Mental State Examination Flashcards
Which disorders are included under anxiety?
- Panic disorder
- Agoraphobia
- Specific phobias
- GAD
- OCD
What are the symptoms of panic disorder?
- Recurrent panic attacks
- Autonomic: palpitations, tremor, sweating, chest pain, nausea
- Psychological: derealisation/depersonalisation, fear of losing control, dying
- Not secondary
- Persistent worry about another attack
- Phobic avoidance
What are the symptoms of agoraphobia?
- Anxiety + panic symptoms associated with places or situations
- Avoidance
What are the symptoms of specific phobias?
- Recurrent/excessive/unreasonable symptoms of anxiety - autonomic, psychological
- Anticipated presence of specific feared object/activity
What are the symptoms of GAD?
- Excessive worry - generalised, free-floating, persistant anxiety
- Apprehension about everyday events/persistent anxiety
- Muscle + psychic tension
- Significant distress/functional impairment
What are the symptoms of OCD?
- Obsessions
- Compulsions
Which disorders are included in mood disorders?
- Depressive episode
- Manic/hypomanic episode
- Bipolar
What are the symptoms of depression?
- Core symptoms: depressed mood, anergia, anhedonia
- Biological symptoms - disturbed sleep, diminished appetite, reduced concentration
- Psychological symptoms: reduced self esteem, self confidence, guilt/unworthiness, bleak view future, ideas/acts self harm/suicide
What is the ICD classification of depression?
- Mild: 2 core + 2 others - not intense - 2w
- Mod: 2 core + 3-1 others - intense
- Severe: 3 core + 2 others - severe intensity - <2w +/- psychosis
What are the symptoms of a manic episode?
- Abnormally + persistently elevated/expansive/irritable mood with 3+ symptoms - 1w - sig impairment functioning
- Increased energy (overactivity reduced sleep)
- FTD (pressures speech, flight of ideas)
- Reduced attention
- Consequential behaviours (schemes, spending, sexual encounter)
- Psychotic symptoms
What are the symptoms of a hypomanic episode?
- 3 + symptoms over 4 days
- Not severe enough to interfere with social/occupational functioning, require admission to hospital, include psychotic features
What is bipolar affective disorder?
- 2+ episodes (one which must be manic/hypomanic or mixed)
- Complete recovery between episodes
What are the 2 classification of bipolar affective disorder?
- BPAD 1 : mania + depressive episodes
- BPAD 2 : hypomania + depressive episodes (suicide more common as depressive episodes more severe)
What disorders are included under psychotic disorders?
- Schizophrenia
- Delusional disorder
What are the symptoms of schizophrenia?
At least 1 of:
- thought echo/insertion/withdrawal/broadcast
- delusions of control/passivity + delusional perception
- auditory hallucinations (3rd person, running commentary)
- implausible delusions
At least 2 of:
- persistent hallucination with non-affective delusions
- breaks in train or thought
- catatonic behaviour
- apathy/blunting
- loss of interest/ social withdrawal
At least 1 month
Positive + negative symptoms
What are the symptoms of delusional disorder?
- Non-bizarre delusions
- No hallucinations/ thought disorder/ mood disorder/ flattening of affect
- Present for 1 m +
What are some abnormalities of movement?
- Agitation, retardation, stupor
- Mannerisms vs stereotypy
- Tics - motor vs vocal
- Dystonia - spasm
- Akathisia
- Myoclonus
- Chorea
What do you assess in mental state examinations?
- Appearance
- Speech
- Mood
- Thoughts
- Perceptions
- Cognition
- Insight
How can you assess a patients speech?
- Form vs content
- Amount
- Rate
- Volume
- Tone
- Neologism
- Logoclonia, echolalia, palilalia
How can you assess a patients mood?
- Mood (emotional state) - apathy
- Affect (behaviour associated with changing emotions) - blunted, labile, emotional incontinence, incongruous affect
- Climate vs weather
How can you assess a patients thoughts?
- Stream - pressure, poverty, thought block
- Form - flight of ideas, loosening of associations, over-inclusive, circumstantiality vs tangentiality, derailment
- Content - phobias, ruminations, obsessional thoughts
- Delusions - fixed belief, primary, secondary, systematised
- Main delusions - persecution, control, misidentification, grandeur, religion, guilt, nihilism, jealousy/love, somatic
- Thought insertion/ withdrawal/ broadcast
- Thought of harm to self or others
How can you assess a patients perceptions?
- Secondary distortion
- Depersonalisation/derealisation
- Illusion
- Hallucination
- Auditory
- Visual - lilliputian, charles bonnet syndrome
- Olfactory, gustatory, tactile
- Hypnopompic/hypnogogic
- Extra Campine = outside limits of sensory field - voices from Antarctica
- Functional vs reflex
How can you assess a patients cognition?
- Orientation - time, place, person
- Memory
- Formal cognitive assessment
How can you assess a patients insight?
- Awareness if phenomena observed by others
- Recognition of this as abnormal
- Accepting cause = mental illness
- Need for treatment
