Mental State Examination (MSE) Flashcards
Define alexithymia
An ability to verbally express one’s emotions
Define aphasia
No speech, an inability to produce words orally
Define thought insertion
The subject experiences thoughts which are not their own intruding into their mind.
Often said to have been inserted by means of radar telepathy or some other means.
Define flight of ideas
Rapid flow of thought, manifested by accelerated speech with abrupt changes, from topic to topic although there is often some form of link between topics.
There is loss of the normal structure of thought, appearing illogical or muddled.
Often seen in manic patients.
Define 2ary person auditory hallucinations
The subject hears voices which appear to talk to them DIRECTLY.
E.g. ‘you’re going to die, you’re going to die’
What are the stages of the MSE?
Appearance
Behaviour
Speech
Mood & Affect
Thought
Perception
Cognition
Insight & Judgement
Risk
What aspects can you look for in ‘appearance’?
- Distinguishing features: these may include scars (e.g. self-harm), tattoos and signs of intravenous drug use.
- Weight: note if they appear significantly underweight or overweight.
- Stigmata of disease: note any stigmata of disease (e.g. jaundice).
- Personal hygiene: this can provide insight into the patient’s current ability to care for themselves.
- Clothing: note if this is appropriate for the weather/circumstances and if the clothes have been put on correctly.
- Objects: look around to see if the patient has brought any objects with them and note what they are.
What aspects can you look for in ‘behaviour’?
Engagement & Rapport
- Note if patient appears engaged in consultation and if you are able to develop a rapport with them
- Note if they appear distracted or appear to be engaging with hallucinations (e.g. replying to auditory hallucinations in schizophrenia)
Eye Contact
* Observe patient’s level of eye contact
Facial Expression
Body Language
* Observe patient’s body language which may appear threatening (e.g. standing up close to you) or withdrawn (e.g. curled up or hands covering their face)
* Any evidence of exaggerated gesticulation or unusual mannerisms?
Psychomotor Activity
* Observe for any evidence of psychomotor abnormalities e.g. psychomotor retardation, restlessness
Abnormal Movements or Postures
What is psychomotor retardation?
Psychomotor retardation is the slowing down or hampering of your mental or physical activities.
Manifestations include slowed speech, decreased movement, and impaired cognitive function.
What aspects of ‘speech’ can be assessed?
Rate
Tone
Quantity
Volume
Fluency & rhythm
Define pressure of speech
A tendency to speak rapidly, motivated by an urgency that may not be apparent to the listener (often a manifestation of thought abnormalities such as flight of ideas, which is described later in the article).
What is psychomotor retardation typically associated with?
Typically associated with major depression.
What may slow speech indicate?
may occur due to psychomotor retardation which is typically associated with major depression.
What may excessive speech indicate?
associated with mania and schizophrenia.
What would a monotonous tone of speech indicate?
associated with conditions such as depression, schizophrenia and autism.
What would tremulous tone of speech indicate?
associated with anxiety.
What would slurred speech indicate?
May occur in major depression due to psychomotor retardation.
Drugs or alcohol.
Define mood
Represents a patient’s predominant subjective internal state at any one time as described by them i.e. what the patient tells you (‘season’ or ‘climate’)
Define affect
Represents an immediately expressed and observed emotion (e.g. the patient’s facial expression or overall demeanour) i.e. what you observe (‘day’ or ‘weather’)
What is a congruent mood?
A mood appropriate to the circumstances
What is a reactive mood?
If their mood changes according to subject matter
What is a labile mood?
Labile mood refers to exaggerated or strong changes in emotion.
What is a fixed affect?
patient’s affect remains the same throughout the interview, regardless of the topicW
What is a restricted affect?
Patient’s affect changes slightly throughout the interview, but doesn’t demonstrate the normal range of emotional expression that would be expected
What is a labile affect?
characterised by exaggerated changes in emotion which may or may not relate to external triggers (patients typically feel they have no control over their emotions)
What is heightened affect associated with?
mania and some personality disorders
What is a blunted or flat affect associated with?
associated with schizophrenia, depression and PTSD
What is congruency of affect?
o If patient’s affect appears in keeping with content of their thoughts
o A patient sharing distressing thoughts whilst demonstrating a flat affect of laughing would be described as showing an incongruent affect (typically associated with schizophrenia)
What is thought disorder?
An abnormality in the mechanism of thinking
To the observer, their speech doesn’t make sense
What does thought form relate to?
Refers to the processing and organisation of thoughts.
Define loose associations
Moving rapidly from one topic to another with no apparent connection between topics
Define circumstantial thoughts
Thoughts which include lots of irrelevant and unnecessary details, can go round in circles
Define tangential thoughts
digressions from main conversation subject, introducing thoughts that seem unrelated, oblique, and irrelevant
Define flight of ideas
accelerated tempo of speech (‘pressure of speech’)
Define thought blocking
sudden cessation of thought, typically mid-sentence, with the patient being unable to recover what was previously said
Define perseveration
repetition of a particular response (word, phrase or gesture) despite the absence/removal of the stimulus (e.g. a patient is asked what their name is, and they then continue to repeat their name as the answer to all further questions)
What condition is perservation often seen in?
Dementia
Define neologisms
words a patient has made up which are unintelligible to another person
Define illogicality
thoughts don’t make sense
Define crowding of thought
too many words
Define concrete thoughts
take meanings and metaphors literally
What 3 terms can thought be described in?
- Form
- Content
- Processing
What can be assessed in ‘thought content’ in an MSE?
- Pre-occupations
- Delusions
- Obsessions
- Compulsions
- Overvalued ideas
- Phobias
- Suicidal thoughts
- Homocidal/violent thoughts
What is a delusion?
A firm, fixed belief based on inadequate grounds, not amenable to a rational argument or evidence to the contrary
E.g. patient erroneously believes another individual/group is trying to harm them or individual incorrectly believes specific events relate to them.
what is a persecutory delusion?
People with this type of delusional disorder believe someone or something is mistreating, spying on or attempting to harm them (or someone close to them). People with this type of delusional disorder may make repeated complaints to legal authorities
what is a grandiose delusion?
Grandiose delusions are unfounded or inaccurate beliefs that one has special powers, wealth, mission, or identity.
What is a nihilistic delusion?
The delusional belief of being dead, decomposed or annihilated, having lost one’s own internal organs or even not existing entirely as a human being.
What is a delusion of passivity?
delusion of control. delusion of being controlled, a delusion in which one experiences one’s feelings, impulses, thoughts, or actions as not one’s own, but as being imposed on by some external force
What is an obsession?
Thoughts, images, impulses that occur repeatedly and feel out of the person’s control
Patient is AWARE these are irrational but unable to control thoughts
Question –> Are there any thoughts that you have a hard time getting out of your head?
What is a compulsion?
repetitive BEHAVIOURS that the patient feels compelled to perform despite RECOGNISING irrationality of behaviour
Question –> Do you sometimes feel the need to perform certain behaviours repetitively, despite understanding these are irrational?
What is an overvalued idea?
A solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the sufferer’s life (e.g. the perception of being overweight in a patient with anorexia nervosa)
Give 3 examples of problems with thought possession
- Thought insertion
- Thought withdrawal
- Thought broadcasting
Define thought insertion
a belief that thoughts can be inserted into the patient’s mind
Question –> Do you ever think people can put ideas in your head, without your control?
Define thought withdrawal
a belief that thoughts can be removed from the patient’s mind
Question –> Have you ever felt like people have removed memories or thoughts from your mind?
Define thought broadcasting
a belief that others can hear the patient’s thoughts
Question –> Do you ever feel like others can hear what you’re thinking?
What does ‘perception’ refer to in an MSE?
Perception involves the organisation, identification, and interpretation of sensory information to understand the world around us.
Define a hallucination
a sensory perception WITHOUT any external stimulation of the relevant sense that the patient believes is real
Define a pseudo-hallucination
the same as a hallucination but the patient is AWARE that it is not real
Define an illusion
the misinterpretation of an EXTERNAL stimulus (e.g. mistaking a shadow for a person)
Define depersonalisation
the patient feels that they are no longer their ‘true’ self and are someone different or strange
Define derealisation
a sense that the world around them is not a true reality
What is ‘cognition’?
The mental act or process of acquiring knowledge and understanding through thought, experience, and the senses
Cognition can be impaired due to mental health conditions and their treatments.
Examples of how you can assess a patient’s cognitive performance:
- whether they are orientated in time, place and person
- what their attention span and concentration levels are like
- what their short-term memory is like
If you are concerned with a patient’s cognition, what should you do?
Perform a formal assessment of cognition that can be achieved through a variety of different validated clinical tests, including:
- Mini-mental state exam (MMSE)
- Abbreviated mental test score (AMTS)
- Addenbrooke’s cognitive examination III (ACE-III)
- Montreal Cognitive Assessment (MOCA)
Define ‘insight’ in an MSE
Insight, in a mental state examination context, refers to the ability of a patient to understand that they have a mental health problem and that what they’re experiencing is abnormal.
Questions:
* “What do you think the cause of the problem is?”
* “Do you think you have a problem at the moment?”
* “Do you feel you need help with your problem?”
Define ‘judgement’ in an MSE
Judgement refers to the ability to make considered decisions or come to a sensible conclusion when presented with information.
