mse

Mental state examination

Appearance

A person’s appearance can provide useful clues into their quality of self-care, lifestyle and daily living skills.

  • distinctive features
  • clothing
  • grooming
  • hygiene

Behaviour

As well as noting what a person is actually doing during the examination, attention should also be paid to behaviours typically described as non-verbal communication.  These can reveal much about a person’s emotional state and attitude.

  • facial expression
  • body language and gestures
  • posture
  • eye contact
  • response to the assessment itself
  • rapport and social engagement
  • level of arousal (e.g. calm, agitated)
  • anxious or aggressive behaviour
  • psychomotor activity and movement (e.g. hyperactivity, hypoactivity)
  • unusual features (e.g. tremors, or slowed, repetitive, or involuntary movements)

Mood and affect

It can be useful to conceptualise the relationship between emotional affect and mood as being similar to that between the weather (affect) and the season (mood).  Affect refers to immediate expressions of emotion, while mood refers to emotional experience over a more prolonged period of time.

Affect:

  • range (e.g. restricted, blunted, flat, expansive)
  • appropriateness (e.g. appropriate, inappropriate, incongruous)
  • stability (e.g. stable, labile)

Mood:

  • happiness (eg, ecstatic, elevated, lowered, depressed)
  • irritability (e.g. explosive, irritable, calm)
  • stability

 

Speech

Speech can be a particularly revealing feature of a person’s presentation and should be described behaviourally as well as considering its content (see also section on Thoughts).  Unusual speech is sometimes associated with mood and anxiety problems, schizophrenia, and organic pathology.

  • speech rate (e.g. rapid, pressured, reduced tempo)
  • volume (e.g. loud, normal, soft)
  • tonality (e.g. monotonous, tremulous)
  • quantity (e.g. minimal, voluble)
  • ease of conversation

Cognition

This refers to a person’s current capacity to process information and is important because it is often sensitive (though in young people usually secondary) to mental health problems.

  • level of consciousness (e.g. alert, drowsy, intoxicated, stuporose)
  • orientation to reality (often expressed in regard to time/place/person - e.g. awareness of the time/day/date, where they are, ability to provide personal details)
  • memory functioning (including immediate or short-term memory, and memory for recent and remote information or events)
  • literacy and arithmetic skills
  • visuospatial processing (e.g. copying a diagram, drawing a bicycle)
  • attention and concentration (e.g. observations about level of distractibility, or performance on a mentally effortful task – e.g. counting backwards by 7’s from 100)
  • general knowledge
  • language (e.g. naming objects, following instructions)
  • ability to deal with abstract concepts (e.g. describing conceptual similarity between two things).

Thoughts

A person’s thinking is generally evaluated according to their thought content or nature, and thought form or process.

Content:

  • delusions (rigidly held false beliefs not consistent with the person’s background)
  • overvalued ideas (unreasonable belief, e.g. a person with anorexia believing they are overweight)
  • preoccupations
  • depressive thoughts
  • self-harm, suicidal, aggressive or homicidal ideation
  • obsessions (preoccupying and repetitive thoughts about a feared or catastrophic outcome, often indicated by associated compulsive behaviour)
  • anxiety (generalised, i.e. heightened anxiety with no specific referent; or specific, e.g. phobias)

Process:

Thought process refers to the formation and coherence of thoughts and is inferred very much through the person’s speech and expression of ideas.

  • highly irrelevant comments (loose associations or derailment)
  • frequent changes of topic (flight of ideas or tangential thinking)
  • excessive vagueness (circumstantial thinking)
  • nonsense words (or word salad)
  • pressured or halted speech (thought racing or blocking)

Perception

Screening for perceptual disturbance is critical for detecting serious mental health problems like psychosis (this is relatively rare in young people, though peak onset is between 19 and 22 years), cases of severe anxiety, and mood disorders.  It is also important in trauma or substance abuse.  Perceptual disturbances are typically marked and may be disturbing or frightening.

Dissociative symptoms:

  • derealisation (feeling that the world or one’s surroundings are not real)
  • depersonalisation (feeling detached from oneself)

Illusions:

  • the person perceives things as different to usual, but accepts that they are not real, or that
  • things are perceived differently by others

Hallucinations:

  • probably the most widely known form of perceptual disturbance
  • hallucinations are indistinguishable by the sufferer from reality
  • can affect all sensory modalities, although auditory hallucinations are the most common
  • in children it is common to experience self-talk or commentary as an internal “voice”
  • command hallucinations (voices telling the person to do something) should be investigated
  • important to note the degree of fear and/or distress associated with the hallucinations

Insight & Judgement

Insight and judgement is particularly important in triaging psychiatric presentations and making decisions about safety.

Insight:

  • acknowledgement of a possible mental health problem
  • understanding of possible treatment options and ability to comply with these
  • ability to identify potentially pathological events (e.g. hallucinations, suicidal impulses)

Judgement:

  • refers to a person’s problem-solving ability in a more general sense
  • can be evaluated by exploring recent decision-making or by posing a practical dilemma (e.g. what should you do if you see smoke coming out of a house?)
  • supergirl s2: so kara and james break up because kara is not actually interested
  • me: wat
  • supergirl s2: j'onn and clark fight about kryptonite and clark is right the organization handling aliens shouldn't have any!!!
  • me: WAT
  • supergirl s2: kara chooses to partner up with mon-el, a guy with superpowers who literally says that he just wants to do the ~hero thing~ to spend time with kara while she tells james that he's not 'strong enough' being a hero out there, trying to actually help people
  • me: what the everlasting fresh fuck--
  • supergirl s2: alex blows off kara on her earth birthday to go on a date
  • me: OKAY NOW YOU JUST GONE TOO FAR
Kisahku 1: Sauna ****2

Sbnarnya abg da lama nk g sauna ni. Sepanjang abg stay KL dlu, abg x pnah sekali pn pegi. Dgr mmber2 cite mcm best. Tp abg still x berani nk pegi. Skrg abg da pndah ke negeri lain baru terhegeh2 nk pegi. Hahaha….

Kisah bermula msa bln May ari tu, bos abg anta abg outstation ke KL. Keesokan harinya abg xthu nk wt pe. Jadi abg roger mmber lme abg kt kl ni ajk lepak. Kire lame la abg x jmpe dy ni. Dah jumpe tu abg luahkan hasrat abg sruh dy bwk abg ke sna. Mule2 tu dy tolak sbb dy ckp dy x suke ke tmpat mcm tu. Lg pn dy mmg x pnah pegi. Abg pn memujuk rayu dy siap janji yg abg akn jga dy kt sna. Patu abg ckp kt dy klau rasa x selesa kita cabut je. Hehehe.

Kite org smpai sne dlm pkul 6ptg. Smpai tu kite org duduk je dlm kete smbil tgk tmpat tu dr jauh. Smbil tu smpat gk kite menganalisis tgk org2 yg dtg tmpat tu. Ade mcm2 ragam, ade yg tua, ade foreigner, ade sotong celup tepung… isk3… dlm setengah jam mengumpul kekuatan tu baru kiteorg melangkah keluar ke tmpat tu. Mse naik tgga pegi ke reception tu mmg gigil gile… maklum la 1st time. Pas bayar semua uncle tu bg kunci loker. Pegi je loker ade la 4 5 org jantan tgh tuko baju. Rasa sedikit akward sbb mmg x pnah dtg. Buke je loker kteorg ambil towel dan tuko pkai towel tu. Tnpa menoleh kiri dan kanan terus abg ngn mmber naik tgga ke tgkt ats. Smpai ats kire trkejut la sbb ramai rupanya kt ats tu. Kwn abg dr tdi mmg berkepit non stop la ngn abg. Abg yg pd mulanya ketakutan tu da mula rasa ok. Prasaan horny da mengusai ketakutan abg. Hahaha. Dlm byk2 jntan dlm tu ade la sorg mamat melayu ensem yg menjadi buruan semua jantan2 keparat dlm tu. Kire mmg hot la.. even kemetot sikit dr abg, tp body mmg sedap la. Dgn sixpaxnye, kulit cerah, muke ensem, mmg semua org kejar la… then ade 1 mse tu, mamat tu tgh mandi kt shower, smua org kerumun dpn pntu shower tu.. mne xnye, semua trpegun tgk mamat tu bogel. Abg pn x trkecuali la prgi cuci mate.. mmg x d nafikan, abg pn stim tgk bubble butt dy… alahai…

Dlm pkui 7.30 mlm cmtu, tmpat tu da mule crowd. Mkin ramai dtg. Jantan2 sado pn makin byk. So mmg byk choice la. Mmber abg dr tdi dh ilang. Pas tgk jntan2 sado, trus ilang takut. Lahanat punye mmber. So abg pn mulakan lgkah la mencuci mata. Msa abg masuk 1 blk gelap berselekoh dlm tu, ade 1 kmpulan jantan keparat block jln abg. Abg x thu la brp org tp rasa dlm 4 5 org. D kepungnye abg, mule2 tu panik la gk. Then dorg trus raba2 abg smpai terlucut towel. D ramas nya bontot abg yg bulat ni. Abg jadi rimas terus abg tolak n slmtkan dri. Hehehe

Dlm pkul 9, bru abg perasan yg dlm tmpat tu ade jakuzi and mmg buka pkul 9. Abg pn pegi la buat lawatan sosial kt sna. Kt situ ade dua jakuzi, 1 yg kluar2 buih, 1 lg yg air nya yg tenang jgn di sangka tiada buaya… hahaha… dlm kolam buih tu mmg crowd la… ade dlm 4 5 org.. kolam yg biasa tu ade 4 org, trmasuk mamat hot yg mula2 abg jmpa tdi tu. Smua pkat keliling dy. Kesian abg yg x ensem ni, sapa pn x serbu. Hahaha… so abg ambk keputusan pegi jejln dlu. 15 mnt lpas tu abg tgk kolam yg berbuih tu cuma ada 2 org je. Abg tgglkan towel, cekup konek abg dgn tgn dan trus masuk dlm kolam tu. Smbil tu abg perhatikan 2 mamat sekolam dgn abg tu. Boleh tahan orgnya. Yg sorg kulit sdikit gelap tp muke mmg jntan abis. Yg sorg plak kulit cerah, tp tgk dr gaya mcm askar. Ape yg abg bley agk dorg mgkin bru knal sbb masing2 msih dok berkenalan. Abg stim plak tgk dorg main raba2 konek dlm air tu. Then abg dgr yg si gelap tu ajk couple dy pegi tmpat lain. Keluar je mamat gelap tu dr kolam, tenganga mulot abg. Pergh… perfect gile body dy. Dgn tgginye, bdan sado, bontot bulat, konek besar siot. Abg trus jadi x keruan. Then pastu si cerah tu pn ikot sama, bdan si cerah tu x la sado, tp ade shape. Btg pn sama besar siot dgn mamat gelap tu. Cuma melengkung ke ats. Pas dorg belah abg pn belah gk follow dorg. Abg perasaan dorg masuk steam room….

Masa dlm steam room tu tercari2 gk abg kt mna dorg lepak. Rupanya dorg ade lepak kt 1 ruang yg mmg bley masuk fit2 2 org je. Abg pn intai2 la ape dorg buat. Abg bley dgr dorg tgh mengerang2 sedap. Then abg curi2 tgk, nmpak la si gelap tgh kulom btg si cerah… abg mmg stim gile. Nk je abg terkam dua2. Grrrr….. tetiba ade mamat mne ntah sibok je nk ngintai gk.. then mamat berdua tu mgkin sedar then dorg trus blah. Tp abg masih x berputus asa. Abg still follow dorg. Abg nmpak dorg masuk lorong gelap. Dlm tu mmg abg x nmpk apa2. Smbil teraba2 jln tu abg dgr suara mengerang lg. Abg mmg yakin 100 persen tu dorg. Abg try jln2 dpn dorg smbil raba2 dorg. Then slh sorg tu tarik tgn abg n mntak abg isap konek. Abg pn apa lg, terus trkam la… abg bley rasa yg konek abg isap tu milik si cerah sbb bengkok ke ats. Abg trus la bukak skill hisapan maut abg. Hahaha… abg buat deeptroat n mgharap dy cpt pancut. Tp hampeh.. mulot abg yg lenguh sbb konek dy trlmpau tebal. Dlm tgh isap tu abg prasan yg si mamat gelap ade kt sebelah, n somebody sesapa tgh blowjob gk. Then abg nyebok2 rebut konek dy dr somebody tu… tamak kan abg… abg time tu mmg bernafsu abis la.. tp tu la, mkin lama abg bley rasa mkin ramai jantan lahanat yg menghimpit kite bertiga.. then mamat berdua tu ckp dorg kna chow… sedey btol abg x smpat nk rasa air nikmat dorg… abg pn akur dgn permintaan dorg. Then abg biar dorg kluar dlu, abg lap2 mulot then abg kluar trus pegi shower. Sblh abg, abg bley prasan ade mamat chinese sado tgh usha2 abg mndi.. abg pn buat2 x prasaan dy, smbil main2 sabun gosok bontot abg yg bulat tu. Dari ank mata abg, abg bley nmpak dy tgh main konek dy smbil tgk abg. Tp maaf la, time tu abg mmg da xde mood. Pas abg brsihkan dri semua, abg trus kluar. Nk d jadikan cerita berselisih dgn mmber abg. Trus di soal siasat abg. Hahaha… d tnya nya abg melacur kt mna… hahah… abg ckp abg x g mna pn… just lepak kt jakuzi je… hahha… then kiteorg trus trun ke loker dan tukar pakaian…

-THE END-

*ni 1st time abg karang cerita abg. Maaf la kalau ada kesalahan kosa kata atau tatabahasa yg keterlaluan. Abg masih baru. Nnt abg akan ceritakan lg pengalaman yg abg pnah lalui spnjg jadi PLu keparat ni.. hahaa

Energy in MSE

For any of you folks who want to make use of the Energy symbol in crafting your custom cards, I made a quick and dirty version of the symbol for use in Magic Set Editor.

It’s fairly easy to make work, too!  All you have to do is put the below image saved as a PNG (I used the filename “mana_energy.png”) in the data/magic-mana-small.mse-symbol-font folder which is located wherever it is you have MSE installed.  Then, you have to use Notepad to edit the file in that folder called “symbol-font” and add the following text:

symbol:
code: E
image: mana_energy.png

It’s generally best to just copy another section of the “code” in there and edit it to match the above.

Then, you can make cards like this:

Use it simply by typing an ‘E’ in the text box where you want the symbol to appear. (Note: You may have to go back and highlight your Es and convert them to symbols by selecting the Star button from the toolbar in MSE.)

Below, is mana_energy.png: