Metal State Examination Flashcards
What is the MSE and how can it be used
A summary of the clinicians observations and impressions of the client at the time of the interview. It can be highly descriptive and allow another clinician to develop a good impression of the client without being there. Can be used as a clinical measure of change over the course of treatment (though has subjectivity). There are some variations as to the components, Included hereafter are those most typical of an MSE.
Appearance
Apparent age Height Weight Dress – nonjudgmental descriptive terms Self-care/grooming – consider their hair, hygiene level, make-up, overall self-presentation Prominent characteristics Ethnicity
Behaviour
Eye-contact Psychomotor – agitation/retardation Gestures/ mannerisms Catatonic Abnormal Behaviour Attitude toward clinician Degree of cooperation Resistance (may be non-verbal, e.g., avoiding eye-contact)
Speech
Quality - volume, pitch/tone (e.g., highness or lowness) clarity Quantity - Rate Other speech abnormalities E.g., Witzelsucht; Poverty of Speech Note if client has hearing aid, or other indication of hearing problems
Mood
The predominant emotion of client; pervasive and sustained Primarily judged through self-report; but also through interpretation of consent Euthymic – Normal Elevated/Elated/Euphoric – happy/happier/happiest (possibly too much) Dysphoric - low, sad, dejected, miserable, depressed Apprehensive - Anxious, fearful, frightened, panicky, tense, worried Angry – frustrated, irritable, hostile Apathetic - having or showing little or no emotion
Affect
The external manifestation of person’s mood Usually variable over course of a session Type – generally same/similar as for mood Intensity – Flat, Blunted, Constricted, Reactive, Exaggerated Range – Restricted, Normal, Expansive, Labile Appropriate - to the content of speech or situation Congruent - matches the persons mood and behaviour
Perceptions
Hallucinations – perception that does not require external stimulus of the relevant sensory organ (5 senses) May be recognised as false sensory perception May be associated with delusional interpretation Illusions - misperceived or misinterpreted external stimulus Déjà vu & Jamais vu Depersonalisation & Derealisation Agnosia - the inability to recognise and interpret the significance of sensory impressions
Cognition
Level of consciousness Orientation - time, place, person Attention & Distractibility Concentration Memory
Thought 1
Thought Form – do thoughts flow logically and have structure? Formal Thought Disorder (FTD) - umbrella term, thoughts don’t follow each other logically, and/or hard to understand and follow structure Many types: Loosening of association; circumstantiality; tangentiality; Incoherence; Thought blocking & poverty of thought; Flight of ideas Thought Possession Thought Insertion/Withdrawal/Broadcasting
Thought 2
Thought Content Delusions - false personal belief based on inference about external reality & firmly held/sustained in spite of other evidence (others beliefs, proof against) Obsessions - undesired and unpleasant, recurrent or intrusive thoughts, feelings, ideas or sensations recognised by patients as unreasonable or unwarranted Phobias - persistent, irrational, exaggerated & pathological dread of some specific type of stimulus or situation Helplessness & Hopelessness Suicidality
Judgement
Ability to make rational plans of action Understanding of the implications of behaviour Able to compare and analyse implications rationally/logically Abulia – reduction in impulse to action and thought coupled with indifference or lack of concern about the consequences of action
Insight
3 aspects aware have illness aware of illness impact aware of benefit of treatment/assistance 6 levels denial impaired/limited/slight awareness external locus Awareness intellectual insight true insight
What are the areas assessed in the MSE
Appearance Behaviour Speech Mood Affect Perceptions Cognition Thought Judgement Insight
Using appropriate terminology outline 3 aspects of a client’s speech that you would be observing when undertaking a MSE.
For each aspect, indicate the term used and what it might indicate about their mental state.
Rate, Flow, Volume, Pitch
Quality - volume, pitch/tone (e.g., highness or lowness) clarity
Quantity - Rate Other speech abnormalities E.g., Witzelsucht; Poverty of Speech Note if client has hearing aid, or other indication of hearing problems
Could also indicate other abnormalities ie translating from second language, cultural or perhaps hearing voices etc
