MSE

Question 1

What is MSE?

Answer 1

Part of psych eval including a “snapshot” description of patient with examiners observations (objective) and complaints/symptoms of patients (subjective) components

Question 2

Outline of MSE (10)

Answer 2

• Appearance/behavior
• Psychomotor abnormalities
• Speech
• Mood
• Affect
• Thought process
• Thought content
• Sensorium/intellectual fxn
• Insight
• Judgment

Question 3

Define appearance/behavior

Answer 3

Objective description of patient as observed (able to identify pt w/o seeing them)

Question 4

Components of appearance/behavior

Answer 4

• Physcial chars (sex, wt, physical health)
• Apparent vs chronological age
• Physical stigmata (Downs, FAS, tattoos)
• Dress
• Grooming
• Posture
• Facial expression
• Eye contact
• Receptiveness to interview (cooperative, attentive, seductive, hostile, guarded)

Question 5

Define psychomotor activity

Answer 5

Amount and type of movement (retardation or agitation)

Question 6

Bradykinesia

Answer 6

Slowness of activity, decrease in spontaneous movement

Question 7

Akasthisia

Answer 7

Subjective feeling of muscular tension –> restlessness (often caused by 1st gen antipsychotics)

Question 8

Catalepsy

Answer 8

Waxy flexibility, immobile position that is constantly maintained

Question 9

Stereotypies

Answer 9

Repetitive, fixed pattern of physical action/speech (e.g. hand flapping, waving, body rocking, head banging); often associated w/ intellectual disability and/or autism

Question 10

Cataplexy

Answer 10

Temporary loss of muscle tone precipitated by emotion (symptom of narcolepsy)

Question 11

Tardive dyskinesia

Answer 11

Abnormal, involuntary, irregular choreoathetoid movements of head, limbs, or trunk – perioral most common (darting, twisting, protrustion of tongue; chewing/lateral jaw movements; lip puckering; facial grimacing)

Question 12

Speech components

Answer 12

Quantity, quality, rate

Question 13

Pressured speech

Answer 13

Rapid speech increased in amount and difficult to interpret

Question 14

Wernicke’s aphasia

Answer 14

Receptive – speech is fluent but comprehension is impaired; normal effort; empty content of words and full of substitutions/neologisms (nonsense)

Question 15

Broca’s aphasia

Answer 15

Expressive – speech is nonfluent; comprehension intact; effortful/frustrating; speech sparse/absent

Question 16

Define mood

Answer 16

Pervasive/sustained emotion experienced by pt over time (subjectively reported)

Question 17

Define affect

Answer 17

Outward expression of mood – objectively observed

Question 18

Components of affect

Answer 18

Variability, intensity, appropriateness to mood

Question 19

Labile affect

Answer 19

Rapid and abrupt changes in emotional tone, unrelated to external stimuli

Question 20

Constricted/restricted affect

Answer 20

Reduction in intensity of feeling, less severe than blunted, but clearly reduced

Question 21

Define thought process

Answer 21

Way that a person puts together ideas/associations

Question 22

Normal thought process

Answer 22

Linear, goal-directed

Question 23

Tangential

Answer 23

Thought process with inability to have goal directed associations (never gets to end point)

Question 24

Circumstantial

Answer 24

Thought process where abundant in detail and delayed in reaching point, but gets there

Question 25

Flight of ideas

Answer 25

Rapid, continuous verbalization w/ constant shifting from one idea to next w/ idea connection (least severe can be followed)

Question 26

Loose associations

Answer 26

Flow of thoughts where ideas shift from one subject to another without relation; severe will be incoherent

Question 27

Word salad

Answer 27

Jumbled words/phrases w/o comprehensible meaning

Question 28

Components of thought content

Answer 28

- Hallucinations - Delusions - Illusions - Recurring themes (e.g. negative ruminations, obesessions) - Suicidal/homicidal ideation

Question 29

Hallucinations

Answer 29

False sensory perception not associated with real external stimuli

Question 30

Types of illusions and assc. features

Answer 30

- Auditory (usually voices; primary psychiatric illness; command w/ obligation to obey/unable to resist) - Visual (formed images or light flashes; usually psychosis from other illness) - Olfactory (assc. w/ another illness) - Gustatory (usually uncinate seizure) - Tactile (e.g. formication "bugs crawling under skin" as assc. w/ substance w/drawal)

Question 31

Hypnagogic hallucinations

Answer 31

False sensory perceptions that occur upon falling asleep (normal)

Question 32

Hypnopompic hallucinations

Answer 32

False sensory perceptions that occur when waking (normal)

Question 33

Delusions

Answer 33

Fixed false belief

Question 34

Types of delusions

Answer 34

Bizarre (couldn't happen) vs. non-bizarre

Question 35

Non-bizarre delusion subtypes

Answer 35

- Grandiose: exaggerated idea of one's importance, power, identity - Reference: incorrectly interpreting casual incidents/external events as having direct personal reference

Question 36

Obession

Answer 36

Pathological persistence of an irresistible thought/feeling that can't be eliminated from consciousness

Question 37

Illusion

Answer 37

Misinterpretation of real external sensory stimuli

Question 38

Recurring theme

Answer 38

Topic patient focuses on and continues to return to during interview (e.g. negative ruminations or obsessions)

Question 39

Suicidal and homicidal ideation considerations

Answer 39

- Passive vs active | - Thoughts vs. plans

Question 40

Components of sensorium/intellectual fxn

Answer 40

- Consciousness - Orientation - Attention/concentration - Memory - Abstraction - Fund of knowledge

Question 41

Consciousness descriptors

Answer 41

Alert, drowsy, comatose

Question 42

Orientation components

Answer 42

Person, place, time (maintained in that order)

Question 43

Attention and concentration tests

Answer 43

- Serial 7s - Spelling word backwards - Repeating series of random #s - Repeating 3/4 unrelated objects after 5-10 min

Question 44

Memory tests -- Immediate, recent, and remote

Answer 44

- Immediate: repeat 3 words - Recent (events w/in 24 hrs): last meal - Remote (from life): DOB, # siblings

Question 45

Abstraction test

Answer 45

Ask for interpretation of proverb and look for either concrete or abstract answer

Question 46

Fund of knowledge test

Answer 46

Ask pt to name past presidents or world events (consideration: education dependent)

Question 47

Define insight

Answer 47

Awareness and understanding of illness (range from denial to true insight)

Question 48

Define judgment

Answer 48

Ability to make/carry out plans, discriminate accurately, and behave appropriately in social situations; can evaluated on history or imaginary scenario