MENTAL STATE EXAMINATION

(overview)

Omair Niaz

Consultant Psychiatrist

Kendray Hospital, Barnsley

MRCPsych Course

NOVEMBER 2013

AIM

Overview of mental state examination for the

MRCPsych exams

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OBJECTIVES

• review the importance of mental state examination

• MSE practice using video clips

• 20 true/false questions

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HOW ARE WE GOING TO DO THIS?

• interaction

WHY IS MSE IMPORTANT?

• fundamental for diagnosis

• determines the treatments offered

• helps establish rapport and engage patients in treatment

• therapeutic

• reference point for monitoring changes

• History/MSE/psychopathology - almost 20% of Paper 1!!

PLEASE SEPARATE INTO

SMALL GROUPS OF 4-5

MSE practice 1

MSE practice 2

MSE practice 3

FLIGHT OF IDEAS

• increased speech rate with tenuous associations between ideas

• punning, alliteration, clanging

e.g. “I love bright light. Height, is it important?” “I hate having to wait. Do you think I’m fat?” “I’m lovely with luscious lips. Lorazepam makes me feel lousy.”

MSE practice 4

MSE practice 5

MSE practice 6

True/false questions

MALHI (2000):

1. Prolixity describes flight of ideas in which the train of thought eventually

returns to its original track

2. Nihilistic delusions are delusional beliefs of negation

3. Apophanous perception is the novel delusional interpretation of a normal

perception which cannot be completely understood in terms of the patient’s

mental state

4. Pareidolia describes visual hallucinations that occur in dim light

5. Gedankenlautwerden describes running commentary auditory hallucinations

6. Elementary hallucinations are pseudohallucinations

7. Hypnopompic hallucinations occur at the time of going to sleep

8. Automatic obedience is also called command automatism

9. Mitmachen is a form of automatic obedience

MICHAEL & LAZARO-PERLADO (2003):

10. Jasper’s phenomenological approach to psychopathology attempts to

describe psychiatric symptoms without aetiological assumptions

11. Echo de la penseé is a passivity experience

12. Formication is a haptic hallucination

13. Autochthonous delusions appear fully formed in the subject’s mind

14. Logoclonia is a disorder of speech in schizophrenia

15. Presence of insight is compatible with a diagnosis of mania

16. Pseudo-hallucinations are sensory distortions

17. An insistent claim by a patient that others can read his thoughts is synonymous with thought broadcasting

RAJU ET AL (2002):

18. Auditory hallucinations of sounds other than voices have little diagnostic value

in schizophrenia

19. Extracampine hallucinations may occur in normal individuals

20. Pareidolic illusions are often prodromal in delirium tremens

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OBJECTIVES

• review the importance of mental state examination

• MSE practice using video clips

• 20 true/false questions

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TAKE HOME MESSAGES

• learn the terms and also ICD-10 criteria - easy marks in the exams

• develop a familiar structure for MSE - practice makes perfect

• use every clerking/review as an opportunity to practise

• present MSEs to Consultants/Registrars on ward rounds

• follow up the patients you admit

• don’t forget to assess risk

REFERENCES

• Core Psychiatry by Wright, Stern & Phelan

• Symptoms In The Mind by Sims

• Fish’s Clinical Psychopathology revised by Casey and Kelly

• MCQs for the MRCPsych by Malhi

• Individual Statement Questions for the MRCPsych Part I Examination by Michael and Lazaro-Perlado

• MCQs for the new MRCPsych Part II by Raju, Reilly, Browne and Glynn

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ANY FINAL QUESTIONS?

PLEASE COMPLETE

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