MSE abnormalities

Question 1

What is a hallucination?

Answer 1

A perception that occurs in the absence of an external stimulus, originating in real space (Not just thoughts)

Question 2

What is an illusion?

Answer 2

A perception occurring in the presence of a stimulus, however the stimulus is misinterpreted (E.g. Hearing wind as someone crying)

Question 3

What is a pseudo-hallucination?

Answer 3

Vivid mental images which are known by the person as being unreal

Question 4

What are some forms of hallucination

Answer 4

Auditory
Olfactory
Gustatory
Somatic/Haptic/Tactile

Question 5

Describe the pathophysiology of hallucination

Answer 5

There is activation of the pathways used in generating inner speech, however there is lack of involvement with supplementary motor area (Monitors self-generated actions) and the parahippocampal gyrus (Detects mismatch between perceived and expected activity)

Question 6

What are the 3 main forms of auditory hallucination?

Answer 6

• Second person - Voices which directly address the patient
• Third person - Voices which discuss the patient or provide a running commentary of their actions
• Thought echo - Patient experiences their own thoughts spoken or repeated out loud

Question 7

What is olfactory hallucination?

Answer 7

False perception of smell

Question 8

What is gustatory hallucination?

Answer 8

False perception of taste

Question 9

What is somatic hallucination?

Answer 9

False perception of bodily sensation (E.g. Insects crawling under skin, sensation of being touched)

Question 10

What is passivity phenomenon

Answer 10

A phenomenon in which the patient experiences their behaviour as being controlled by an external agency, rather than by themselves

Question 11

What is thought insertion?

Answer 11

The delusion that someone is placing thoughts in your head

Question 12

What is thought withdrawal?

Answer 12

The delusion that someone is removing thoughts from your head

Question 13

What is thought broadcasting?

Answer 13

The delusion that people around you can hear your thoughts

Question 14

What is this an example of:

“Patient feels they are being controlled via telepathy or via a spirit who opens and closes the back channels of their brain to release words and hold back the truth”

Answer 14

Passivity phenomenon

Question 15

Describe the pathophysiology of passivity phenomenon

Answer 15

Abnormalities occur in the parietal and cingulate cortices, which are involved in interpretation of sensory information

Question 16

What is a thought disorder

Answer 16

This is a disorder of the form of thought, shown by the patients speech or writing showing an abnormality in the way their thoughts are linked together

There is often disturbance in organisation, control and processing of thoughts

Question 17

What are the 3 main types of thought disorder

Answer 17

• Flight of ideas
• Loosening of associations
• Neologism

Question 18

What is meant by flight of ideas?

Answer 18

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 recognisable links such as rhyming, punning or environmental distractions

Question 19

Example:

“How would you say you were at the moment?”

“I’m absolutely fine, and terribly busy, so I can’t give you long, thats a nice tie you are wearing, did you buy it in Paris? I love Paris in the sping-time, I love Paris in the fall. Fallen arches, you look as though you could have those, would you like me to cure them for you?”

Answer 19

Flight of ideas - Thought disorder

Question 20

What is meant by loosening of associations?

Answer 20

The patients speech is muddles, illogical, difficult to follow and cannot be clarified

The patient talks fairly freely, but so vaguely that no information is given in spite of the number of words used

There may be jumps from topic to topic with no logical connection between them (Knights move thinking)

Question 21

What is neologism?

Answer 21

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, but which have idiosyncratic meaning to the patient

Question 22

What is a delusion?

Answer 22

A delusion is a false belief or a belief held on false grounds, which is inappropriate to the patient’s background

The belief will be held in the face of logical argument or evidence to te contrary and is not modified by experience or reason

Question 23

What are the 3 parts of a delusion?

Answer 23

Form
Theme
Content

Question 24

What is the form of a delusion?

Answer 24

The form of delusion is not the belief itself, but the way in which it is believed

Question 25

What is the theme of delusion?

Answer 25

What the delusion is about, put into simple termsW

Question 26

What are some common themes of delusions in depression?

Answer 26

• Disease
• Nihilism
• Poverty
• Sin
• Guilt

Question 27

What are some common themes of delusion in schizophrenia?

Answer 27

• Control
• Persecution
• Reference
• Religion
• Love

Question 28

What are some common themes of delusion in mania?

Answer 28

• Grandiosity
• Persecution
• Religion

Question 29

What is the content of delusion?

Answer 29

A culturally defined aspect of the delusion, relating to current events

For example, the persecutor described in the theme will have a culturally specific form (E.g. IRA, Mafia) or a delusion of disease may be specific to current diseases (E.g. AIDS, Covid)