Mental State Examination Flashcards
What is a MSE assessing?
Not history but what they are like at the moment
What is a MSE not assessing?
History
What are the seven broad categories in the MSE?
Appearance and behaviour Mood and affect Speech Thought content Insight and illness beliefs Abnormal perceptions Cognitive state
What kind of things are covered in appearance and behaviour?
Clothing Gait Facial appearance Hair Eye contact Posture and movement
What kind of things should you look for in clothing?
Dull/flamboyant
Baggy
Socially appropriate
Seasonally appropriate
How does posture normally present in depression?
Shoulders hunched
Downward gaze
Immobile
How does posture/movement normally present in anxiety?
Easy to startle Tremor Restfulness Visual scanning Pacing
How does posture/movement normally present in mania?
Overactive
How does posture/movement normally present while hallucinating?
Distracted
Stop mid sentence
Stare at nothing
What is mood?
What the patient is feeling at this moment in time
What is affect?
How the patient comes across
What are the three categories of altered mood?
Persistent change in mood
Labile mood
Incongruous mood
Give some examples of persistent changes in mood
Depression
Anxiety
Elation
Irritability
What is normal mood called
Euthymic
What can cause elation?
Mania
Intoxication
What is labile mood?
Different emotions rapidly follow one another.
Excessively emotional over trivial events.
What can cause labile mood?
Mixed affective states
Mild depression
Pseudobulbar palsy
What is effect blunting?
Absence of emotions often seen in schizophrenia
What can speech give insight into?
Often help show disorders of thinking/stream of thought.
What are you looking for in their voice?
Monotone or modulated Rate Rhythm Tone What they are saying
What should you look for in what they are saying?
Disorders of stream of thought
DIsorders of form of thought
What are some disorders of thought stream?
Pressure of speech
Poverty of speech
Thought block
What is pressure of speech and what is it seen in?
Mania
Loud and rapid speech
‘Can’t get a word in edgeways’
What is poverty of speech and what is it seen in?
Depression
Absences of thoughts therefore speech
What is thought blocking and what is it seen in?
Schizophrenia
Abrupt and complete interruption of thoughts
What are some disorders of form of thought?
Flight of ideas Perseveration Thought broadcast Thought insertion Thought withdrawal
What is flight of ideas and what is it often seen in?
Mania
Thoughts jump rapidly from one topic to another.
Clang association- run through similar sounding but unrelated words
Respond to distracting cues
What is perseveration and what is it seen in?
Frontal lobe disorders
Persistent and inappropriate repetition of the same thought
What is thought broadcasting?
Thinks others can read their minds
What is thought insertion?
Thinks others are implanting thoughts into their mind
What is thought withdrawal?
Thinks thoughts being taken away from them without their control
What is thought content?
The worries and preoccupations expressed by the patient
Give some examples of abnormal thought content?
Obsessional rumination
Compulsions
Abnormal beliefs
What is obsessional ruminations?
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’.
What are compulsions?
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
What can compulsions be associated with?
Can be used to counteract ruminations
What is an example of an abnormal belief?
Delusions
What is a delusion?
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.
What must a delusion be distinguished from?
Overvalued ideas- beliefs in accordance with background.
How can delusions be used to diagnose schizophrenia?
Can be interpreted as being under control from some other being- diagnostic of schizophrenia
What are the two forms of delusions?
Primary
Secondary
What is a primary delusion?
Rare
Sudden
Full conviction
No preceding event
What is a secondary delusion?
Have preceding event
What is an idea of self-reference?
Step below delusion- in people who are very self-conscious. Feel people are laughing at them etc
What is insight?
Degree to which person recognizes they’re ill
What is illness belief?
Patients explanation for their symptoms
What is a good questions to ask for insight?
‘Do you think you are well?’
What things are needed for insight and illness belief?
Awareness of symptoms
Attribute symptoms to mental illness
Realize consequences of symptoms
What are some abnormal perceptions?
Illusions Hallucinations Pseudohallucinations Depersonalisation Derealisation Increased sensitivity
What is an illusion?
Misperceptions of external stimuli and are most likely to occur when the general level of sensory stimulation is reduced
What is a hallucination?
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.
What can cause hallucinations?
Grief Waking up Delerium Schizophrenia Intoxication
What is the most common form of hallucination?
Auditory
What are two common forms of auditory hallucinations?
2nd person- can be commanding
3rd person- can be narrative
What is a pseudohallucination?
Hallucination which the sufferer knows isn’t real
What is the most common form of pseudohallucination?
Auditory
What is pseudohallucinations usually seen in?
Mood disorders
What is depersonalisation?
Change of self-awareness- Might feel they’re not real/detached from their body
What can cause depersonalisation?
Healthy: tired, sensory deprivation, drugs
Anxiety
Schizophrenia
Temporal lobe epilepsy
What is derealisation?
Feel external environment has become unreal. Day dream like state
What can cause derealisation?
Healthy: tired, sensory deprivation, drugs
Anxiety
Schizophrenia
Temporal lobe epilepsy
What can sensory sensitivity be caused by?
Anxiety
Migraine
Why do you need to asses the cognitive state?
To differentiate from organic brain disorders eg. Delirium or dementia.
How do you test cognitive state?
Diffuse: orientation, attention, verbal memory, long term memory
How do you test orientation?
Time and place
What is consciousness?
Awareness of self and world around
What is delirium?
FLuctuating conciousness
How do you test attention?
Months backwards
How do you test verbal memory?
Repeat name and address with 10+ items in
How do you test long term memory?
Recall that morning’s news, favorite football team etc
What is amnesia?
Absence of memory
