Professional Documents
Culture Documents
Mental State Examination
Mental State Examination
EXAMINATION
What is mental state examination?
An act of OBSERVATION
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Standard Elements of the MSE
Appearance
Behaviour
Conversation
Affect
Perception
Cognition
Insight
Judgement
Rapport
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APPEARANCE
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This may give substantial information
about internal psychic functioning:
Facial expression
Posture
Dress
Self-care
Grooming
State of physical health
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Facial Appearance
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Posture
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Dress
the ordinary
eccentricity – this does not always
equate to abnormal mental state
the bizarre - may reflect abnormality
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Self-care and Grooming
Impairment in grooming
(poorly washed, soiled nails, matted hair,
(offensive body odour…..
may indicate……..????
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Physical Health
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This is an assessment of the person’s
activity during the course of the interview
and is distinct from mere appearances.
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The motor activity may be :
ordinary !
excessive - hyperactive
deficient - retarded
inappropriate
abnormal
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Motor Agitation
Hand wringing
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Motor Retardation
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Inappropriate
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Abnormal Movements
Bizarre – catatonia
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CONVERSATION
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We make an assumption that :
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Flow of Thought
Rate of speech
Volume of speech
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Form of Thought
Refers to HOW the conversation (by implication thought) is put
together – impairment is referred to as
“FORMAL THOUGHT DISORDER”
Examples:
Looseness of association
#disconnectedness between successive ideational concepts
#may be mild to gross (“word salad”)
#tangentiality, verbigeration, “interpenetration of themes” are
variations of loose associations
#an important sign of active psychosis because it cannot be
readily faked.
Flight of ideas
a continuous flow of speech which continues to digress from the
original topic and fails to come to a conclusion – the person often
needs to be interrupted
Thought blocking – stream of thought suddenly, inexplicably
stops
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Content of Thought
Refers to… what is actually said….the ideas that
occupy the mind :
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Feelings are transient emotional states
that are highly reactive to the internal
and external environment and change
constantly
Affect is the form that feelings take
over a relatively brief period of time
Mood is a more pervasive emotional
state that is more stable over time
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Mood is subjective :
the patient TELLS YOU how they feel
Affect is objective :
judged by the OBSERVER and also deduced
from behaviour…..
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Affect can be conceptualised along three
domains:
• Quality – the nature of the affect
depressed, anxious, sad, despondent, anguished, elevated……
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PERCEPTION
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A MSE is not documenting a past history
of these but whether they are active
during the assessment.
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Percept Disturbances
Hallucinations
• are the main disorder of perception that we
describe
• their presence
is elicited by asking the patient, or
revealed by observing behaviour
Illusions
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Depersonalisation - a sense of being disconnected
from yourself
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Hallucinations
True hallucinations
experienced as originating outside the head
(eg. are heard “with the ears”)
Pseudo-hallucinations
experienced as originating inside the head
(eg. seen with the “mind’s eye”)
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Auditory hallucinations are most common in schizophrenia -
they may be elementary or complex. There are typical forms :
Two or more people arguing or commenting about the
person in the third person
A running commentary about the person’s behaviour
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COGNITIVE TESTING
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An essential part of the mental state examination
Aims to detect the presence of an organic brain
syndrome
Results have to be interpreted in context of….
medication educational level
motivation age
tiredness cultural factors
There are good standardized instruments - some
very simple [Folstein’s MMSE] - which screen for
cognitive function but are not very good at detecting
subtle deficits
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Orientation
Memory
Attention and concentration
Language
Parietal lobe tests
Frontal lobe tests
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Orientation
Immediate memory
or registration - ability to hold discrete
information in conscious awareness and
repeat back. Capacity limited, decays
rapidly, impaired by distraction
Short term memory
ability to recall information after distraction
from minutes to hours later. Decays over a
day or two. Requires intact registration.
Long term memory
ability to retrieve information stored from
days to years ago. Does not decay but
retrieval can become impaired
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Memory
Registration
ask the person to repeat
3 objects/sentence immediately giving at
least two attempts
Recall
ask the person to recall
3 objects/sentence after 5 minutes (during
which you distract with other tests)
Retrieve
ask for autobiographical data – where they
spent last Christmas Day, birth-date,
address, where they grew up…..
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Attention and Concentration
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The person’s understanding of their experience :
the nature of it
the consequences for them
their response to it
an awareness of possible reasons why the person
is suffering symptoms at this time and connections
between events and consequent experiences
Arguably THE MOST IMPORTANT FEATURE of
the mental state of a person as may represent the
greatest challenge for intervention and is a key
issue in risk assessment
Several levels:
Partial or complete
Variable or permanent
Intellectual or emotional
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Directly enquire from the person :
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JUDGEMENT
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Ability to make appropriate decisions
Based on :
weighing up of available information
+
anticipating consequences of certain choices
then choosing an appropriate action
Important as impaired judgment is a key issue in
risk assessment
Usually assessed during interview by looking at the
decisions the patient has recently made, or intends
to make, in response to their symptoms or
experiences.
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RAPPORT
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The quality of the relationship formed
between the patient and you the interviewer.
You try to objectively judge the ability of the
patient to engage in the interview process,
to be warm and open in their manner, to
disclose information
(Should) improve as the interview goes on
Some patients (and interviewers!) are
unable to form rapport – an important
mental state sign, as it predicts the capacity
of the person to engage and cooperate with
treatment
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