Mental State Examination Flashcards
What are the components of the MSE?
Appearance and Behaviour Speech Emotions: Mood & Affect Perceptions Thought: Form, Content, Flow Insight Cognition
(“ASEPTIC”)
What is the mnemonic to remember the components of the MSE?
“ASEPTIC”
What do you look at in Appearance part of MSE?
Age, gender, ethnicity
Description of physical appearance
Dress: description related to circumstances
Self care: kempt/unkempt, cleanliness, odour
Anything striking, unusual, out of place
What do you look at in Behaviour part of MSE?
Appearance and Behaviour
Rapport, engagement, hostility
Eye contact: quality and quantity
Appropriateness of interaction
Movements/ postures/mannerisms
Psychomotor retardation or agitation
What do you look at in Speech part of MSE?
Volume
Tone
Rate and Rhythm
Fluidity, word finding difficulties, dysphasia, dysarthria, stutter/ stammer
Spontaneity/paucity/pressure
What is the difference between mood and affect?
Mood vs Affect: Climate vs Weather
What do you look at / find out in Emotion (mood and affect) part of MSE?
Apathy, Anhedonia, Anergia, Feeling sad…
Somatic symptoms
- sleep (EMW), appetite/ weight, diurnal variation
- Concentration, energy, libido, motivation, enjoyment /pleasure
Depressive cognitions:
- guilt/self blame/ rumination/ catastrophizing
- Poor self esteem
- Negative thoughts
- hopes/future plans
Suicide and DSH
What do you look at / find out in Perception part of MSE?
Illusion:
- sensory input that becomes augmented by the mind to become something else
Hallucination:
- sensory perception with no incoming actual stimuli
(auditory, visual, olfactory, gustatory, tactile/somatic)
Timing, associations, frequency
What types of auditory hallucinations might there be?
- 2nd person (“you are no good!”)
- 3rd person (“he/she/they are no good!”)
- Echo
- Running commentary
- Commanding
What do you look at / find out in Thoughts part of MSE?
A description of not only CONTENT of the mind
But also how the content is structured (its FORM) as well as it’s output (FLOW)
5 things that could be the content of thoughts?
- Preoccupations
- Obsessions/compulsions
- Worries/anxieties
- Overvalued ideas
- Delusions
What is a delusion and what types can there be?
“false, unshakeable belief that is out of keeping with the patient’s social and cultural background”
- Paranoid/ persecutory
- Grandiose
- Erotomanic
- Reference
- Control
- Religious
- Nihilistic
What different “Forms” can thoughts take?
Form: describes coherency and structure/organisation of information
- Incoherence ie word salad, aka schizaphasia
- Illogicality (non-sequitur – knights move)
- Derailment (loosening of association)
- Tangentiality (off point and irrelevant)
- Circumstantiality (finally gets there!)
- Thought block
- Thought paucity/poverty
- neologisms
- clanging
- stilted speech
What do you consider in thought “Flow”?
Rapidity of though thought process – seen in mania – loose association, as well as crowding of thoughts/ideas
Flight of ideas,
crowding, retardation, perseveration of thought
This is often lumped into the thought form.
What types of insight can there be?
Cognitive insight: eg “I have diagnosis X” often someone told them this…
Emotional insight: “my mental health means X to me”
Describes attitudes to treatment, and self-awareness of symptoms,