Mental State Examination Flashcards
Name the components of MSE [6]
- Appearance and behaviour
- Mood and affect
- Thought (form and content) and speech
- Perception
- Cognition
- Insight and Judgement
How would you describe someone’s appearance and behaviour? [10]
Use adjectives.
- Appearance:
- build, posture, dress, grooming, prominent physical abnormalities
- Rapport:
- established or not
- Level of alertness:
- drowsy or alert
- Attitude:
- co-operative/aggressive/abusive
- Eye contact:
- poor/good/intense
- Psychomotor activity:
- retardation/agitation
- Movements:
- tremor/abnormal movements
- Other signs
- mannerisms → odd purposeful movements
- stereotypes → non-goal directed movements
- tics → sudden involuntary movements.
What is the difference between mood and affect? [2]
- Mood:
- pervasive subjective feeling state that is communicated by the patient (climate)
- Affect
- objective and less pervasive (weather)
- Congruence of affect
- Reactivity of affect
- Range of reactivity
- Stability of affect
- objective and less pervasive (weather)
What are the common abnormalities that alter a person’s mood and affect? [3]
- schizophrenia
- mania
- major depressive disorder
How would you describe the mood and affect in a patient with schizophrenia? [3]
- incongruent
- blunt
- restricted
How would you describe the mood and affect in a patient with mania? [4]
- euphoric
- ecstatic
- expansive
- labile
How would you describe the mood and affect in a patient with major depressive disorder? [3]
- sad
- low
- restricted
What features of speech and language would you observe and record? [4]
-
quantity
- talkative/spontaneous/expansive/paucity/poverty
-
rate
- fast/slow/normal/pressured
-
volume (tone)
- loud/soft/monotone/weak/strong
-
fluency and rhythm
- slurred/clear/with appropriately placed inflections/hesitant/with good articulation/aphasic
How would you describe the following aspects of thought and speech in a manic patient:
- form? [1]
- content? [1]
- stream and flow? [1]
- possession? [1]
- flight of ideas
- delusions of grandeur
- pressure of speech
- the patient’s own thoughts
Define flight of ideas and what type of patient can it be seen in? [2]
- accelerated thinking that results in rapid speech, moving from one topic to another and reflecting causal associations between ideas (which may be linked, e.g. by puns or rhymes)
- occurs in manic/hypomanic illness and attention-deficit/hyperactivity disorder
What is loosening of association and in what condition is it seen in? [2]
- form of formal thought disorder in which the linkage of the person’s train of thoughts gets lost or disrupted
- seen in psychosis
Describe the 3 disorders of thought flow [3]
-
Retardation of thinking:
- train is slowed down,
- long latency,
- increased pauses
-
Pressure of speech:
- excessive thoughts
- rapid voluminous speech
-
Perseveration:
- the response continues even if the stimulus has changed
What is the difference between overvalued ideas and delusions? [2]
- Overvalued ideas
- something that individuals are thinking about a lot
- an idea that is held with increased importance but IS shakeable
- individuals have some insight into the fact that this idea is being overvalued
- Delusions
- false fixed firm belief
- held in spite of evidence to the contrary
- not in keeping with cultural and educational setting
Name the types of delusions [6]
- Delusions of persecution
- Delusions of reference
- Delusions of grandeur
- Nihilistic delusions
- Hypochondriacal delusions
- Delusions of jealousy
What are obsessions? [4]
- Recurrent and persistent ideas, thoughts, impulses, or images
- intrusive
- cause marked anxiety/distress
- Attempts to ignore or suppress unsuccessful
- Recognised as own thoughts
- Usually ego-dystonic
What are compulsions and what do they aim to do? [3]
- Repetitive behaviours or mental acts driven to perform or in response to an obsession
- Aimed at
- preventing or reducing distress
- preventing some dreaded event or situation
Define perception [1]
- reception and processing of sensory information
- visual
- auditory
- tactile
- gustatory
- olfactory
Describe the features of the 2 types of hallucinations:
- true hallucinations? [7]
- pseudo-hallucinations [6]
-
True Hallucinations
- objective, outside spatial location
- experienced as a sensation - same quality as normal perception
- same object could be experienced in another sensory modality
- takes place at the same time as other perceptions
- takes place in the same space as other percept
- involuntary/absence of insight
- usually in psychosis
-
Pseudo-hallucinations
- located in subjective space
- perceived with inner eye (or ear)
- involuntary
- not the same quality as normal perception
- insight is often present
- more common in personality disorders
- located in subjective space
What are the 4 types of auditory hallucinations? [4]
- Elementary
- when a person hears voices or noises
- First person
- Second person
- when they hear a person talking to them, which may be a derogatory voice
- Third person
- when they hear two people talking about them
What are the 3 types of visual hallucinations? [3]
- Lilliputian
- Charles Bonnet Syndrome
- Hypnogogic and hypnopompic (can be normal)
Define cognition and what features of cognition are assessed? [6]
- how we take in information, process it and use it in our daily activities
- attention
- orientation (to time/person/place)
- memory
- executive function
- language and praxis
How do you assess orientation (as part of cognition exam)? [3]
- Time:
- day, date, season, month, year
- Place:
- place, building, floor, country
- Person:
- identify people
How do you assess attention (as part of cognition exam)? [3]
- serial 7 test
- days of week backwards
- WORLD backwards
How do you assess memory (as part of cognition exam)? [3]
- registration - 3 words (apple/table/penny)
- recall after 5 minutes
- digit span - forwards and backwards
