Mental State Examination Flashcards
Difference between mood and affect?
Mood refers to a person’s emotional state or frame of mind. It is a subjective feeling that can be influenced by various internal and external factors, such as hormonal changes, stress, or life events.
Affect refers to the observable expression of a person’s mood or emotional state. It can be seen in a person’s facial expressions, tone of voice, body language, and overall demeanour.
Affect is an external manifestation of mood and can be influenced by social and cultural factors
Difference between delusion and hallucination?
Delusion = false belief i.e. “They’re watching me”.
Hallucination = sensory perception. Can affect the 5 senses visual, olfactory (your sense of smell), gustatory (taste), auditory (hearing), or tactile (touch). Can involve hearing or seeing something that isn’t actually present.
Features of the mental state examination?
“ASEPTIC”
A- appearance and behaviour
S- speech
E- emotions
P- perception
T- thoughts
I- insight
C- cognition
What to look for in patient appearance?
Observe the patient’s general appearance:
Personal hygiene: are there any signs of self-neglect?
Clothing: are they dressed appropriately for the weather/circumstances? Are clothes put on correctly?
Physical signs of underlying difficulties: any self-harm scars or signs of intravenous drug use?
Stigmata of disease: note any stigmata of disease (e.g. jaundice).
Weight: note if they appear significantly underweight or overweight.
Objects: look around to see if the patient has brought any objects with them and note what they are.
What to look for in patient behaviour?
Engagement and rapport
Note if patient is engaged in the conversation and developing a rapport with the clinician. Note if they appear distracted or appear to be responding to hallucinations (e.g. replying to auditory hallucinations in schizophrenia).
Eye contact
Observe the patient’s level of eye contact and note if this appears reduced or intense and staring.
Facial expression
Observe the patient’s facial expression (e.g. relaxed, fearful, angry, disengaged). Note if they respond appropriately (e.g. becoming tearful when discussing difficult topics vs laughing incongruously).
Body language
Observe the patient’s body language, which may appear threatening (e.g. standing up close to you) or withdrawn (e.g. curled up or hands covering their face).
Note any evidence of exaggerated gesticulation or unusual mannerisms.
Observe for any signs of paranoia. Does the patient appear on edge, fearful or glancing around the room?
Psychomotor activity
Observe for any evidence of psychomotor abnormalities:
Psychomotor retardation: associated with a paucity of movement and delayed responses to questions.
Restlessness: the patient may continuously fidget, pace and refuse to sit still.
What to look for in patient speech?
Rate of speech
Pay attention to the patient’s rate of speech:
Pressure of speech: a tendency to speak rapidly, motivated by an urgency that may not be apparent to the listener (often a manifestation of thought abnormalities such as flight of ideas, described later in the article). This can be present in mania.
Slow speech: may occur due to psychomotor retardation, typically associated with depression.
Quantity of speech
Note the quantity of the patient’s speech:
Poverty of speech: associated with depression.
Excessive speech: associated with mania.
Tone of speech
Note the tone of the patient’s speech:
Monotonous speech: associated with conditions such as depression, psychosis and autism.
Tremulous speech: associated with anxiety.
Volume of speech
Note the volume of the patient’s speech:
Quiet speech may be seen in depression.
Loud speech can be seen in mania.
Fluency and rhythm of speech
Note the fluency and rhythm of the patient’s speech for abnormalities:
Stammering or stuttering
Slurred speech: may occur in major depression due to psychomotor retardation. It may also be a sign of acute intoxication.
What to look for when assessing patient mood?
A patient’s mood can be explored by asking questions such as:
“How are you feeling?”
“What is your current mood?”
“Have you been feeling low/depressed/anxious lately?”
Examples of mood states
Low mood
Anxious
Angry
Enraged
Euphoric
Guilty
Apathetic
What to look for when assessing patient affect?
To assess affect, observe the patient’s facial expressions and overall demeanour.
Apparent emotion
Observe the apparent emotion reflected by the patient’s affect. Examples may include:
Sadness
Anger
Hostility
Euphoria
Range and mobility of affect
Range and mobility of affect refer to the variability observed in the patient’s affect during the assessment.
Abnormalities may include:
Fixed affect: the patient’s affect remains the same throughout the interview, regardless of the topic.
Restricted affect: the patient’s affect changes slightly throughout the interview, but doesn’t demonstrate the normal range of emotional expression that would be expected.
Labile affect: characterised by exaggerated changes in emotion which may or may not relate to external triggers. Patients typically feel like they have no control over their emotions.
What is checked for in patients thought form?
Thought form refers to the processing and organisation of thoughts.
Speed of thoughts:
Patients may demonstrate abnormally fast (i.e. racing, as seen in mania) or abnormally slow thought processing.
Flow and coherence of thoughts:
In healthy individuals, thoughts flow at a steady pace and in a logical order. However, in several mental health conditions, the flow and coherence of thoughts can become distorted.
What is checked for in patients thought content?
Abnormalities of thought content can include:
Delusions: a firm, fixed belief based on inadequate grounds, not amenable to a rational argument or evidence to the contrary and not in sync with regional and cultural norms. These may include persecutory delusions, in which the patient erroneously believes another individual or group is trying to harm them or ideas of reference, in which the individual incorrectly believes specific events relate to them (e.g. news reports on the television). Delusions can be mood congruent, such as grandiose delusions (e.g. that they have special powers) in mania.
Obsessions: thoughts, images or impulses that occur repeatedly and feel out of the person’s control. The patient is aware these obsessions are irrational, but the thoughts continue to enter their head.
Compulsions: repetitive behaviours that the patient feels compelled to perform despite recognising the irrationality of the behaviour.
Overvalued ideas: a solitary, abnormal belief that is neither delusional nor obsessional but preoccupying to the extent of dominating the person’s life (e.g. the perception of being overweight in a patient with anorexia nervosa).
What is checked for in patients thought possession?
Abnormalities of thought possession include:
Thought insertion: a belief that thoughts can be inserted into the patient’s mind.
Thought withdrawal: a belief that thoughts can be removed from the patient’s mind.
Thought broadcasting: a belief that others can hear the patient’s thoughts.
What is checked for in patients perception?
Perception involves the organisation, identification and interpretation of sensory information to understand the world around us. Abnormalities of perception are a feature of several mental health conditions.
Abnormalities of perception include:
Hallucinations: a sensory perception without any external stimulation of the relevant sense that the patient believes is real (e.g. the patient hears voices, but no sound is present).
Pseudo-hallucinations: the same as a hallucination, but the patient knows it is not real.
Illusions: the misinterpretation of an external stimulus (e.g. mistaking a shadow for a person).
Depersonalisation: the patient feels that they are no longer their ‘true’ self and are someone different or strange.
Derealisation: a sense that the world around them is not a true reality.
What is checked in patients cognition?
Whether they are orientated in time, place and person
What their attention span and concentration levels are like
What their short-term memory is like
What is checked in patients insight?
Insight, in a mental state examination context, refers to the ability of a patient to understand that they have a mental health problem and that what they’re experiencing is abnormal. Several mental health conditions can result in patients losing insight into their problem.
Some examples of questions which can be used to assess insight include:
“What do you think the cause of the problem is?”
“Do you think you have a problem at the moment?”
“Do you feel you need help with your problem?”
Examples of abnormalities with thought flow and coherence?
Loose associations: moving rapidly from one topic to another with no apparent connection between the topics.
Circumstantial thoughts: these are thoughts which include lots of irrelevant and unnecessary details but do eventually come back to the point.
Tangential thoughts: digressions from the main conversation subject, introducing thoughts that seem unrelated, oblique, and irrelevant.
Flight of ideas: seen with fast, pressured speech. Ideas run into one another, making it difficult for the observer to follow the flow of speech.
Thought blocking: sudden cessation of thought, typically mid-sentence, with the patient unable to recover what was previously said.
Perseveration: refers to the repetition of a particular response (such as a word, phrase or gesture) despite the absence/removal of the stimulus (e.g. a patient is asked what their name is, and they then continue to repeat their name as the answer to all further questions).
Neologisms: words a patient has made up which are unintelligible to another person.
Word salad: speaking a random string of words without relation to one another.
