MSE

Question 1

What is the difference between a formal and informal mental status exam?

Answer 1

• Formal = set of question

- Informal = listening for things as you ask about other things

Question 2

What are the major components of the informal mental exam? (11)

Answer 2

• Appearance
• Behavior
• Attitude toward exam
• Speech
• Mood
• Affect
• Thinking
• Perception
• Sensorium
• Insight
• Judgement

(JA, A BAPTISMS)

Question 3

What is mood?

Answer 3

Subjective emotional experience of the patient

Question 4

What is affect?

Answer 4

Objective assessment of the patient’s emotional responsiveness, as inferred from facial expressions and/or behavior

Question 5

What is the thinking part of the MSE?

Answer 5

• Logical vs illogical
• Goal directed vs not
• Delusions

Question 6

What is the perception of the MSE?

Answer 6

• Hallucinations

- Derealization or depersonalization

Question 7

What is the insight of the MSE?

Answer 7

Do they understand their condition

Question 8

What are the three major indications for a full mental status exam?

Answer 8

If there is concern that a patient

• is psychotic
• Has any type of organic brain dysfunction
• Is functioning so poorly to need hospitalization

Question 9

True or false: cognition tests (e.g. serial 7s) are a part of the full MSE

Answer 9

True

Question 10

True or false: a full MSE is rarely indicated in the outpatient setting

Answer 10

True

Question 11

Are direct questions asked in an informal MSE?

Answer 11

Not usually–based on responses to normal outpatient questions

Question 12

True or false: the appearance part of the MSE can include clothing, grooming etc

Answer 12

True

Question 13

What are the parts of the overt behavior of the MSE?

Answer 13

-Includes patients’ motor behavior, mannerisms, etc

Question 14

What is the attitude part of the MSE?

Answer 14

Describes the patient’s attitude toward the examiner

Question 15

What is the speech part of the MSE?

Answer 15

Describes the patient’s physical characteristics of the patient’s speech (e.g. volume, speed, impairments, etc)

Question 16

True or false: thinking process is distinct from content

Answer 16

True

Question 17

What is circumstantial thinking?

Answer 17

Extraneous information that are irrelevant, but comes back to original thought

Question 18

What is the tangential thinking?

Answer 18

Thinking that does not lead back to the original thought

Question 19

What is derailment / loose associations?

Answer 19

Loss of the logical connection between ideas or sentences as they are being spoken

Question 20

What is clang associations?

Answer 20

Linking words together based on sound, rather than content

Question 21

What is the flight of ideas?

Answer 21

Jumping from topic to topic quickly that are only loosely assocaited

Question 22

What is perseveration?

Answer 22

Repetition of the same words to ideas over and over, despite the conversation moving on

Question 23

What is a non-bizarre delusion? What about bizarre?

Answer 23

Delusions that are plausible

Bizarre = delusions that are implausible

Question 24

What is the judgement bit of the MSE?

Answer 24

Is the patient able to understand the likely consequences of behavior and make decisions accordingly

Question 25

What is the consciousness/alertness bit of sensorium?

Answer 25

Overall level of awareness of the environment

Question 26

What is the orientation bit of sensorium?

Answer 26

Person place and time

Question 27

What is the concentration bit of sensorium?

Answer 27

Capacity to focus on the conversation or can formally assess with serial 7s

Question 28

What is the memory bit of sensorium? (3)

Answer 28

- Immediate-repeat a series of number - Recent--Recall events from a few minutes to a few days ago - Remote--Recall events from years ago

Question 29

What is the fund of knowledge bit of sensorium?

Answer 29

Recall for basic facts about the world

Question 30

What is the abstract reasoning bit of sensorium?

Answer 30

Can be tested by asking the patient to explain a proverb like, make hay while the sun shines

Question 31

What is the reading and writing bit of sensorium?

Answer 31

Ask the patient to read a sentence and write a sentence

Question 32

What is the visuospatial ability bit of sensorium?

Answer 32

Ask the patient to draw a clock or copy a figure

Question 33

Does speech describe the content what is spoken?

Answer 33

No--only the physical characteristics of it

Question 34

Talkative vs unspontaneous (only responsive to questions) is listed in what component of the PE?

Answer 34

Speech

Question 35

What is a normal affect?

Answer 35

Variable and appropriate to content

Question 36

What is an incongruent affect?

Answer 36

Affect that does not match mood

Question 37

What is thought blocking?

Answer 37

When there is an abrupt stop or break in the flow of ideas

Question 38

Does the perceptions part of the MSE include the content of a hallucination?

Answer 38

Yes

Question 39

Does the perceptions part of the MSE include the time when a hallucination occurs?

Answer 39

Yes

Question 40

What should you always begin the interview with?

Answer 40

Overview of what you intend to do with the time

Question 41

Should you use leading questions or open ended questions during a MSE?

Answer 41

Open ended

Question 42

How can you build a sense of collaboration between you and your patient?

Answer 42

- Look for their strengths | - Quick to understand, slow to offer advice

Question 43

What are the three major problems if a pt feels shame during an MSE?

Answer 43

- lost to f/u - Leave out details - Strike back

Question 44

Is reflecting and summarizing what a patient said good?

Answer 44

Yes

Question 45

What are the five factors that should always be elicited with a psych history?

Answer 45

- Substance use - H/o trauma - Occupation - Relationship - Social support (SORTS)

Question 46

What should always be assessed with a suicidal patient?

Answer 46

- Ideation - Plan - Means - Intent