20. mental state exam

Question 1

sections of a MSE

Answer 1

ASEPTIC

Appearance and behaviour
Speech
Emotion and Affect
Perception
Thought
Insight
Cognition

Question 2

Appearance and behaviour

Answer 2

Describe someone so that someone could pick them out in a waiting room
Ethnicity, age, clothing, well-kempt

Body language : eye contact, rapport. E.g relaxed, agitated, intense eye contact, were able to establish a rapport, didn’t want to engage during the consultation

Abnormal movements : EPSEs - tremor, stiffness, gait, tardive dyskinesia (rhythmic abnormal movement, tongue protrusion) - it is difficult to treat. ⅓ will get better but lots of ppl it continues, oculogyric crisis

Question 3

Speech MSE

Answer 3

Rate, tone, volume, rhythm
Fluency, coherency
Any dysphasias

Question 4

Emotions/mood MSE

Answer 4

Objective: dysthymic, euthymic (in the middle) or elated/hyperthymic
Subjective (mood) : pt perspective/rate on a scale,
Affect : reactive (responds to humour, good news, bad mood etc)/flattened (restricted range) congruent/incongruent “in terms of emotions and mood - objectively her mood is x, subjectively she describes this as x. Her affect is x and this is mood congruent/incongruent”

Question 5

Perceptions MSE

Answer 5

Illusions: false perception in the presence of an actual stimulus
Hallucinations

Auditory, visual, olfactory, gustatory, tactile

Question 6

Thought MSE

Answer 6

Formal thought disorders
- circumstantiality
- tangentality
- Neoligisms
- Clang associations
- Word salad
- Knights move
- Flight of ideas
- Perseveration
- Echolalia
- Jargon dysphasia

Content
- overvalued ideas
- obsessions
- delusions
- thought alienation
- passivity
- is the thought content congruent with affect?

Question 7

Insight MSE

Answer 7

Full, partial, none

Question 8

Cognition MSE

Answer 8

Oriented to time place and person but not formally assessed

Attention - spell world backwards

MMSE, MOCA, ACE III

Capacity (to accept admission/treatment)

Question 9

4 areas of risk assessment

Answer 9

To self
To others
Of exploitation
Of retaliation

Question 10

what is circumstantiality

Answer 10

the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return the original point.

Question 11

what is tangentality

Answer 11

wandering from a topic without returning to it.

Question 12

what are neoligisms

Answer 12

new word formations, which might include the combining of two words.

Question 13

what are clang associations

Answer 13

ideas are related to each other only by the fact they sound similar or rhyme

Question 14

what is word salad

Answer 14

incoherent speech where real words are strung together into nonsense sentences

Question 15

what is knights move thinking

Answer 15

a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.

Question 16

flight of ideas

Answer 16

thought disorder where there are leaps from one topic to another but with discernible links between them.

Question 17

perseveration

Answer 17

Repetition of ideas or words despite an attempt to change the topic

Question 18

echolaia

Answer 18

repetition of someone else’s speech, including the question that was asked.

Question 19

overvalued ideas

Answer 19

somewhat shakable, not functionally impairing but they still believe it

Question 20

obsessions

Answer 20

recurrent intrusive thought that can be associated with compulsions

Question 21

delusion define

Answer 21

false or illogical belief that is unshakable and doesn’t fit with someone’s social or cultural background

Question 22

Belief that you have more power, wealth, intelligence or grand traits than is true

Answer 22

delusion of grandeur

Question 23

beliefs that they will be/or soon will be destitute

Answer 23

Delusion of poverty

Question 24

belief there are parasites/bugs under skin

Answer 24

Parasitosis (ekoms)

Question 25

belief that part of or all of someones body/soul is dead/rotting away

Answer 25

Cotard’s (nihilistic)

Question 26

a feeling of some change in the self, feeling detached from one’s own body, actions feel mechanical and patient feels like an apathetic spectator of their own activities

Answer 26

Depersonalisation

Question 27

experiencing thoughts, actions and feelings as being foreign or manufactured against their will by a foreign influence

Answer 27

Passivity

Question 28

types of passivity

Answer 28

• Somatic passivity : delusional belief of body sensations from an external source
• Made act passivity: actions feel controlled by an external influence

Question 29

false perception of being in a relationship/that someone has romantic interest in them, often a celebrity

Answer 29

Delusional erotomania (de clerambauts)

Question 30

other name for delusion of infidelity

Answer 30

othello syndrome

Question 31

a belief that a familiar person has been replaced by an imposter

Answer 31

capgras

Question 32

a belief that a stranger is a familiar person in disguise

Answer 32

Fregoli delusion

Question 33

types of delusion of misidentification

Answer 33

Capgras : that a familiar person has been replaced by an imposter (a delusion of misidentification)

Fregoli delusion : that a stranger is a familiar person in disguise (a delusion of misidentification

Question 34

a belief that unrelated occurrences in the external world have a special significance for the patient

Answer 34

Delusion of reference

Question 35

whata re elementary hallucinations

Answer 35

Elementary auditory hallucinations: sounds such as whistling, hissing, mumbling

Elementary visual hallucinations: seeing lights, colours, geometric shapes, and indiscrete objects

Question 36

2nd vs 3rd person auditory hallucibations

Answer 36

2nd person auditory hallucinations : “you are..”
3rd person auditory hallucinations : speaking about the person

Question 37

what is an extracampine hallucination

Answer 37

sense that someone is there eg someone standing behind you

Question 38

hallucinations associated with sleep

Answer 38

Hypnopompic: hallucinations when waking up

Hypnagogic: hallucinations when going to sleep

Question 39

negative symptoms what is affective flattening

Answer 39

unchanging and unresponsive facial expression, avoidance of eye contact, diminished body language

Question 40

what is alogia

Answer 40

poverty of speech, not speaking much. Lack of spontaneity and flow in conversation