Mental State Examination Flashcards
What is the mental examination analogous to?
The physical examination
What are some features of a mental state examination?
Draws evidence to back up conclusions of history
Based on observation by doctor = objective assessment and technical description
Much of examination is done at same time as history
What are the contents of the mental state examination?
Appearance and behaviour, speech, affect and mood, thoughts, perception, cognition, insight
What are you looking for when assessing a patient’s appearance?
Age, gender, race, body habitus, grooming, attire, posture and gait, smell (alcohol, urine, vomit)
Odd movements = tics, tremors, mannerisms
Evidence of injuries/illness = self harm, abuse, fights, drug use (pupil size, bruising on arms)
What aspects of a patient’s behaviour are you looking for in a mental state examination?
Eye contact, rapport, agitation, psychomotor retardation, disinhibition, guarded, overfamiliarity
What aspects of speech would you be assessing?
Rate = abnormally fast or slow
Volume, variation in tone or speech delay
Amount = increased (pressured), decreased (monosyllabic, mute)
What are some features of mood?
Subjective = how is the patient feeling today
What is the affect?
Objective assessment = observation of how patient appears through the interview, often corresponds to mood
What are some features of a patient’s affect?
Consider where the baseline affect is (e.g low, anxious) and to what extent it varies (appropriately reactive, labile, unreactive, flattened)
What makes up someone’s cognitive function?
Orientation in time, place and person
Concentration (e.g do months of year backwards)
Memory and insight
What questions would assess a patient’s orientation in time, place and person?
What is the date today?
What time is it?
Where are we right now?
What is your name, age and date of birth?
What are the different types of memory?
Autobiographical = personal events Retrograde = past events (e.g things on news) Anterograde = new memories
How is a patient’s insight assessed?
Does the patient recognise that they are unwell?
Do they attribute symptoms to a mental health issue?
Do they accept the need for treatment?
What is a hallucination?
A perception which occurs in the absence of an external stimulus = experienced as originating in real space (not just in thoughts)
What are some features of hallucinations?
Same qualities as normal perception
Significant only in the context of other symptoms
Not subject to any conscious manipulation and can occur in any sensory modality
What happens in the brain when an auditory hallucination is taking place?
Pattern of brain activity very similar to that in normal volunteers generating inner speech except supplementary motor area and hippocampus activated
What are some examples of auditory hallucinations?
Second person voice which directly addresses patient
Third person voices which discuss the patient
Thought echo = patient experiences own thoughts spoken or repeated out loud
What are some features of visual hallucinations?
Often associated with altered consciousness
Simple = flashes of light
Complex = figures or faces
What are the types of hallucination?
Auditory, visual, olfactory, gustatory or somatic (bodily sensations)
What is passivity phenomena?
Behaviour experienced as being controlled by an external agency rather than by the individual
How can passivity phenomena affect thoughts?
Thought insertion, withdrawl or broadcasting
How is the brain affected by passivity phenomena?
Abnormalities in parietal and cingulate cortices on PET = these are involved in interpretation of sensory info, abnormalities may lead to internal actions being misinterpreted
What is thought disorder?
Disorder of form of thought = disturbance in organisation, control and processing of thought
What is the abnormality in thought disorder?
Abnormality is in the form of their speech rather than it’s content
What are some examples of thought disorder features?
Flight of ideas, loosening of associations and neologism
What occurs in flight of ideas?
Patient jumps from topic to topic but with recognisable links such as rhyming, punning or environmental distractions
How are words associated in flight of ideas?
Associated together inappropriately because of their meaning or rhyme = speech loses its aim and patient wanders far from original theme
What occurs in loosening of association?
Patient’s speech is muddled, illogical and difficult to follow = talks freely but so vaguely that no info is given in spite of number of words used
What kind of thinking occurs in loosening of association?
Knight’s move thinking = may be jumps from topic to topic with no logical connection between them
What is neologism?
Patient makes up new word/phrase or uses existing words in a bizarre way which has no generally accepted meaning but which have idiosyncratic meaning to patient
What are delusions?
false beliefs = inappropriate to patient’s sociocultural background, firmly held in face of evidence, not modified by reason
How are delusions identified?
By its form, but described by its content or theme
What are some common themes of delusions?
Disease, nihilism, poverty, sin, guilt = typical in depression
Control, persecution, reference, religion, love = typical in mania
Grandiosity, persecution, religion = typical in mania
