MSE Flashcards
Appearance
Physical state: how old do they appear? Do they appear physically unwell? Are they sweating? Are they too thin or obese? Etc
Clothes and accessories: Are their clothes clean? Are they wearing the same clothes since when you last saw them? Are clothes appropriate for the weather/circumstance? Is the patient carrying strange objects?
Self-care & hygiene: does the patient appear to have been neglecting their appearance or hygiene (eg. Unshaven, malodourous, dishevelled)? Is there any evidence of self-harm (eg cuts to wrists/forearm)?
BEHAVIOUR
Abnormal movements: tremors, tics, twitches
How the patient is acting: Are they relaxed/ suspicious/ aggressive/ fearful/ catatonic?
Psychomotor abnormalities: retardation (slow, monotonous speech, slow/absent body movements), agitation (inability to sit still; fidgeting, pacing, hand wringing, rubbing/scratching skin or clothes)
Rapport: What is their attitude towards you? Do they make good eye contact? May be described as cooperative, cordial, uninterested, aggressive, defensive, guarded, suspicious, fearful, perplexed, preoccupied, disinhibited, etc
Parkinsonism
drug-induced signs are most commonly a reduced arm swing + unusually upright posture while walking. Tremor + rigidity are late signs, in contrast to idiopathic parkinsonism
Acute dystonia
involuntary sustained muscular contractions or spasms
Akathisia
subjective feeling of inner restlessness and muscular discomfort, unable to sit still
Tardive dyskinesia
rhythmic, involuntary movements of the head, limbs and trunk, especially chewing, grimacing of the mouth and protruding, darting movements of the tongue
Bradykinesia
slowness of movement
SPEECH
Rate: may be regular, may have pressure of speech (seen in mania), long pauses/hesitancy + poverty of speech
(seen in depression)
Tone: may be regular tonality, monotonous
Volume: regular, increased or decreased
Also comment on dysarthria (articulation difficulties), dysprosody (unusual speech rhythm, melody, intonation or pitch), stuttering, slurring
Mood
Refers to a patient’s sustained, subjectively experienced emotional state over a period of time
Assessed by asking the patient how they are feeling
- Described objectively (your impression from the interview) and subjectively (their description of how they feel)
Dysphoric: an unpleasant mood, eg. Depression, anxiety, irritability
Euthymic: the mood is within the “normal” range, implying that mood is neither depressed nor elevated
Expansive: the mood is more elevated than normal, but does not necessarily imply pathology
Euphoric: an intense feeling of well-being
AFFECT
A subjective feeling/emotional experience that is manifested by observable behaviours such as attitude, facial expression, tone of voice, etc.
Affect is assessed by observing patient’s posture, facial expression, emotional reactivity
(1) Changeability
• Restricted – characterised by discernible decrease in range + intensity of expressions
• Labile – characterised by rapid & abrupt changes , eg. Friendly + cheerful one minute and then
angry and belligerent the next for no apparent reason
(2) Range = Normal/ increased/ decreased
(3) Appropriateness = congruent/incongruent (discordance between speech and affect)
(4) Intensity
• Blunted – associated with marked diminuition in emotional expression
• Flat – the normal signs of a broad range of affective expression are absent; voice may be
monotonous, face may be immobile/expressionless
THOUGHT FORM - Circumstantial
An inability to answer a question without giving excessive, unnecessary detail – differs from tangential thinking, in that the person does eventually return to the original point
THOUGHT FORM - tangential
Wandering from the topic and never returning to it nor providing the information requested
THOUGHT FORM - Loosening of association
characterized by discourse consisting of a sequence of unrelated or only remotely related ideas. The frame of reference often changes from one sentence to the next.
THOUGHT FORM - Neologisms
Creation of a new word, often consisting of a combination of other words, that is understood only by the speaker
THOUGHT FORM - Flight of ideas
A rapid shifting of ideas with only superficial associative connections between them that is expressed as a disconnected rambling from subject to subject and occurs especially in the manic phase of bipolar disorder
THOUGHT FORM - Thought blocking
Occurs when a person’s speech is suddenly interrupted by silences that may last a few seconds to a minute or longer
THOUGHT FORM - preservation
Persistent repetition of
words or ideas even when another person attempts to change the topic
THOUGHT FORM Echolalia
Echoing of another speech
THOUGHT FORM - Alogia
Poverty of speech, either in amount of content
Thought Content - Preocupations
over-valued or recurrent thoughts
THOUGHT CONTENT - obsessions
Distressing recurring unwanted thoughts
THOUGHT CONTENT - Delusions
A fixed false belief not accounted for by patient’s cultural background
THOUGHT CONTENT - PARANOID DELUSIONS
The person/group is being attacked, threatened, harassed, endangered, deceived or persecuted
THOUGHT CONTENT - GRANDIOSE DELUSIONS
a delusion in which the
person has an exaggerated view of his/her own
importance, power, knowledge, or identity
THOUGHT CONTENT - DELUSIONS OF REFERENCE
events/objects/other
people in the subject’s immediate environment
are seen to have unusual & special significance
THOUGHT CONTENT - IDEAS OF REFERENCE
similar to delusions of
reference but the beliefs are more shakeable
THOUGHT CONTENT - DELUSIONS OF CONTROL/ PASSIVITY EXPERIENCES
belief that the person’s feelings/ impulses/ thoughts/ actions are not his or her own, but rather are inserted by another
THOUGHT CONTENT - SOMATIC DELUSIONS
Relates to functioning of the body e.g being pregnant, rotting brain
THOUGHT CONTENT - NIHILISTIC DELUSIONS
false belief that self, part of self, others, or the world is nonexistent or ending
PERCEPTION
Determine whether the abnormal perceptions are genuine hallucinations, pseudohallucinations, illusions, or intrusive thoughts
• Describe from which sensory modality the hallucinations arise – eg. Auditory, visual, tactile, olfactory, gustatory, somatic
• Determine whether auditory hallucinations are elementary or complex
• If complex – are they experienced in first person (audible thoughts, thought echo), second person (critical,
persecutory, complimentary or command hallucinations) or third person (voices arguing or discussing the
patient, or giving a running commentary)
• It is also important to note whether the patient is responding to hallucinations during the interview, as
evidenced by them laughing as though they are sharing a private joke, suddenly tilting their head as though listening, or quizzically looking at hallucinatory objects around the room
COGNITION
- Screened by checking orientation to person, place, time
* Usually not formerly assessed unless you have time for an MMSE
INSIGHT
• Often described as good, partial, or poor – however usually patients lie somewhere on a spectrum and vary over time
Key questions to answer;
- Does the patient believe they are unwell in any way? Do they believe they are mentally unwell?
- Do they think they need treatment?
- Do they think they need to be in hospital?
JUDGEMENT
- Reasoning regarding current important issues
- Ideas about decisions or actions to be taken, including about current illness
- Evidence from past judgements as clues to current thinking
