Mental State Examination Flashcards
Components of exam mneumonic:
ASEPTIC?
What is an MSE?
Appearance and behaviour
Speech
Emotion (mood)
Perception
Thought
Insight
Cognition
An examination of the patient’s mental state at the time you see them.
Appearance and behaviour:
What to look out for in appearance? - 4
What to look for in behaviour? - 5
What comment can you use for someone who is healthy?
Overall impression Physical condition - overweight/underweight Suitability of dressing Cleanliness ---- Appropriateness of behaviour (e.g. aggressive, agitated, over-familiar) Eye contact Distractibility Abnormal involuntary movement Rapport -----
‘They were casually dressed, well-kept, calm and had good eye contact. Rapport was easily established.’
Appearance and behaviour -Abnormal Behaviour:
- What is too much? - 2
- What is too little? - 3
Disinhibition and overfamiliarity
Withdrawn
Poor eye contact
Poor rapport
Appearance and behaviour:
Signs of anxious behaviour?
- general
- hands
- feet
- the way they sit in chair?
Signs of depressed mood?
- posture
- eyes
- lips
- affect
Fidgeting, trembling Nail biting Shuffling feet Squirming in the chair Sits on edge of chair ----- Hunched, self hugged posture Little eye contact Downcast eyes - tears Biting or licking lips Slow thought, speech and movement -
Appearance and behaviour - abnormal movements:
What may cause motor slowing (psychomotor retardation? - 2
What is tardive dyskinesia and what may cause it? How does the person present?
Depression
Schizophrenia
Side effect of antipsychotics
Schizophrenia
Grimacing and movements of the tongue
Appearance and behaviour - abnormal movements:
What can cause parkinsonism’s such as a mask like appearance on their face?
What is Catatonia and what is it a sign of?
Side effect of antipsychotics - may also have reduced arm swing and stooping
Stuporous catatonia is characterized by immobility during which patients may show reduced responsiveness to the environment (stupor), rigid poses (posturing), an inability to speak (mutism), and waxy flexibility (in which they maintain positions after being placed in them by someone else).
Schizophrenia
Appearance and behaviour - Social behaviour:
- What is disinhibition?
- What is overfamiliarity?
A diminution or loss of the normal control exerted by the cerebral cortex, resulting in poorly controlled or poorly restrained emotions or actions. (Swearing in dementia)
Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
Speech:
What are you looking at in their speech? - 5
Comment for normal speech
Rate Quantity Volume Tone Articulation (smooth/dysarthria/stammer)
‘Speech is of a normal quantity, rate, volume and tone, and is fluent and smooth.’
Speech - Rate and quantity:
What is pressured speech and what patient is it seen in? - 2
Speech in depression - 2
Slowing of speech means…
What causes latency of speech?
What is circumstantiality & tangentiality?
Fast (high rate and quantity) and uninterruptible speech - Mania and schizophrenia
Low quantity and tone
Psychomotor slowing
Cognitive problems such as thought blocking, depression or thought disorders.
When the focus of a conversation drifts, but often comes back to the point – patient often derails, adding irrelevant details to the conversation - schizo
The tendency to speak about topics unrelated to the main topic of discussion - Schizophrenia
Speech - Content:
What are neologisms and what do the indicate?
What does incoherent speech mean?
What is echolalia and what causes this?
What is clanging associations and what causes it?
A newly coined word or expression made up by them - Seen in schizophrenia and neurological diseases
Disordered thoughts - hard to distinguish from disordered thoughts
Repeating words another person has spoken - schizophrenia and dementia
Grouping of words that are usually rhyming words even though they don’t have any logical reason to be grouped together. - Psychosis, bipolar disorder or schizophrenia.
Speech - Flow:
How does thought blocking present?
What is a ‘Knight’s move’ (flight of ideas) in psych?
Person stops speaking suddenly and without explanation in the middle of a sentence.
A complete loosening of associations where there is no logical link between one idea and the next - bipolar disorder
Emotion (Mood):
Depression - what may you see?
Anxiety - what may you see?
Suicidal
Tearful
Lethargy
Self-loathing, failure, worthlessness
Fearful
Restless
Obsessive
Irritable
Emotion (Mood):
What does grandiose mean in someone who is manic?
An unrealistic sense of superiority, characterized by a sustained view of one’s self as better than other people, which is expressed by disdainfully viewing them as inferior.
Emotion (Mood):
Define:
- Dysphoric
- Euphoric
- Euphoric
What is objective vs subjective?
Normal mood
Elevated mood
Low mood
What you observe vs what the patient tells you they feel
Emotion (Mood) - AFFECT:
3 ways to describe affect?
What does incongruous mean and think of an example?
What is labile mood?
What is flattening? Who does it happen in? - 2
Example for someone who is normal
Reactive
Blunted
Labile
Flat
A mismatch between experienced emotion and its expression - ‘they seem happy while describing traumatic events.’
Unstable display of emotion - happy one minute then sad the next
A severe reduction in emotional expressiveness - depression and schizo
“The patient was subjectively and objectively euphoric, with reactive affect”
