MSE - Template - mid sem exam PDF

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mid sem exam...

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MSE – MENTAL STATE EXAM

Physical appearance: Age, gender, build, ethnicity, defining features (piercings tattoos), hygiene

Behaviour: Eye contact, motor activity, rapport with nurse o Cooperative? o Pacing?

Speech: Rate (rapid, pressured, mute), flow, volume (soft, whispered, loud) and content o Spontaneous speech?

Female, black hair, red top & jeans, Asian ethnicity teenager early twenties, small build, well groomed, good personal hygiene, nil defining features. = (*someone looks poor) dishevelled/ unkept Intermittent/ minimal eye contact, fidgeting with nails & hands but remains comfortable/ seated, responsive to the conversation, no psychomotor agitation noted. = responsive to the conversation = engages in normal conversation = no psychomotor agitation = warm & cooperative or hypervigilant

"Speech is of a normal quantity, rate, volume, and tone, and is fluent and smooth". "Speech is of a normal quantity,

rate, volume, and tone, and is fluent and smooth". Speech is normal quantity rate, volume, grammatical and tone fluent and smooth.

Mood/ affect: Subjective, objective congruent (is it in line with what pt is saying)?

= Reduced rhythm, soft volume Pt stated felt “crap”. (affect) congruent with mood, mood anxious. Pt reactive to topic discussed

= pt described mood as “ “….objectively pt mood o Affect: is it congruent or not seemed .. elevated depressed congruent, what the mood looks like Thought form (and stream):

Normal production thought & continuity ideas. Thoughts are logical and linear.

Amount of thought and its production o Linear: normal o Tangential: (tangent)  give example; when pt asked how day responded by talking about….. o Circumstantiality: (unnecessary details) Thought content: Delusions o Depressive/ anxious thoughts o Obsessions & phobias o SUICIDAL THOUGHTS & HARM TO SELF Perception: Hallucinations, depersonalisation

= Tangential thought (moving thought to thought = overvalued idea = nil thought form disorders

Nil evidence of delusions, nil obsessions & phobias noted or overvalued ideas.

No disturbances in hallucinations nil signs of depersonalisation, pt not seen to respond to unseen stimuli

o Can be visual, auditory, or tactile Cognition: Orientation time, place and person Insight & judgement: Understand problem, symptoms or illness, willing to receive help

Risk: self-harm (risk to property  wanting to give money away), risk to others/ from others protective factors (children, parents, partners) o Suicidal ideation

= pt reports auditory hallucinations “I hear voices in my head” Not cognition formally assessed. Appears orientated to time & place. Pt appears alert & hypervigilant Poor insight as evidence pt stated a plan to end life, although willing to receive help. = Lack of insight as they couldn’t identify there was a problem couldn’t attribute anything and not willing to receive help. = insight impaired in context of depressive state High risk of suicide intent to end life, suicide ideations, pt states “I will jump off the bridge”, recent self-harm. = access to weapons/ access to means to carry out plan ending life = previous harm to self = expresses plan & intent to end life, suicide ideations = presence a plan to end life = this pt is low risk because although they have suicidal thought there is no current plan or intent to end their life. Number of protective factors e.g. kids, parents

Formulation (small summary of MSE): Adolescent female presented appropriately dressed, cooperative, maintained good eye contact. Normal speech described mood as… with a congruent affect. The thought content consisted of…. *Depression. Linear thought form, no perceptual disturbances. Good insight, willingness to get help. Overall, this pt is low risk as they have a number of protective factors, nil suicidal plan or intent to end life.  nil psychotic phenomena (no delusions or hallucinations)

Plan: Pt is current high risk of suicide not to leave ED without psychiatric review. Inspect wounds (medical review), identify with pt triggers of depressive state & copying factors.  low risk: out pt mental health appt with pysch  psychiatric input/ review  admitted: needs urgent psych input, not to leave ED consider mental health act 1) Appearance

Record o Apparent age o Gender o Ethnicity o Grooming and dress (descheveled, clean, lots of layers, not much clothes on?) o Build, height, weight, level of nutrition (slim? fat? well nourished?) o Level of hygiene (body odour?) o Facial Expression o Pupil dilation / constriction o Hair / clothing / style (eccentric? Disorganised?) o Cosmetics and jewellery o Physical identifiers, abnormalities, syndromic or striking features (tattoos, scars, piercings?) o Congruence between age + appearance (look, dress like their age?) 2) Behaviour Behaviour relating with others (clinicians, parents, etc.) Eye contact (good? Downcast? Looking around?) Facial expression Appropriate physical boundaries (defiance, eagerness to please, overfamiliar?) Note presence of hallucinatory behaviours (talking to self, laughing incongruently?) Level of activity psychomotor slowing or agitation, sustained or episodic, coordinated, goal-oriented or erratic o Balance and gait o Unconventional body movements or behaviour o scanning environment, odd mannerisms, repetitive movements, tics, stereotypies, tremor

o o o o o o

3) Speech Assess for

o o o o o o o

Quality: Spontaneous, fluent, accent, language Quantity: Talkative, poverty, mute Rate: Slow, rapid, pressures, mute, normal Volume: Soft, whispered, loud, normal Tone: Prosody, monotonous Articulation Disturbances: slurring, stuttering, mumbling Cluttering: Tongue-tied, rapid, disorganised

4) Mood + Affect Mood: Predominant Emotional experience - Subjective (how feeling?) o Can use 0-10 scale o Client’s own words • Happiness (ecstatic, elevated, lowered, depressed) • Irritability (explosive, irritable, calm) • Stability Affect: Objective and observable. Is immediate expression of emotional state Describe: o Type o Range and stability: constricted, restricted, stable, labile o Reactivity: blunted, flat, expansive, reactive o Appropriateness: appropriate, inappropriate, congruent, incongruous 5) Thought Stream- Amount and Rate/Speed o

Poverty of thought (thought blocking?)

o

Pressure of though

o

Poverty of content (perseveration)

o

Flight of ideas (think about lots at once)

o

Racing ideas

o

Vague, slow or hesitant?

Disturbance in language or meaning: o Neologisms o

Word approximations

Thought content- Delusions (Rigidly held firm beliefs) Have any of the following? o

Obsessions (EG: think they queen)

o

Overvalued ideas (EG: body dysmorphia)

o

Preoccupations (EG: preoccupied with guilt)

o

Depressive thoughts

o

Thoughts of harm to self or others (suicidal thoughts, self-harm, aggressive etc)

o

Persecutory

o

Referential

o

Control, influence, passivity

o

Very firm beliefs (EG: someone trying to kidnap them)

Form: Amount of thought and its production. How do they put thought together? Continuity of ideas: Is it logical & goal-oriented, or Disorganised/ disordered? o Tangential o Derailment o

Circumstantial

o Thought blocking (stop speaking mid-sentence) o

Concrete thinking

Disturbance in language? o Word salad o

Neologisms

o Clanging o Flight of ideas 6) Perception Experiencing any of the following? Hallucinations (responding to things that aren’t there)? 

Person cannot distinguish them from reality



All sensory modality (auditory, visual, olfactory, gustatory, tactile, etc.)



Hearing commands (voice telling person to do something) Illusions?



Person perceives things as different to usual, but accepts that they are not real or that they are perceived differently by others Dissociative symptoms (altered bodily experiences)?



Derealisation = world or surroundings do not feel real



Depersonalisation = feeling detached from self)

7) Cognition Assess the following... Level of consciousness 

Alert, drowsy, delirium, stupor Orientation



Awareness to current setting, date, time, place, person, familiar people awareness to confusion of self



Need for redirection/repeating, sustained activity, distractibility



Immediate - repeat numbers or names back



Short-term - recall 3 objects at 2 and 5 mins



Long-term - recall events of past week Ability



Impression for current abilities



Concrete to abstract thinking

8) Insight and judgement Insight 

Intact, partial or poor insight?



Ability to identify that “something is wrong”, e.g. suicidal thoughts, impulses etc



Acknowledgement of possible mental health problem



Locus of control



Internal vs external

Judgement 

Intact to impaired judgement



Can make good judgements?



Problem solving ability in context of current psychological state 

Current ability to make sound decisions



Being able to foresee/calculate consequences to their actions, etc.

9) Risk Assessment

Risks to self     

Self-harm and suicide Repetitive self-injury Absconding, wandering Health related: drug and alcohol abuse; medical condition (withdrawal, unstable diabetes, delirium, organic brain injury, epilepsy) Quality of life (dignity, reputation, social and financial status)

Risks to others      

Harassment, stalking, predatory intent Violence or aggression Sexual assault or abuse Property damage, incl. arson Public nuisance Reckless behaviour endangering others (e.g. drink driving)

Risks by others 

Physical, sexual or emotional harm or abuse by others • Social or financial abuse or neglect by others...