belief?

A

Awareness of symptoms
Attribute symptoms to mental illness
Realize consequences of symptoms

49
Q

What are some abnormal perceptions?

A 
Illusions
Hallucinations
Pseudohallucinations
Depersonalisation
Derealisation
Increased sensitivity
50
Q

What is an illusion?

A

Misperceptions of external stimuli and are most likely to occur when the general level of sensory stimulation is reduced

51
Q

What is a hallucination?

A

A perception in the absence of a stimulus. It is:

  • A false perception and not a distortion
  • Perceived as inhabiting objective space

  • Perceived as having qualities of normal perception
  • Perceived alongside normal perceptions
  • Independent of the individual’s will.
52
Q

What can cause hallucinations?

A 
Grief
Waking up
Delerium
Schizophrenia
Intoxication
53
Q

What is the most common form of hallucination?

A

Auditory

54
Q

What are two common forms of auditory hallucinations?

A

2nd person- can be commanding

3rd person- can be narrative

55
Q

What is a pseudohallucination?

A

Hallucination which the sufferer knows isn’t real

56
Q

What is the most common form of pseudohallucination?

A

Auditory

57
Q

What is pseudohallucinations usually seen in?

A

Mood disorders

58
Q

What is depersonalisation?

A

Change of self-awareness- Might feel they’re not real/detached from their body

59
Q

What can cause depersonalisation?

A

Healthy: tired, sensory deprivation, drugs
Anxiety
Schizophrenia
Temporal lobe epilepsy

60
Q

What is derealisation?

A

Feel external environment has become unreal. Day dream like state

61
Q

What can cause derealisation?

A

Healthy: tired, sensory deprivation, drugs
Anxiety
Schizophrenia
Temporal lobe epilepsy

62
Q

What can sensory sensitivity be caused by?

A

Anxiety

Migraine

63
Q

Why do you need to asses the cognitive state?

A

To differentiate from organic brain disorders eg. Delirium or dementia.

64
Q

How do you test cognitive state?

A

Diffuse: orientation, attention, verbal memory, long term memory

65
Q

How do you test orientation?

A

Time and place

66
Q

What is consciousness?

A

Awareness of self and world around

67
Q

What is delirium?

A

FLuctuating conciousness

68
Q

How do you test attention?

A

Months backwards

69
Q

How do you test verbal memory?

A

Repeat name and address with 10+ items in

70
Q

How do you test long term memory?

A

Recall that morning’s news, favorite football team etc

71
Q

What is amnesia?

A

Absence of memory

Psychiatry (22 decks)

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