Psychiatric History & Mental State Examination

Question 1

components of an MSE?

Answer 1

"ASEPTIC"
Appearance + behaviour
Speech
Emotion - mood and affect
Perception - hallucinations and illusion
Thought
Insight + judgement
Cognition

Question 2

main mnemonic for psychiatric symptoms?

Answer 2

SOCRATES again (remove S+R)

Question 3

what should be included in past psychiatric history?

Answer 3

previous diagnoses
their timescale
symptoms in previous episodes
effect on function
previous contacts
admissions/detentions

Question 4

how can you relate PMH to psych?

Answer 4

effect of their PMH on their functioning

relevance to mental health symptoms

Question 5

how can you find out how severe a psychiatric illness is in the history?

Answer 5

any admissions?

ask about effect on function

Question 6

what extra things are asked in a psychiatric social history?

Answer 6

chronological!!!
upbringing - family (divorce?), health
school - bullying? academics? behaviour?
work- jobs, performance, leave?
relationships- length, breakups, children?
current living situation- housing, finances?

Question 7

how should you ask a forensic history?

Answer 7

any trouble with the police in the past?

Question 8

what is the patient’s premorbid personality?

Answer 8

what they were like before their symptoms

Question 9

what should you ask to find out the patient’s premorbid personality?

Answer 9

"what were you like before these problems started?"
attitudes to self and others
relationships
interests
temperament
standards and values
religion

Question 10

what is affect?

Answer 10

your observation of how the patient is

Question 11

what is mood?

Answer 11

a pervasive and SUSTAINED emotion

Question 12

an MSE requires an explanation for each observation T or F

Answer 12

F, no explanation needed

Question 13

what can be commented on in the appearance section of an MSE

Answer 13

age, gender, race, weight (begin with this)
self care - attire/grooming
posture
gait and movements
evidence of injuries eg self harm/injection sites
smell

Question 14

components of the “behaviour” section of an MSE?

Answer 14

eye contact
rapport
open or guarded?
agitated or slow to react?
disinhibition or overfamiliarity?

Question 15

how should you assess speech in MSE?

Answer 15

rate
amount
tone
volume
speech delay

Question 16

increased speech is called ___ speech

Answer 16

pressure

Question 17

decreased speech where the patient only answers yes/no is called ____ speech

Answer 17

monosyllabic

Question 18

how could you work out mood for an MSE rather than for the history?

Answer 18

“how are you feeling TODAY?”

write down what they say

Question 19

how do you note down affect in MSE?

Answer 19

write down the emotional tone the patient is expressing eg distressed AND if it varies

Question 20

euthymic means…

Answer 20

normal

Question 21

affect should be ____

Answer 21

reactive

Question 22

what is a flattened affect?

Answer 22

not showing any positive affect and negative affect is raised

Question 23

how will a blunted affect present?

Answer 23

very neutral, neither positive nor negative

Question 24

a blunted affect is a common sign of what condition?

Answer 24

schizophrenia

Question 25

an unreactive affect will present in what way?

Answer 25

look low and depressed

doesn’t change

Question 26

an excessively variable affect is called…

Answer 26

a labile affect

Question 27

main sections of the cognitive part of MSE?

Answer 27

orientation to time, place and person
concentration
memory

Question 28

reciting the months of the year backwards is a test of the ___ section of cognition?

Answer 28

concentration

Question 29

what would test a patient’s retrograde memory?

Answer 29

past events eg date of the 2nd world war

Question 30

what form of memory tests new memories?

Answer 30

anterograde memory

Question 31

how would you able to assess insight in MSE?

Answer 31

ask the q’s:
does the patient realise they’re unwell?
do they attribute it to a mental health problem?
do they accept the need for treatment?