MSE Flashcards
What is an MSE?
Examination that is based on observation by doctor
An objective assessment
Technical description
What is examined in an MSE?
Appearance Behaviour Speech Affect and mood Thoughts; control and content Perception Cognition Insight
What is assessed in appearance as part of the MSE?
Age Gender Race Body habitus Grooming Attire Posture Gait, odd movements; tice, tremors, stereotypes, mannerisms Evidence of injuries or illness; self harm, abuse, fights, drug use Smell; alcohol, urine, vomit, body odour
What is assessed in behaviour as part of the MSE?
Eye contact Rapport Open/ guarded/ suspicious Agitation/ psychomotor retardation Disinhibition/ overfamiliarity
What is assessed in speech as part of the MSE?
Rate; slow or fast Amount; increased, decreased (monosyllabic, mute) Variation in tone (prosody) Speech delay Volume
What is the difference between mood and affect?
Mood; subjective..how do you feel today
Affect; observable, objective
What are the different types of affect?
Low Anxious Elated Euthymic Irritable Does is vary; reactive, labile, unreactive, flattened, blunted, incongruent
How is cognitive function assessed in MSE?
Orientation to time, place, and person
Concentration; can you go through the months of the year but in reverse order
Memory; autobiographical memory, retrograde memory, anterograde memory
What is observed in insight in assessment for MSE?
Does the patient recognise that they are unwell
Do they attribute it to a mental health problem
Do they accept the need for treatment? Hospitalization?
What is a hallucination?
A perception which occurs in the absence of an external stimulus
Experiences as originating in real space, not just in thoughts
Some qualities as a normal perception i.e. vivid, solid and compelling
Not subject to conscious manipulation
Can occur in any sensory modality
What is the pathophysiology of auditory hallucinations?
Pattern of brain activity during auditory hallucinations is very similar to that in normal volunteers generating inner speech
EXCEPT supplementary motor areas and the hippocampus
What are the different types of auditory hallucinations?
Second person; voices which directly address the patient
Third person; voices which discuss the patient or provide a running commentary on his actions
Thought echo; the patient experiences his own thoughts spoken or repeated out loud
What are the different types of visual hallucinations?
Often associated with altered consciousness/ organic impairment
Simple; flashes of light
Complex; face or figure
Olfactory
Gustatory
Somatic; bodily sensations e.g. insects crawling under the skin, being touched
What is passivity phenomena?
Behaviour is experiences as being controlled by an external agency rather than by the individual
Can affect; thought insertion, thought withdrawal, thought broadcasting, made actions and feelings
What is the pathophysiology of passivity phenomena?
Show abnormalities in parietal and cingulate cortices on PET scanning
Areas involved in interpretation of sensory info
Lead to internal actions being misinterpreted as being caused by external agency
What is disorder of the form of thought?
Evidence from the patient’s speech or writing that there is an abnormality in the way their thoughts are linked together
Disturbance in organisation, control and processing of thoughts
What are the 2 main thought disorders?
Flight of ideas
Loosening of associations
What is flight of ideas?
Words are associated together inappropriately because of their meaning or rhyme so that speech loses its aim and the patient wanders far from the original theme
The patient jumps from topic to topic but with recognizable links such as rhyming, punning or environmental distractions
What is loosening of associations?
Patient’s speech is muddled, illogical, difficult to follow and cannot be clarified
Patient talks freely but so vaguely that no info is given in spite of the number of words used
There may be jumps from topic to topic with no logical connection between them
What is neologism?
An abnormality of speech in which the patient makes up a new word or phrase or uses existing words or phrases in bizarre ways which have no generally accepted meaning by which have idiosyncratic meaning to the patient
What is a delusion?
False belief held on false grounds
Inappropriate to the pts socio-cultural background
Firmly held in the face of logical argument or evidence to the contrary
Not modified by experience or reason
Very individualised
How are delusions identified?
By their form, but described by its content or theme
What is the theme of a delusion?
What it is about
What are the different types of delusional themes?
Disease, nihilism, poverty, sin, guilt; typical in depression
Control, persecution, reference, religion, love; schizophrenia
Grandiosity, persecution and religion; mania
What defines the specific content of delusions?
Culturally defined; a persecutor is often recognisable to society/ culture as a danger/ threat (IRA, mafia, MI5, KGB, CIA, devil, evil spirits)
Control is by ghosts/ spirits/ x-ray/ radio
What are common feared diseases in delusions?
Plague
Syphilis
Cancer
AIDS
What is commonly the origin of delusions?
Often attempts to explain anomalous experiences e.g. hallucinations, passivity experiences, depression
What is a delusion?
Fixed, false belief that cannot be corrected by logic and are not consistent with culture and education of the patient
What is a hallucination?
False sensory perception experienced without real external stimulus
They are usually experienced as originated in the outside world not within the mind as imagination
What is an illusion?
Misperception of real external stimulus
Most likely to occur when general level of sensory stimulation is reduced
