Mental state examination Flashcards
DDx for psychotic episode
- Organic psychosis e.g. NMDA encephalitis
- Drug induced psychosis
- Schizophrenia
- Schizoaffective disorder
- Manic psychosis
- Severe depressive episode with psychosis
subtypes of schizophrenia
- Paranoid
- Hebephrenic
- Simple
- Catatonic
- Residual
- Undifferentiated
what are schneider’s 1st rank symptoms
• Delusional perception
• 3rd person auditory hallucinations
o Discussing patient
o Commenting on patient’s actions
• Thought echo
• Thought insertion, withdrawal, or broadcast
• Passivity- feeling controlled by someone else
o Movement, sensation, emotion, or thought
examples of positive symptoms
- Hallucinations
- Delusions
- Disorder of the form of thought- presents as speech coherence
- Disorder of though possession- content of their thoughts
- Passivity experiences- this symptom alone is enough for a diagnosis of schizophrenia
- Ideas of reference- people in the media are making direct reference to them
examples of negative symptoms
- Anhedonia, inability to experience pleasure
- Alogia, poverty of speech
- Affective blunting, flat or non-reactive affect
- Avolition, lack of drive
- Generically referred to as “social decline”
components of a psychiatric assessment
- Full psychiatric history
- Mental state examination
- Risk assessment
- Collateral history/ physical examination/ investigations
- Formulation
- Diagnosis
- Management
things to consider in a psychiatric history
- Timeline of events leading to presentation
- Triggers/stressors
- Impact on daily life
- Review of current psychiatric symptoms- enquiry about recent/current symptoms of psychosis leading to presentation
- Circumstances of referral/presenting complaint
- Alcohol and drug use
- Personal history- early development, education, occupation, sexual relationships, pre-morbid personality forensic history
components of a MSE
- Appearance
- Behaviour
- Speech
- Mood and affect
- Thought: form, content, ownership
- Perceptions
- Cognitive function
- Insight
things to explore under appearance
- Ethnicity
- Apparent age
- Gender
- Clothing cleanliness, physical condition, appropriate?
- Dishevelled or unkempt
- Posture
- Distinguishing marks/scars
things to consider under behaviour
• Eye contact and rapport
• Body language
• Psychomotor activity
• Abnormal movements
• Social manner
o Odd, aggressive, agitate, elated, appropriate (or not)
o Withdrawn, guarded, pre-occupied or perplexed
o Overemotional, dramatic, confrontational
o Alert, cooperative, distractible
• Distractibility- appearing to respond to unseen stimuli?
things to consider under speech
- Rate
- Volume
- Tone
- Intonation
- Spontaneity, hesitation, pauses
- Strange words, clanging or punning
- Note samples of their own speech
thinsg to consider under mood and aspect
• Subjective mood o Ideally in patients own words o Low or high mood o Anxiety, irritable] o Ask for a quantifier 1-10 • Objective mood o What you observe o Intensity, congruence, appropriateness o Note evidence of anxiety and panic • Affect o How they respond during the interview o Labile, reactive, blunted, flat
what to consider under thought form?
• Abnormality of the form of the thought is observed from the patients speech
• Loss of logical association between ideas
• Abnormal flow of thoughts
• Mania
o Racing thoughts, flight of ideas punning and clag associations
• Depression
o Poverty of speech, hesitations, pauses
• Schizophrenia
o Loosening of associations, tangentiality, circumstantial, knights move thinking
o Thought block
things to consider under thought content
• Delusions
o Fixed, unshakable belief despite evidence to the contrary
o Not in context of family, cultural, nationality, religious, social belief
• Other considerations in thought content
o Preoccupations
o Ruminations, worries, anxieties and phobias, overvalued ideas
o Obsessions
o Thoughts of self-harm or suicide (if not covered in mood)
o Thoughts of harming others
what to consider under cognition
alertness
orientation
attention
memory
