MSE Flashcards
What is the difference between a formal and informal mental status exam?
- Formal = set of question
- Informal = listening for things as you ask about other things
What are the major components of the informal mental exam? (11)
- Appearance
- Behavior
- Attitude toward exam
- Speech
- Mood
- Affect
- Thinking
- Perception
- Sensorium
- Insight
- Judgement
(JA, A BAPTISMS)
What is mood?
Subjective emotional experience of the patient
What is affect?
Objective assessment of the patient’s emotional responsiveness, as inferred from facial expressions and/or behavior
What is the thinking part of the MSE?
- Logical vs illogical
- Goal directed vs not
- Delusions
What is the perception of the MSE?
- Hallucinations
- Derealization or depersonalization
What is the insight of the MSE?
Do they understand their condition
What are the three major indications for a full mental status exam?
If there is concern that a patient
- is psychotic
- Has any type of organic brain dysfunction
- Is functioning so poorly to need hospitalization
True or false: cognition tests (e.g. serial 7s) are a part of the full MSE
True
True or false: a full MSE is rarely indicated in the outpatient setting
True
Are direct questions asked in an informal MSE?
Not usually–based on responses to normal outpatient questions
True or false: the appearance part of the MSE can include clothing, grooming etc
True
What are the parts of the overt behavior of the MSE?
-Includes patients’ motor behavior, mannerisms, etc
What is the attitude part of the MSE?
Describes the patient’s attitude toward the examiner
What is the speech part of the MSE?
Describes the patient’s physical characteristics of the patient’s speech (e.g. volume, speed, impairments, etc)
True or false: thinking process is distinct from content
True
What is circumstantial thinking?
Extraneous information that are irrelevant, but comes back to original thought
What is the tangential thinking?
Thinking that does not lead back to the original thought
What is derailment / loose associations?
Loss of the logical connection between ideas or sentences as they are being spoken
What is clang associations?
Linking words together based on sound, rather than content
What is the flight of ideas?
Jumping from topic to topic quickly that are only loosely assocaited
What is perseveration?
Repetition of the same words to ideas over and over, despite the conversation moving on
What is a non-bizarre delusion? What about bizarre?
Delusions that are plausible
Bizarre = delusions that are implausible
What is the judgement bit of the MSE?
Is the patient able to understand the likely consequences of behavior and make decisions accordingly
What is the consciousness/alertness bit of sensorium?
Overall level of awareness of the environment
What is the orientation bit of sensorium?
Person place and time
What is the concentration bit of sensorium?
Capacity to focus on the conversation or can formally assess with serial 7s
What is the memory bit of sensorium? (3)
- Immediate-repeat a series of number
- Recent–Recall events from a few minutes to a few days ago
- Remote–Recall events from years ago
What is the fund of knowledge bit of sensorium?
Recall for basic facts about the world
What is the abstract reasoning bit of sensorium?
Can be tested by asking the patient to explain a proverb like, make hay while the sun shines
What is the reading and writing bit of sensorium?
Ask the patient to read a sentence and write a sentence
What is the visuospatial ability bit of sensorium?
Ask the patient to draw a clock or copy a figure
Does speech describe the content what is spoken?
No–only the physical characteristics of it
Talkative vs unspontaneous (only responsive to questions) is listed in what component of the PE?
Speech
What is a normal affect?
Variable and appropriate to content
What is an incongruent affect?
Affect that does not match mood
What is thought blocking?
When there is an abrupt stop or break in the flow of ideas
Does the perceptions part of the MSE include the content of a hallucination?
Yes
Does the perceptions part of the MSE include the time when a hallucination occurs?
Yes
What should you always begin the interview with?
Overview of what you intend to do with the time
Should you use leading questions or open ended questions during a MSE?
Open ended
How can you build a sense of collaboration between you and your patient?
- Look for their strengths
- Quick to understand, slow to offer advice
What are the three major problems if a pt feels shame during an MSE?
- lost to f/u
- Leave out details
- Strike back
Is reflecting and summarizing what a patient said good?
Yes
What are the five factors that should always be elicited with a psych history?
- Substance use
- H/o trauma
- Occupation
- Relationship
- Social support
(SORTS)
What should always be assessed with a suicidal patient?
- Ideation
- Plan
- Means
- Intent
