MSE Flashcards
What do you look for in Appearance
Age Self care clothing hygeine necglect
What do you look for in behaviour
- Eye contact
- engagement/rapport
- Social behaviour: over familliar (mania) disorientated, preoccupied
- Level of arousal: calm / agitated / aggressive
- Any unusual features: tremors / choreiform movements
(involuntary movements) / dystonia
What should you comment on Mood (subjective)
How do you feel? How do you feel over a period of time How would you rate your mood out of 10 Happiness Irritability stability
What should you comment on for affect (objective)
Is it congruent with what they've said above Elated Euthymic blunted flat
What should you comment on for perception
Hallucinations
Illusions
Dissociative symptoms
What is a hallucination
Sensory perception without external stimuli
Unaware they are not real
Auditory, visual, smell, taste
What is illusions
Sensory perception without external stimuli but patient is aware they are not real
What are dissociative symptoms
Derealisation: the feeling the world or surroundings are not real
Depersonalisation: feeling detached from oneself
what should you comment on in thought form
• Linear – in a logical order
• Incoherent – makes no logical sense
• Circumstantial – lots of irrelevant/unnecessary details (not to the point)
• Tangential – the patient goes off on tangents relating loosely to the initial thought
• Perseveration – repetition of a particular response despite the absence/removal of the stimulus
- Flight of ideas
What should you comment on in thought posession
- Insertion - putting thoughts into my head
• Withdrawal - taking thoughts out of my head
• Broadcasting - people can hear my thoughts
What should you comment on in thought content
- Over valued ideas vs, delusions
- Negative cognitions
- Suicidal ideation
What are delusions
Fixed, false beliefs not consistent with the person’s background
What are over-valued ideas
unreasonable belief e.g. anorexic person thinking they’re overweight
When a patient admits to being suicidal, how do you break it down
- Do they want their life to end, but not thought of ending it themselves
o They want their life to end and have thought of doing it themselves
o They have actively planned to commit suicide
What are persecutory delusions
False belief that one is being harmed, threatened, harassed or victim of a conspiracy theory
What are grandiose delusions
False belief that one is particularly powerful, important or talented
What are delusions of reference
False belief that certain objects or people or events have intense personal significance and refer specifically to oneself
What are religious delusions
False beliefs pertaining to religious themes, often grandiose in nature
Delusions of love (etromania)
False belief that someone is in love with them
Delusions of misidentification
False belief that ones family member has been replaced by an imposter
What are delusions of infidelity
False belief that one’s lover has been unfaithful (careful as can be an overvalued idea, not a psychotic jealousy)
what are Nihilistic delusions
- False belief that ones self, others or the world is non-existent or about to end
- insides rotting (somatic delusions)
WHat are delusions of control
False belief that ones thoughts, feelings, actions or impulses are controlled or made by an external agent
What should you consider when discussing insight
- Do they know they have a problem
- Can they attribute it to something e.g. illness
- Do they think they’re physically or mentally ill
- Do they think they need treatment
- Are they willing to accept treatment
- Do they think stress might be contributing towards there illness
What should you consider when performing a risk assessment
- Risk to self
- Risk to others
- Neglect (including self neglect)
- Any children involved
Risk factors for suicide
S: sex- male A: age (<19, >45) D: depression P: previous attempt E: excessive Alcohol/drug use R: rational thinking loss S: social support lacking O: organised plan N: no spouse S: sickness
What features of a previous suicide increase the risk of a completed suicide at a later date
efforts to avoid discovery planning leaving a written note final acts such as sorting out finances violent method
What considered protective factors to prevent suicide
family support
having children at home
religious belief
