MSE Flashcards
What is the main headings of the MSE
Appearance
Behaviour
Rapport
Physical issues
Mood
Affect
Speech
Thought form
Thought Content
Perceptual disturbances
Orientation/Cognition
Insight and Judgement
Risk
How to describe appearance with example of things to talk about
Appearance is a general impression of everything you see - objective if family reading it
- Grooming & personal hygiene
- Apparent age of client (cf. chronological age)
- Attire own clothing? Hospital gown? appropriate for the weather ?
- Distinguishing features
- level of consciousness (alert, sedated, etc)
- condition of living environment (eg. cleanliness, contents of fridge)
XXyo F/M appears …
dressed in… clothing. interview took place in the..
How to describe behaviour with example of things to talk about
- Eye contact
- Acute distress/ distraction
- Level of co-operation/engagement with assessment eg. quality of information provided (eg. reliable, vague, inconsistent …)
- interaction between clients and family/caregiver
pt was (able) to maintain good eye contact, appeared “distracted/distressed’ throughout the assessment
What is involved in describing rapport, + example
Rapport is the attitude to the interview and to the interviewer
- Quality of the rapport built – process of establishing and maintaining
- ?superficial / patient guarded
“Rapport was easy/difficult to establish, pt appeared …”
Oppositional, agitated aggressive,
dismissive,
suspicious
flirtatious, overfriendly,
What is involved in describing motor issues + example
Any pain, abnormal movements, psychomotor retardation/agitation
- Signs of extrapyramidal side effects from long term antipsychotic use
= tremor, bradykinesia, cogwheel rigidity, paratonia, dystonia (in group of muscles) - akathisia : motor restlessness SE of neuroleptic meds
- Catatonic behaviours - motor immobility (catalepsy), purposeless agitation, extreme negativism (motiveless resistance to instructions), mutism, posturing, stereotyped movements, echolalia or echopraxia.
- disinhibited behaviours
- regressed behaviour - psychosocially less mature
- psychomotor retardation: slowing of body movements secondary to psychic dysfunction
- Bruxisims - meth intoxication
- Complex partial seizure - lip smacking
- Tics: abnormal sudden repetitive stereotyped jerky movements
- Tremors,
- athetoid movements - snake like
“Patient exhibited .. movements at times
What is involved in describing mood + example
Use the patients own words, comment on change of mood throughout meeting
The patient reported mood as.. and objectively appeared (first part of affect)
- Euthymic : calm / fine
- Hyperthymic -high energy, talkative agitated , irritable,
- Dysphoric: despondent, distraught, hopeless
- apathetic: flat
- Euphoric : happy , cheerful
- Elevated:
- Angry: hostile, oppositional, irritable
- apprehensive: anxious, fearful, tense, overwhelmed
- if pt can’t describe their mood at all (alexithymia) then record ‘ the pt objective mood was…
Can use a scale if successive meetings
What is involved in describing affect + example
The qualities of the external manifestation of persons mood
- Congruency –matching behaviour/thought to mood display
eg. appropriate/ congruent - Intensity – (Normal), blunted, exaggerated, flat. overly dramatic
- Mobility – labile, fixed, immobile, constricted
- Range – restricted, expansive, or full (normal)
- Reactivity – change in affect in response to external stimuli (eg. emotional cues from interviewer) - sluggish? delayed, reactive/ non reactive
“Affect appropriate/ incongruent to mood, reactive with restricted/full range demonstrated “
What is involved in describing speech + example
Speech : commenting on the The quality of spontaneous speech
- Rate: Normal, slow or rapid
- Rhythm
- Tone/ Prosody and volume
- Fluency (non-fluent speech features reduced phrase length, gaps)
- Quantity
– Spontaneity - question answer latency
– Comprehension – how well the client your
speech
- Stuttering, word finding difficulties, paraphasia, aphasia
“Pt speech was quiet and slow, with question answer latency, lacking prosody
rapid, loud, increased amount, difficult to interrupt (referred to
as “pressured speech”)
limited amount, word-finding difficulties, non-fluent,
lacking substantive content, comprehension problems
What is involved in describing thought form + example
THOUGHT FORM is how thoughts formulated, organised and expressed
Normal
* Linear, goal oriented, on task
Problems with attaining goal :
* Circumstantial
* Tangential
Problems with connections between thoughts
*tangential association : not fully connected but some logical linkage
* Flight of ideas -every 1-2 sentences tangential associations
* derailment - no apparent connection between words
*word salad - no connection between words
* incoherent - no connection between sounds
Others
* Perseveration - same response to different stimuli
* Thought blocking (loss midsentence with pause) no recollection
Neologisms
clang - associating similar sounding words
“Pt thought form was linear and goal directed
What do you describe in thought content (in general) + example
- Delusions
- Bizarre vs non bizarre (based on truth)
- fixed, perseverate, ruminate
- distressing, influencing behaviour ?
- inconsistent with client’s background (new beliefs?)
New delusions
- overvalued ideas, magical thinking
Intrusive thoughts
- obsessions (cannot be suppressed)
- preoccupation
Phobias - dread
As per history, thought content included delusions with themes of … . These are distressing/fixed
List the different types of delusions ; define delusion
Paranoid
- Persecutory
- Grandeur
- Reference (media referring)
-Guilt
A person is located elsewhere
- capgras (imposter as familiar person)
- fregoli (strangers identified as a familiar person)
Control
- Passivity : person externally controlled
- Thought broadcasting : others can hear
- Mind reading
- Thought insertion
- Thought withdrawal
Relationship
- Erotomania - another person in love with pt
- Jealousy - unfaithful
poverty, nihilistic,
somatic - illness
What do you describe in perceptual disturbance (in general) + example
Perceptions of perceptions : Not always abnormal
– Hallucinations: perceiving something that isn’t there, most commonly affecting
visual and hearing senses
– Illusions: an exaggeration/distortion of an actual physical stimulus (eg. seeing a
face in the leaves of a tree that isn’t apparent to others)
- tactile (drug withdrawal)
Temporal lobe epilepsy
– Depersonalisation: feeling that self/body is unreal/unfamiliar
– Derealisation: feeling that world is unreal
– Déjà vu: perception of previously seeing or living in situation
– Jamais vu: perception that something familiar is strange/novel
- olfactory
“Not responding to non-apparent stimuli”
Otherwise record if hallucinations
- continuous or intermittent?
* distressing?
* affecting the person’s behaviour?
* (in the case of auditory hallucinations)
commanding (i.e. telling person what to do) or
derogatory?]
What do you describe in orientation / cognition
(in general) + example
ACE 3 or MOCA
Not formally assessed but can comment
- Alertness
- Orientation
- Attention and Concentration
- Memory
Can they think in abstract way?
can they inhibit responses
What do you describe in Insight &judgement + example
Insight -does patient know whats going on - in regards to illness, treatment adherence, psychotic experiences
- Insight generally partial unless demented
Judgement - is patient able to synthesise and weigh factors drawing a conclusion (past , present and future)
- Used mainly as relapse risk rather than illness severity
“Insight & Judgement - as it pertains to ….. Adherence to treatment, reason for being in hospital, substance abuse.. “
What do you describe in risk + example
Record any risks below elicited in assessment
Risks relating to suicide / DSH
- passive death wish
-suicidal ideation,
Risk relating to harming others (homicidal ideation)
Risk to reputation
Risk to self - unable to perform self cares
Quantify
- frequency of suicidal thoughts, methods of self harm
- degree of planning and preparation
- degree of intent
- protective factors
