Mental state examination Health Dictionary

Mental State Examination: From 1 Different Sources


(MSE) a full psychiatric examination of signs and symptoms, which takes place during a psychiatric interview and should apply only to signs and symptoms elicited at that time; it should not take into account historical information. The examination is usually divided into the following subheadings: appearance and behaviour, speech, mood, *affect, thought and perception, *insight, and orientation. Usually it also includes a *risk assessment.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Mental Illness

All forms of illness in which psychological, emotional or behavioural disturbances are the dominating feature. The term is relative and variable in different cultures, schools of thought and definitions. It includes a wide range of types and severities.... mental illness

Mental Handicap

See LEARNING DISABILITY.... mental handicap

Mental Impairment

A disorder characterized by the display of an intellectual defect, as manifested by diminished cognitive, interpersonal, social and vocational effectiveness and quantitatively evaluated by psychological examination and assessment.... mental impairment

Physical Examination

That part of a patient’s consultation with a doctor in which the doctor looks, feels (palpates) and listens to (auscultates) various parts of the patient’s body. Along with the history of the patient’s symptoms, this enables the doctor to assess the patient’s condition and decide whether an immediate diagnosis is possible or whether laboratory or imaging investigations are needed to reach a diagnosis. A full physical examination may take 30 minutes or more. Physical examination, along with certain standard investigations, is done when a person attends for a ‘preventive’ check-up of his or her state of health.... physical examination

Mental Age

A measurement of the intellectual development of a person, with regard to the normal age at which that level of achievement is attained.

For example, a 13 year-old child with learning difficulties may have a mental age of 5.... mental age

Mental Health Act

The Mental Health

Act (1983) details the rights of patients with mental illness and the grounds for detaining mentally ill people against their will. It also outlines forms of legal guardianship for such patients.

When a person is endangering his or her own or other people’s health or safety (for example, threatening harm or suicide) because of a recognized mental illness, he or she may be compulsorily taken into hospital to be given treatment.

If a person breaks the law because of a mental disorder, the courts may remand him or her to hospital.... mental health act

Mental Retardation

See Learning difficulties.... mental retardation

Persistent Vegetative State

Long-term unconsciousness caused by damage to areas of the brain that control higher mental functions. The eyes may open and close, and there may be random movements of the limbs, but there is no response to stimuli such as pain. Basic functions such as breathing and heartbeat are not affected. There is no treatment to reverse the situation, but, with good nursing care, survival for months or years is possible.... persistent vegetative state

Anxiety State

See NEUROSIS.... anxiety state

Community Mental Health Centre

An entity which provides comprehensive mental health services (principally ambulatory), primarily to individuals residing or employed in a defined catchment area.... community mental health centre

Community Mental Health Teams

Intended as a key part of the NHS’s local comprehensive mental health services serving populations of around 50,000, these multidisciplinary, multi-agency teams have been less e?ective than expected, in part due to varying modes of operation in di?erent districts. Some experts argue that the services they provide – for example, crisis intervention, liaison with primary care services and continuing care for long-term clients – could be delivered more e?ectively by several specialist teams rather than a single, large generic one comprising psychiatrists, psychologists, community mental health nurses, occupational therapists, support and (sometimes) social workers.... community mental health teams

Mental Health

The absence of psychiatric disorders or traits. It can be influenced by biological, environmental, emotional and cultural factors. This term is highly variable in definition, depending on time and place.... mental health

Mental Health Problems In Children

Emotional and behavioural problems are common in children and adolescents, affecting up to one-?fth at any one time. But these problems are often not clear-cut, and they may come and go as the child develops and meets new challenges in life. If a child or teenager has an emotional problem that persists for weeks rather than days and is associated with disturbed behaviour, he or she may have a recognisable mental health disorder.

Anxiety, phobias and depression are fairly common. For instance, surveys show that up to

2.5 per cent of children and 8 per cent of adolescents are depressed at any one time, and by the age of 18 a quarter will have been depressed at least once. Problems such as OBSESSIVE COMPULSIVE DISORDER, ATTENTION DEFICIT DISORDER (HYPERACTIVITY SYNDROME), AUTISM, ASPERGER’S SYNDROME and SCHIZOPHRENIA are rare.

Mental-health problems may not be obvious at ?rst, because children often express distress through irritability, poor concentration, dif?cult behaviour, or physical symptoms. Physical symptoms of distress, such as unexplained headache and stomach ache, may persuade parents to keep children at home on school days. This may be appropriate occasionally, but regularly avoiding school can lead to a persistent phobia called school refusal.

If a parent, teacher or other person is worried that a child or teenager may have a mental-health problem, the ?rst thing to do is to ask the child gently if he or she is worried about anything. Listening, reassuring and helping the child to solve any speci?c problems may well be enough to help the child feel settled again. Serious problems such as bullying and child abuse need urgent professional involvement.

Children with emotional problems will usually feel most comfortable talking to their parents, while adolescents may prefer to talk to friends, counsellors, or other mentors. If this doesn’t work, and if the symptoms persist for weeks rather than days, it may be necessary to seek additional help through school or the family’s general practitioner. This may lead to the child and family being assessed and helped by a psychologist, or, less commonly, by a child psychiatrist. Again, listening and counselling will be the main forms of help o?ered. For outright depression, COGNITIVE BEHAVIOUR THERAPY and, rarely, antidepressant drugs may be used.... mental health problems in children

Mental Health Services

Comprehensive mental health services, as generally defined under some national (or state) laws and statutes, include: inpatient care, outpatient care, day care and other partial hospitalization and emergency services; specialized services for the mental health of the elderly; consultation and education services and specialized programmes for the prevention, treatment and rehabilitation of alcohol and drug abusers. They generally include a variety of services provided to people of all ages, including counselling, psychotherapy, psychiatric services, crisis intervention and support groups. Issues addressed include depression, grief, anxiety and stress, as well as severe mental illnesses.... mental health services

State Medicine (health Care Systems)

Major government schemes to ensure adequate health services to substantial sectors of the community through direct provision of services.... state medicine (health care systems)

Persistent Vegetative State (pvs)

PVS may occur in patients with severe brain damage from HYPOXIA or injury. Patients do not display any awareness of their surroundings, and are unable to communicate. Sleep alternates with apparent wakefulness, when some re?exes (see REFLEX ACTION) may be present: for example, patients’ eyes may re?exly follow or respond to sound, their limbs can re?exly withdraw from pain, and their hands can re?exly grope or grasp. Patients can breathe spontaneously, and retain normal heart and kidney function, although they are doubly incontinent (see INCONTINENCE).

For a diagnosis of PVS to be made, the state should have continued for more than a prede?ned period, usually one month. Half of patients die within 2–6 months, but some can survive for longer with arti?cial feeding. To assess a person’s level of consciousness, a numerical marking system rated according to various functions – eye opening, motor and verbal responses – has been established called the GLASGOW COMA SCALE.

The ETHICS of keeping patients alive with arti?cial support are controversial. In the UK, a legal ruling is usually needed for arti?cial support to be withdrawn after a diagnosis of PVS has been made. The chances of regaining consciousness after one year are slim and, even if patients do recover, they are usually left with severe neurological disability.

PVS must be distinguished from conditions which appear similar. These include the ‘LOCKED-IN SYNDROME’ which is the result of damage to the brain stem (see BRAIN). Patients with this syndrome are conscious but unable to speak or move except for certain eye movements and blinking. The psychiatric state of CATATONIA is another condition in which the patient retains consciousness and will usually recover.... persistent vegetative state (pvs)

Post-mortem Examination

Also called an autopsy (and less commonly, necropsy), this is an examination of a body to discover the causes of death. Such an examination is sometimes required by law. An unnatural death; a death occurring in suspicious circumstances; or a death when a doctor feels unable to complete a certi?cate about the cause – all must be reported to the CORONER (in Scotland, to the procurator ?scal). He or she may order an autopsy to be carried out as part of the inquiry into cause of death. Sometimes doctors may request the permission of relatives to perform a post-mortem so that they may discover something of value for the improvement of medical care. Relatives may refuse consent. (See also DEATH, CAUSES OF.)... post-mortem examination

Confusional State

An acute distressing symptom in elderly and very young people. ‘Lack of clarity in thinking.’ Mild brain failure. Temporary character-change and alteration in behaviour. Absence of classical symptoms of illness. Cannot formulate answers.

Diagnosis: dementia requires six months mental impairment, whereas acute confusional states may develop in a few days. Distinguish from Alzheimer’s disease.

Causes: Oxygen deficiency in the tissues (Vitamin E). Toxaemia (eliminatives). Delirium (nerve relaxants). Infections (Echinacea). Metabolism (Dandelion). Drugs (Ginseng). Hypothermia (Cayenne). Nutritional (Slippery Elm, thiamine).

Tea. Combine herbs, equal parts: Agrimony, Skullcap, Balm. 2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup freely.

Ginkgo: Favourable results reported.

Vitamins. B-complex. B12. Thiamine. E (1000iu daily). Minerals. Dolomite. Zinc. ... confusional state

Examinations Jitters

Excessive nervousness. Overwhelmed by cumulative effects of prolonged worry, chronic fatigue, feeling of unwellness, loss of appetite, stomach upsets, poor concentration. To relax nerves, aid digestion and healthful sleep:

Alternatives: tablets, capsules, tinctures, extracts etc. Alfalfa, Primrose flowers, Ginseng, Vervain, Skullcap, Valerian, Passiflora, Ginkgo, Siberian Ginseng, Hops.

Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Skullcap, Valerian, Mistletoe. Doses. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water thrice daily.

On retiring. Cup Passion flower tea. (1-2 teaspoons to cup boiling water) ... examinations jitters

Barium X-ray Examinations

Procedures used to detect and follow the progress of some gastrointestinal tract disorders. Because X-rays do not pass through it, barium is used to outline organs, such as the stomach, which are not normally visible on an X-ray. In some cases, barium X-rays are an alternative to endoscopy. Barium sulphate mixed with water is passed into the part of the tract requiring examination, and X-rays are taken. X-rays may be singleor double-contrast. Single-contrast barium X-rays use barium sulphate alone. The barium fills the section of the tract and provides an outline image that shows up prominent abnormalities. In double-contrast barium X-rays, the barium forms a thin film over the inner surface of the tract, and the tract is filled with air so that small surface abnormalities can be seen.

Different types of barium X-ray examination are used to investigate different parts of the gastrointestinal tract. Barium swallow involves drinking a barium solution and is used to investigate the oesophagus. A barium meal is carried out to look at the lower oesophagus, stomach, and duodenum. Barium followthrough is used to investigate disorders of the small intestine; X-rays are taken at intervals as the barium reaches the intestine. A barium enema is used to investigate disorders of the large intestine and rectum; barium is introduced though a tube inserted in the rectum. Barium remaining in the intestine may cause constipation. Therefore, it is important to have a high-fibre diet and drink plenty of water after a barium examination, until all the barium has passed through.... barium x-ray examinations

Mental Hospital

A hospital, formerly known as an asylum, specializing in the treatment of psychiatric illness.

Most admissions to mental hospitals are for acute psychiatric illness.

The majority of admissions are voluntary, but in some cases detention under the Mental Health Act may be necessary.... mental hospital

Pelvic Examination

Examination of a woman’s external and internal genitalia.

After examination of the external genitalia, a speculum is inserted into the vagina to allow a clear view of the cervix.

A cervical smear test may be performed.

The doctor inserts 2 fingers into the vagina and, with the other hand, feels the abdomen to evaluate the position and size of the uterus and the ovaries and to detect any tenderness or swelling.... pelvic examination

Breast Self-examination

Visual and manual examination of the breasts carried out by a woman to detect lumps

and other changes that might be an indication of early breast cancer. To carry out self-examination, the breasts should be checked in a mirror for any dimpling of the skin or changes in the nipples or breast size and shape. Then, with one arm behind the head, and using small circular movements, the breast should be gently but firmly pressed. The entire breast, armpit area, and nipple should be examined. Regular self-examination helps a woman to become familiar with the appearance and feel of her breasts; any changes should be reported to a doctor without delay.... breast self-examination

Dental Examination

An examination of the mouth, gums, and teeth by a dentist as a routine check or as part of the assessment a person complaining of a symptom. Routine examinations enable tooth decay and gum disease to be detected and treated at an early stage.

During a routine dental examination, the dentist uses a metal instrument to

probe for dental cavities, chipped teeth, or fillings. Dental X-rays are sometimes carried out to check for problems that may not be visible. Dentists also check how well the upper and lower teeth come together. Regular examinations in children enable the monitoring of the replacement of primary teeth by permanent, or secondary, teeth. Referral for orthodontic treatment may be made. dental extraction See tooth extraction. dental X-ray An image of the teeth and jaws that provides information for detecting, diagnosing, and treating conditions that can threaten oral and general health. There are 3 types of dental X-ray: periapical X-ray, bite-wing X-ray, and panoramic X-ray.

Periapical X-rays are taken using X-ray film held behind the teeth. They give detailed images of whole teeth and the surrounding tissues. They show unerupted or impacted teeth, root fractures, abscesses, cysts, and tumours, and can help diagnose some skeletal diseases. Bite-wing X-rays show the crowns of the teeth and can detect areas of decay and changes in bone due to periodontal disease. Panoramic X-rays show all the teeth and surrounding structures on one large film. They can show unerupted or impacted teeth, cysts, jaw fractures, or tumours. The amount of radiation received from dental X-rays is extremely small. However, dental X-rays should be avoided during pregnancy.... dental examination

Ear, Examination Of

The ear may be examined to investigate earache, discharge from the ear (see ear, discharge from), hearing loss, a feeling of fullness in the ear, disturbed balance, tinnitus, or swelling of lymph nodes (see glands, swollen) around the ear.

To view the ear canal and eardrum, an otoscope may be used. To obtain images of the middle and inner ears, X-rays, CT scanning, or MRI may be carried out. Hearing and balance can be assessed by means of hearing tests or caloric tests. Electronystagmography assesses balance by watching eye movements when water is inserted into the ear. ear, foreign body in Foreign bodies can easily enter the ear canal. Children often insert objects into their ears, and insects may crawl or fly in. Objects in the ear must be removed by a doctor. This can be done by syringing of the ear or by using fine-toothed forceps. Insects can sometimes be floated out with olive oil or lukewarm water.... ear, examination of

Examination, Physical

The part of a medical consultation in which the doctor looks, feels, and listens to various parts of the patient’s body to assess the patient’s condition or to gather information to help make a diagnosis.

Most examinations include palpation, by which the doctor examines relevant parts of the body for signs such as swelling, tenderness, or enlargement of organs. In some cases, percussion of the chest, or other parts of the body, may be performed by tapping with the fingers and then listening to the sound produced. Auscultation may be used to listen to blood flow through arteries and sounds made by the heart and lungs. The doctor may take the pulse or blood pressure, examine the eyes and ears, and assess the strength and coordination of the muscles.... examination, physical

Eye, Examination Of

An inspection of the structures of the eyes, either as part of a vision test or to make a diagnosis when an eye disorder is suspected.

An eye examination usually begins with inspection of the external appearance of the eyes, lids, and surrounding skin. A check of eye movements is usually performed and the examiner looks for squint. A check of the visual acuity in each eye using a Snellen chart follows. Refraction testing (using lenses of different strengths) may be performed to determine what glasses or contact lenses, if any, may be needed. A test of the visual fields may be performed, especially in suspected cases of glaucoma or neurological conditions. Colour vision may be checked because loss of colour perception is an indication of certain disorders of the retina or optic nerve. To check for abrasions or ulcers, the conjunctiva and cornea may be stained with fluorescein. Applanation tonometry is an essential test for glaucoma.

The ophthalmoscope is an instrument used to examine the inside of the eye, particularly the retina. The slit-lamp microscope, with its illumination and lens magnification, allows examination of the conjunctiva, cornea, front chamber of the eye, iris, and lens. For a full view of the lens and the structures behind it, the pupil must be widely dilated with eye-drops.... eye, examination of

Postmortem Examination

An alternative term for an autopsy.... postmortem examination

Auditory Steady State Response

(ASSR) an objective test of hearing that measures the electrical activity in the auditory nerve and *brainstem following sound stimulation using a modulated continuous tone.... auditory steady state response

Community Mental Health Team

(CMHT) a multidisciplinary team consisting of psychiatrists, psychiatric nurses, psychologists, social workers, and occupational therapists who treat patients with severe mental illness in the community.... community mental health team

Diagnostic And Statistical Manual Of Mental Disorders

see DSM.... diagnostic and statistical manual of mental disorders

Hyperosmolar Hyperglycaemic State

(HHS) a state of extreme hyperglycaemia seen in type 2 diabetes accompanied by dehydration that can be severe, typically triggered by illness in a patient with type 2 diabetes or a patient with previously unknown type 2 diabetes. It was previously known as hyperosmolar non-ketotic hyperglycaemia (HONK). Emergency hospital treatment is required to control blood glucose levels and to treat the dehydration and the underlying precipitating cause. There is a significant mortality, especially in the elderly and patients with other disorders (e.g. vascular disease). While insulin is required as part of the initial emergency treatment, the patient often does not need insulin in the longer term, when well.... hyperosmolar hyperglycaemic state

Independent Mental Capacity Advocate

(IMCA) a person who must, by virtue of the *Mental Capacity Act 2005, be contacted to represent the *best interests of a patient who lacks *capacity and has no family or friends while acting as a proxy in medical decision-making. IMCAs are available via the local Independent Mental Capacity Advocacy Service.... independent mental capacity advocate

Mental Capacity Act 2005

legislation for England and Wales, which came into force in October 2007, to govern the treatment of people who lack *capacity to make decisions. It gives legal force to the importance of *autonomy in health care and to *advance directives, decisions, or statements. It also provides statutory legislation for medical and social decision-makers to act in the patient’s best interests should he or she lose capacity (see Independent Mental Capacity Advocate). It allows proportionate force to implement decisions made in a patient’s best interests. For Scotland the current legislation is the Adults with Incapacity (Scotland) Act 2000.... mental capacity act 2005

Mental Health Act Commission

a regulating body in England and Wales, governed by the Mental Health Act 2007, that was responsible for regularly visiting psychiatric hospitals, reviewing psychiatric care, giving second opinions on the need for certain psychiatric treatments, and acting as a forum for the discussion of psychiatric issues. It was subsumed under the *Care Quality Commission in April 2009.... mental health act commission

Mental Health Review Tribunal

(MHRT) a tribunal, established under the Mental Health Act 1959 and now operating under the Mental Health Act 2007, to which applications may be made for the discharge from hospital of a person compulsorily detained there under provisions of the Act (see compulsory admission). When a patient is subject to a restriction order an application may only be made after his or her first six months of detention. The powers of the tribunal, which comprises both legally and medically qualified members, include reclassifying unrestricted patients, recommending leave of absence for a patient, delaying discharge, and transferring patients to other hospitals. Detained patients may also apply to have a managers hearing to review their detention. The powers of the managers hearing are slightly different from those of the MHRT, but both are defined in the Mental Health Act 2007 and both can discharge a patient from a section of the Mental Health Act.... mental health review tribunal

Minimally Conscious State

(MCS) a disorder of consciousness distinct from *persistent vegetative state (PVS) and locked-in syndrome (see vegetative state). Unlike PVS, patients with MCS have partial preservation of conscious awareness although the level of awareness frequently fluctuates over time.... minimally conscious state

Mini-mental State Examination

(MMSE) a brief 30-point questionnaire that is used to screen for cognitive impairment in the diagnosis of dementia. It is also used to estimate the severity of cognitive impairment and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document response to treatment. It tests functions including arithmetic, memory, and orientation.... mini-mental state examination

Mixed Affective State

a state of disordered mood that combines elements of *mania and *depression; it is a common feature of *bipolar affective disorder. Symptoms include overactivity, flight of ideas, depressed mood, and suicidal *ideation.... mixed affective state

Objective Structured Clinical Examination

(OSCE) a type of examination used increasingly in the health sciences (medicine, dentistry, nursing, physiotherapy, pharmacy) to assess clinical skills in examination, communication, medical procedures, and interpretation of results. The examination usually takes the form of a circuit of stations around which each candidate moves after a specified time interval (5–10 minutes) at each station. Stations are a mixture of interactive and noninteractive tasks. Some have an examiner and a simulated patient, either an actor for assessment of communication or history-taking skills or a manikin of a specific part of the body (e.g. to demonstrate how to use an auriscope). Other stations have investigation results with a list of questions that are to be completed on computer-marked examination papers. Each station has a different examiner and the stations are standardized with specific marking criteria, thus enabling fairer comparison with peers.... objective structured clinical examination

Vegetative State

the clinical condition of unawareness of the self or the environment. The patient breathes spontaneously and has a stable circulation and sleep/wake cycles. It results from extensive damage to the cerebral cortex and thalamus while the brainstem and hypothalamus remain intact. The commonest causes are traumatic brain injury (e.g. road-traffic accidents) and cardiopulmonary arrest. Conditions that mimic the vegetative state include the psychiatric state of *catatonia and the locked-in syndrome, resulting from damage to the brainstem, in which the patient is conscious but unable to speak or make any movements of the body except for blinking and upward eye movements. See also persistent vegetative state.... vegetative state



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