MSE Flashcards
What is MSE?
Part of psych eval including a “snapshot” description of patient with examiners observations (objective) and complaints/symptoms of patients (subjective) components
Outline of MSE (10)
- Appearance/behavior
- Psychomotor abnormalities
- Speech
- Mood
- Affect
- Thought process
- Thought content
- Sensorium/intellectual fxn
- Insight
- Judgment
Define appearance/behavior
Objective description of patient as observed (able to identify pt w/o seeing them)
Components of appearance/behavior
- Physcial chars (sex, wt, physical health)
- Apparent vs chronological age
- Physical stigmata (Downs, FAS, tattoos)
- Dress
- Grooming
- Posture
- Facial expression
- Eye contact
- Receptiveness to interview (cooperative, attentive, seductive, hostile, guarded)
Define psychomotor activity
Amount and type of movement (retardation or agitation)
Bradykinesia
Slowness of activity, decrease in spontaneous movement
Akasthisia
Subjective feeling of muscular tension –> restlessness (often caused by 1st gen antipsychotics)
Catalepsy
Waxy flexibility, immobile position that is constantly maintained
Stereotypies
Repetitive, fixed pattern of physical action/speech (e.g. hand flapping, waving, body rocking, head banging); often associated w/ intellectual disability and/or autism
Cataplexy
Temporary loss of muscle tone precipitated by emotion (symptom of narcolepsy)
Tardive dyskinesia
Abnormal, involuntary, irregular choreoathetoid movements of head, limbs, or trunk – perioral most common (darting, twisting, protrustion of tongue; chewing/lateral jaw movements; lip puckering; facial grimacing)
Speech components
Quantity, quality, rate
Pressured speech
Rapid speech increased in amount and difficult to interpret
Wernicke’s aphasia
Receptive – speech is fluent but comprehension is impaired; normal effort; empty content of words and full of substitutions/neologisms (nonsense)
Broca’s aphasia
Expressive – speech is nonfluent; comprehension intact; effortful/frustrating; speech sparse/absent
Define mood
Pervasive/sustained emotion experienced by pt over time (subjectively reported)
Define affect
Outward expression of mood – objectively observed
Components of affect
Variability, intensity, appropriateness to mood
Labile affect
Rapid and abrupt changes in emotional tone, unrelated to external stimuli
Constricted/restricted affect
Reduction in intensity of feeling, less severe than blunted, but clearly reduced
Define thought process
Way that a person puts together ideas/associations
Normal thought process
Linear, goal-directed
Tangential
Thought process with inability to have goal directed associations (never gets to end point)
Circumstantial
Thought process where abundant in detail and delayed in reaching point, but gets there
Flight of ideas
Rapid, continuous verbalization w/ constant shifting from one idea to next w/ idea connection (least severe can be followed)
Loose associations
Flow of thoughts where ideas shift from one subject to another without relation; severe will be incoherent
Word salad
Jumbled words/phrases w/o comprehensible meaning
Components of thought content
- Hallucinations
- Delusions
- Illusions
- Recurring themes (e.g. negative ruminations, obesessions)
- Suicidal/homicidal ideation
Hallucinations
False sensory perception not associated with real external stimuli
Types of illusions and assc. features
- Auditory (usually voices; primary psychiatric illness; command w/ obligation to obey/unable to resist)
- Visual (formed images or light flashes; usually psychosis from other illness)
- Olfactory (assc. w/ another illness)
- Gustatory (usually uncinate seizure)
- Tactile (e.g. formication “bugs crawling under skin” as assc. w/ substance w/drawal)
Hypnagogic hallucinations
False sensory perceptions that occur upon falling asleep (normal)
Hypnopompic hallucinations
False sensory perceptions that occur when waking (normal)
Delusions
Fixed false belief
Types of delusions
Bizarre (couldn’t happen) vs. non-bizarre
Non-bizarre delusion subtypes
- Grandiose: exaggerated idea of one’s importance, power, identity
- Reference: incorrectly interpreting casual incidents/external events as having direct personal reference
Obession
Pathological persistence of an irresistible thought/feeling that can’t be eliminated from consciousness
Illusion
Misinterpretation of real external sensory stimuli
Recurring theme
Topic patient focuses on and continues to return to during interview (e.g. negative ruminations or obsessions)
Suicidal and homicidal ideation considerations
- Passive vs active
- Thoughts vs. plans
Components of sensorium/intellectual fxn
- Consciousness
- Orientation
- Attention/concentration
- Memory
- Abstraction
- Fund of knowledge
Consciousness descriptors
Alert, drowsy, comatose
Orientation components
Person, place, time (maintained in that order)
Attention and concentration tests
- Serial 7s
- Spelling word backwards
- Repeating series of random #s
- Repeating 3/4 unrelated objects after 5-10 min
Memory tests – Immediate, recent, and remote
- Immediate: repeat 3 words
- Recent (events w/in 24 hrs): last meal
- Remote (from life): DOB, # siblings
Abstraction test
Ask for interpretation of proverb and look for either concrete or abstract answer
Fund of knowledge test
Ask pt to name past presidents or world events (consideration: education dependent)
Define insight
Awareness and understanding of illness (range from denial to true insight)
Define judgment
Ability to make/carry out plans, discriminate accurately, and behave appropriately in social situations; can evaluated on history or imaginary scenario
