Psychiatry - MSE

Question 1

Steps of MSE

Answer 1

• Appearance and behaviour
• Speech
• Mood and affect
• Thoughts
• Perception
• Insight
• Cognition
• Risk to self/others, neglect, vulnerability, misadventure

Question 2

Appearance

Answer 2

• Distinguishing features
• Weight
• Stigmata of disease
• Personal hygeine
• Clothing
• Objects

Question 3

Behaviour

Answer 3

• Engagement and rapport
• Eye contact
• Facial expression
• Body language
• Psychomotor activity
  
  • Retardation, restlessness
• Abnormal movements or postures
  
  • Involuntary movement, tremors, tics, lip-smacking, akathisias, rocking

Question 4

Speech

Answer 4

• Rate
  
  • Pressure of speech, slow speech
• Quantitiy
  
  • Minimal, absent, excessive
• Tone
  
  • Monotonous, tremulous
• Volume
• Fluency and rhythm
  
  • Stammering or stuttering, slurred, rhyming

Question 5

Mood

Answer 5

• Ask patinet current mood
  
  • Low, anxious, angry, engaged, euphoric, guilty, apathetic

Question 6

Affect

Answer 6

• Apparent emotion
• Range and mobility
  
  • Fixed, restricted (changes slightly) , labile (exaggerated changes)
• Intensity
  
  • Heightened, blunted/flat
• Congruency
  
  • Congruent if affect is in keeping with thought

Question 7

3 aspects of thought

Answer 7

• Form
• Content
• Possession

Question 8

Thought form

Answer 8

• Refers to processing and organisation of thoughts
  
  • Speed of thoughts - fast or slow thinking
  • Flow and coherence
    
    • Loose associations
    • Circumstantial thoughts
    • Tangential thoughts
    • Flight of ideas
    • Thought blocking
    • Perseveration
    • Neologisms

Question 9

Thought content

Answer 9

• Delusions
• Obsessions
• Compulsions
• Overvalued ideas
• Suicidal thoughts
• Homicidal/violent thoughts

Question 10

Thought possesions

Answer 10

• Thought insertion
• Thought withdrawal
• Thought droadcasting

Question 11

Perceptions

Answer 11

• Hallucinations
• Pseudo-hallucinations
• Illusions
• Depersonalisation
• Derealisation

Question 12

Cognition

Answer 12

• Vague
  
  • Orientation in time, place and person
  • Attention span and concentration
  • Short term memory
• Formal assessment
  
  • Mini-mental state exam (MMSE)
  • Abbreviated mental test score (AMTS)
  • Addenbrooke’s cognitive examination III (ACE-III)

Question 13

Insight and judgement

Answer 13

• Insight
  
  • Do they understand they have mental health condition
• Judgement
  
  • Can they make considered decisions or come to sensible conclusion about information
  • Ask what they would do if they could smell smoke in their house