Symposium 1- History taking, mental state exam and diagnosis

Question 1

What steps should be taken in a mental state exam?

Answer 1

• Appearance
• Behaviour
• Mood
• Speech
• Thoughts
• Beliefs
• Percepts
• Suicide/Homicide
• Cognitive function
• Insight

Question 2

What are some possible appearance and behaviour signs?

Answer 2

Responding to unseen stimuli
Evidence of side effects of medication
Evidence of intoxication
Movement disorder

Question 3

What is mood?

Answer 3

Mood- generally held to be the patient’s subjective report on their current mood state in terms of how they rate themselves from depressed through euthymic (neutral) to elated.

Question 4

What is affect?

Answer 4

Affect- held to be the emotions conveyed and observed objectively during interview in terms of:
•Types of affect observed; anxiety, anger, euphoria etc
•Range and reactivity of affect. Range from flattened to labile. Record reactivity to themes.
•Congruity of affect i.e. observation of congruity to themes; may be grossly incongruous in schizophrenia

Question 5

What are the four categories that thought can be organised in to?

Answer 5

• Speed and tempo of thoughts
• Types of thoughts demonstrated (preoccupations, phobias, paranoia, obsessions, delusions)
• Linkage and thought form
• Possession of thoughts

Question 6

What is delusion?

Answer 6

A delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction. They can be:
•Grandiose
•Paranoid (correctly persecutory)
•Hypochondriacal
•Self referential

Question 7

What is a though disorder?

Answer 7

Thought disorder is a pattern of interruption or disorganization of thought processes is broadly referred to as formal thought disorder, and can be described more specifically as:
•Thought blocking,
•Fusion,
•Loosening of associations,
•Tangential thinking,
•Derailment of thought, or knight’s move thinking

Question 8

What are the classes of perception anomalies?

Answer 8

• Hallucinations (have full force and clarity of true perception, no external stimulus, not willed or controlled, can affect any sense)
• Pseudohallucinations
• Illusions

Question 9

How can cognitive function be assessed?

Answer 9

• Orientation - time, place, person
• Attention/concentration - throughout i/v
• Standard concentration test is Reversed Months
• Short term memory - 3 objects or name & address
• Long term memory - personal history
• If any concerns - perform objective tests eg MSQ, MOCA, MMSE, FAS, Clock drawing, executive function tests

Question 10

How is insight assessed on a MSE?

Answer 10

• This should be conceptualised as a spectrum; rarely 100% absent or present.
• Three questions can indicate place on this continuum: 1. Do you think you are ill? 2. If you are ill is it a mental illness? 3.If you are ill and it is a mental illness do you agree broadly with the current treatment plan?