MSE Flashcards
All Sane Men Think That Pizza Is Italian
Appearance & Behaviour Speech Mood & Affect Thought disorder Though content Perceptions Insight IQ/Cogntiion SUCIDE RISK
Appearance
Physical state: Age (= chronological age?) Gender? Physically unwell? Level of consciousness?
Clothing & accessories: Attire? Cleanliness? Grooming? Matching? Appropriate to weather & circumstances? Carrying strange objects?
Behaviour
Posture/facial appearance? Eye contact & rapport? Striking or bizarre features? Friendly, alert, suspicious, hostile? Awareness? Peculiarities e.g. tics, mannerisms, compulsions Inappropriate behaviour? Maturity?
Psychomotor abnormalities:
retardation & agitation?
EPD side effects?
Speech
Rate? (pressured in mania, long pauses & poverty of speech in depression), fragmented/single-word (SZ)
Flow? (spontaneous or in response to questions, retarded, dysarthia - articulation difficulties
Form? (coherent/incoherant - i.e. evidence of formal thought disorder, neologisms - schizophrenia
Clang associations - rhyming or similarly rhyming words
Mood/Affect
Subjective: How does patient describe their mood?
Objective: How do they appear to you?
Labile mood: fluctuating mood (e.g. mania)
Mood congruent
Depressed, elated, anxious, guilty, frightened, angry etc.
Affect: Incongrous affect (e.g. SZ) Blunted affect Flat affect (e.g. SZ) Reactive
Though form?
Was it easy to gather information?
Did the patient speak spontaneously?
What did he/she talk about?
How smoothly did the ideas flow from one to another?
Did the patient answer the questions directly?
Were questions repeated and rephrased?
Was conversation direct and informative or confusing and vague?
Loosening of associations (schizophrenia)
Flight of ideas (mania)
Tangentiality - lack of focus that never comes back to original topic
Circumstantiality/over inclusive - lack of focus that comes back to original point
Illogicality
Neologisms
Thought block
Perseveration - persistant repetition of words/phrase they have previously expressed (associated with Parkinson’s)
Concrete thinking - literal thinking that is focused on the physical world.
Echolalia - senseless repetition of words/phrases that have been spoken near them
Crowding of thought
Though insertion, withdrawal, broadcast, echo
- FTD
Thought content
Pre-occupations
Phobias
Obsession & Compulsions
Negative cognitions: guilt (past), helplessness & worthlessness (present), hopelessness (future)
Delusions:
Persecutory - harmed, threatened, cheated, harassed, or victimised
Grandiose
Nihilistic - oneself, others or the world is non-existent or about to end
Control/passivity - one thought’s, feelings, actions are controlled or made by external agent.
Though insertion, withdrawal, broadcast, echo
Risk assessment
Have you felt that life is not worth living? Have you wished you could die? Have you thought about ending your life? ”
Have you though about harming yourself?
Have you though about harming anyone else?
“Have you considered any ways in which you could end your life? Have you any plans to end your life? Do you want to kill yourself?”
Perceptions
Hallucinations: auditory, visual, olfactory, tactile, gustatory, somatic
Illusions - misperception of a real external stimulus
Déjà vu (jamais vu)
Depersonalisation
Derealisation
Schneider’s First Rank Symptoms (11 of them)
Insight?
Is the patient aware of phenomena or symptoms that other people have observed?
Does the patient think they are ill?
What is the cause (mental, physical or social)?
Do they accept that they have a mental disorder or illness?
Do they think they need treatment (what treatment?)
Are they willing to accept treatment?
What do they think about the future?
Cognition/IQ?
Orientation in place, person and time?
Attention/concentration
Recent/long term memory
Cognitive assessment (AMTS)
