Mental State Examination

Question 1

What is the mental examination analogous to?

Answer 1

The physical examination

Question 2

What are some features of a mental state examination?

Answer 2

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

Question 3

What are the contents of the mental state examination?

Answer 3

Appearance and behaviour, speech, affect and mood, thoughts, perception, cognition, insight

Question 4

What are you looking for when assessing a patient’s appearance?

Answer 4

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)

Question 5

What aspects of a patient’s behaviour are you looking for in a mental state examination?

Answer 5

Eye contact, rapport, agitation, psychomotor retardation, disinhibition, guarded, overfamiliarity

Question 6

What aspects of speech would you be assessing?

Answer 6

Rate = abnormally fast or slow
Volume, variation in tone or speech delay
Amount = increased (pressured), decreased (monosyllabic, mute)

Question 7

What are some features of mood?

Answer 7

Subjective = how is the patient feeling today

Question 8

What is the affect?

Answer 8

Objective assessment = observation of how patient appears through the interview, often corresponds to mood

Question 9

What are some features of a patient’s affect?

Answer 9

Consider where the baseline affect is (e.g low, anxious) and to what extent it varies (appropriately reactive, labile, unreactive, flattened)

Question 10

What makes up someone’s cognitive function?

Answer 10

Orientation in time, place and person
Concentration (e.g do months of year backwards)
Memory and insight

Question 11

What questions would assess a patient’s orientation in time, place and person?

Answer 11

What is the date today?
What time is it?
Where are we right now?
What is your name, age and date of birth?

Question 12

What are the different types of memory?

Answer 12

Autobiographical = personal events
Retrograde = past events (e.g things on news)
Anterograde = new memories

Question 13

How is a patient’s insight assessed?

Answer 13

Does the patient recognise that they are unwell?
Do they attribute symptoms to a mental health issue?
Do they accept the need for treatment?

Question 14

What is a hallucination?

Answer 14

A perception which occurs in the absence of an external stimulus = experienced as originating in real space (not just in thoughts)

Question 15

What are some features of hallucinations?

Answer 15

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

Question 16

What happens in the brain when an auditory hallucination is taking place?

Answer 16

Pattern of brain activity very similar to that in normal volunteers generating inner speech except supplementary motor area and hippocampus activated

Question 17

What are some examples of auditory hallucinations?

Answer 17

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

Question 18

What are some features of visual hallucinations?

Answer 18

Often associated with altered consciousness
Simple = flashes of light
Complex = figures or faces

Question 19

What are the types of hallucination?

Answer 19

Auditory, visual, olfactory, gustatory or somatic (bodily sensations)

Question 20

What is passivity phenomena?

Answer 20

Behaviour experienced as being controlled by an external agency rather than by the individual

Question 21

How can passivity phenomena affect thoughts?

Answer 21

Thought insertion, withdrawl or broadcasting

Question 22

How is the brain affected by passivity phenomena?

Answer 22

Abnormalities in parietal and cingulate cortices on PET = these are involved in interpretation of sensory info, abnormalities may lead to internal actions being misinterpreted

Question 23

What is thought disorder?

Answer 23

Disorder of form of thought = disturbance in organisation, control and processing of thought

Question 24

What is the abnormality in thought disorder?

Answer 24

Abnormality is in the form of their speech rather than it’s content

Question 25

What are some examples of thought disorder features?

Answer 25

Flight of ideas, loosening of associations and neologism

Question 26

What occurs in flight of ideas?

Answer 26

Patient jumps from topic to topic but with recognisable links such as rhyming, punning or environmental distractions

Question 27

How are words associated in flight of ideas?

Answer 27

Associated together inappropriately because of their meaning or rhyme = speech loses its aim and patient wanders far from original theme

Question 28

What occurs in loosening of association?

Answer 28

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

Question 29

What kind of thinking occurs in loosening of association?

Answer 29

Knight’s move thinking = may be jumps from topic to topic with no logical connection between them

Question 30

What is neologism?

Answer 30

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

Question 31

What are delusions?

Answer 31

false beliefs = inappropriate to patient’s sociocultural background, firmly held in face of evidence, not modified by reason

Question 32

How are delusions identified?

Answer 32

By its form, but described by its content or theme

Question 33

What are some common themes of delusions?

Answer 33

Disease, nihilism, poverty, sin, guilt = typical in depression
Control, persecution, reference, religion, love = typical in mania
Grandiosity, persecution, religion = typical in mania