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Mental States

Mental state examination
by

Brijesh Desai

on 10 May 2015

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Transcript of Mental States

Brain- the final frontier
General Principles
Appearance & behaviour
Speech
Mood
Thoughts
Perception
Cognition
Insight
Further Reading
Mental states are not static - they change over time. Hence reassess.
Always rule out substance use.
What people tell and what one observes are both important.
Try to record important verbatim responses.
App & behav
A disheveled appearance may indicate depression or psychosis or even substance abuse.
A person with psychosis may be very suspicious in behaviour.
Mania may be indicated by unusually gaudy dressing or make up or abnormally familiar or inappropriate behaviour.
The patient may be very agitated and restless (psychomotor agitation) or hardly move (psychomotor retardation)
THOUGHT DISORDERS
Thought disorders
Flow and form
Control
How words and ideas associate with each other,
the flow of thoughts as reflected in speech.
Flight of ideas
Circumstantiality
Perseveration
Retardation
Block
Fusion
Loosening of association
Jumping
from
idea
to
another
one
idea
with
some
link
Rapidly
Takes ages to come to the point
Trail of thought
...suddenly stops
Slow with no initiative
Tangentiality
Thoughts
Ideas
Jumble
Into
One another
Thoughts are too jumbled up to make sense
Mental states
Brijesh Desai

Consultant Psychiatrist
Blackpool CCTT
5.3.14
Mood
Euthymic
Feeling - +ve/ -ve reaction to an experience, marked but transitory.

Affect- differentiated specific feelings directed towards objects

Mood - prolonged prevailing state or disposition

[ used interchangeably in practice]
{From Symptoms in the Mind, Sims}
Perception
Hallucination
Perception without an object
Modality
Auditory
Visual
Tactile
Olfactory
Gustatory
Hypnogogic &
Hypnopompic
Extracampine
Functional
Pseudo- hallucination - 'not concrete or real', an 'as if' experience, in 'inner subjective space' rather than 'external objective space'.

Not a very helpful or robust concept.

Generates a fallacy that it is 'pseudo'
Broken record responses

Think: 'Organic'

Thought insertion
Thought withdrawal
Thought broadcast
(forms of thought passivity)
First Rank Symptoms of Schizophrenia (Schneider, 1959)

Delusion : Delusional percept
Auditory Hallucination: Audible thoughts / thought echo
Voices arguing or discussing
Voices commenting on patient's action
Thought disorder : Thought withdrawal, insertion, broadcast
Passivity experience : Passivity of affect ('made' feelings)
Passivity of impulse ('made' drives)
Passivity of volition ('made' volition)
Somatic passivity

Delusions
Beliefs unshakable by logic despite contrary evidence, out of keeping with patient's cultural beliefs.
Themes of
Delusions
Persecution
Grandiose
Guilt
Severe depression
Infestation
Ekbom's syndrome
Nihilistic
Cotard syndrome
Schizophrenia
Other psyshoses
Mania
Control
Reference
Jealousy
Erotomania
Cognition
Orientation
Attention and concentration
Memory
Language
Visuospatial function
Executive function
MMSE- Mini-mental state examination
(Copyright issues)

MOCA - Montreal Cognitive Assessment

6-CIT - Cognitive Impairment Test
Insight
Awareness
Diagnosis
Treatment
Need for help
Fluctuates over time
Partial / complete
A good sign
Primary
{Autochthonous}
Secondary
Multi-dimentional
Always check for thoughts of harm to self or suicide

and harm to others
Speech
Rate, volume, tone
Coherence
Goal-directedness
Pressured: fast, loud, can't interrupt
Retardation: slow, few words, labored
Alogia
Echolalia
Neologism
Word salad
Further Reading
1. Symptoms in the Mind, Andrew Sims

2. Fish's Clinical Psychopathology, Ed. Max
Hamilton

3. If you are really really really keen:
General Psychopathology, Karl Jaspers
Thank You
EMQ
1. Patient's arms or body can be moved like an anglepoise lamp just with fingertip pressure.

2. Patient remains in the same posture that he is kept in for sustained period.

3. Sudden change in the direction of thinking.

4. Patient imitates your actions despite instructed not to.

5. Patient complains of hearing ones own thoughts spoken aloud.
(A) Mitgehen (B) Waxy flexibility (C) Echopraxia
(D) Knight's move (E) Gedankenlautwerden
Emil Kreplin
Eugene Bleuler
Kurt Schneider
1. Described 'first-rank' symptoms of Schizophenia
2. Coined the term Schizophrenia
3. Separated 'manic depression' from 'dementia praecox'
4. Won Nobel Prize for work on Dopamine
Arvid Carlsson
Hi doctor. Good man. Not good. I am a genius. Injection makes me kind of soft. I have no personality...ha ha ha....like a squirrel. I am not allowed to make mistakes in life.
Illusion
Full transcript