Mental State Exam and Histories Flashcards
(35 cards)
what is a personal history
expanded social history, gives an idea of premorbid function/ difficulties/ personality
do you assess sleep in MSE
no, MSE is observations, dont observe someone sleeping unless they fall asleep during exam
what is the difference between MSE and a history
MSE is:
- based on observation by doctor
- objective assessment
- technical description
what is this patients mood and affect:
A previously depressed patient says that generally they are feeling a lot better but today they feel “very low” and at interview looks unhappy but is able to laugh at jokes. What would be the best description of their mood and affect at interview?
Mood “very low”, affect low but reactive
what is a perception without a stimulus
hallucination
which of the following is an example of passivity experience:
- Persecutory delusion
- Self-referential thought
- Thought blocking
- Thought broadcasting
- Threatening Auditory Hallucination
thought broadcasting- dont have control over own thoughts
A patient on their own at home hears a voice say “Get out of the house or we will bomb the house”. What abnormality of mental state is this is an example of?
- Auditory Hallucination
- Auditory Illusion
- Persecutory Delusion
- Reduced insight
- Thought insertion
auditory hallucinations
The patient says that the threatening voice came from an RAF plane flying over her house. What abnormality of mental state is this is an example of?
- Auditory Hallucination
- Persecutory Delusion
- Nihilistic Delusion
- Reduced insight
- Thought broadcasting
persecutory delusion (persecutory as about other people doing harmful things)
what is included in the MSE
appearance and behaviour speech affect and mood thoughts: control & content perception cognition insight
what do you look for in appearance in MSE
age, gender, race body habitus grooming attire posture gait, odd movements (tics, tremors, stereotypes, mannerisms) evidence of injuries of illness (self harm, abuse, fights, drug use: pupils, bruising) smell
what do you look for in behaviour is MSE
eye contact rapport open/ guarded/ suspicious agitation/ psychomotor retardation disinhibition/ overfamiliarity
what do you look for in speech in MSE
rate amount (increased -> pressured. decreased -> monosyllabic -> mute) variation in tone (prosody) speech delay volume
what is mood
how does the patient feel today (not how they have been feeling over the past few months)
subjective- record in patients own words
what is affect
your observation of how the patient appears through the interview, how reactive they are during conversation
consider their baseline affect and to what extend this varies
what are the terms for how an affect can vary/ stay the same
appropriately reactive
labile (varies too much and too often)
unreactive (stays emotionally low)
flattened (reaches low emotions (sad) reactions but not high ones (happy))
blunted (neutral- unreactive to both happy and say)
incongruent (inappropriate reactions)
how do you assess cognitive function in MSE
orientation to time, place and person
concentration (months of year backwards)
memory (autobiographical, retrograde (past events), anteriorgrade (new memories- remember 3 things, name and address))
what is insight
self awareness
does the patient recognise that they are unwell
do the attribute it to a mental health problem
do they accept the need for treatment/ hospitalisation
what is a hallucination
a perception which occurs in the absence of an external stimulus
is experienced as originating in real space not just in thoughts
same qualities as a normal perception
is not subject to conscious manipulation
can occur in any sensory modality, can be simple (formless sound) or complex
=a misrepresentation of inner experience as having an external origin
when are hallucinations significant
only when in the context of other relevant symptoms
where in brain is abnormally active during auditory hallucinations
supplementary motor area (monitors self generated actions)
hippocampus - parahippocampal gyrus (detects mismatch between perceived & expected activity)
what are the types of auditory hallucinations
second person- voices which directly address the patient
third person- voices which discuss the patient or provide a running commentary on their actions
thought echo- patient experiences his own thoughts spoken or repeated out loud
what are the types of visual hallucinations
(often associated with altered consciouness/ organic impairment)
simple- flashes of light
complex- face or figure
what other senses can experience hallucinations
olfactory
gustatory
somatic (body sensations e.g. being touches, bugs crawling under skin)
what is passivity phenomena
behaviour is experienced as being controlled by an external agency rather than by the individual
can affect:
thoughts (insertion, withdrawal, broadcasting), actions and feelings (made actions and feelings)