Mental Status Examination: Course Instructor Ms. Erum Kausar

Mental Status Examination
Course Instructor
Ms. Erum Kausar
What it is it?
The Mental Status Exam (MSE) is the
psychological equivalent of a physical
exam that describes the mental state
and behaviors of the person being seen.
It includes both objective observations
of the clinician and subjective
descriptions given by the patient.
Why do we do them?
The MSE provides information for diagnosis
and assessment of disorder and response to
treatment.
A Mental Status Exam provides a snap shot
at a point in time
If another provider sees your patient it allows
them to determine if the patients status has
changed without previously seeing the patient
To properly assess the MSE information
about the patients history is needed
including education, cultural and social
factors
It is important to determine what is
normal for the patient. For example
some people always speak fast!
Components of the Mental
Status Exam
Appearance
Behavior
Speech
Mood
Affect
Thought process
Thought content
Cognition
Insight/Judgment
Appearance: What do you
see?
Build, posture, dress, grooming,
prominent physical abnormalities
Level of alertness: drowsy, alert
Emotional facial expression
Attitude toward the examiner:
Cooperative, uncooperative
Behavior
Eye contact: ex. poor, good, piercing
Psychomotor activity: ex. retardation or
agitation i.e.. hand wringing
Movements: tremor, abnormal
movements i.e.. stereotypes, gait
Speech
Rate: increased/pressured,
decreased/ monosyllabic
Rhythm: articulation, monotone, slurred
Volume: loud, soft, mute
Content: fluent
Mood
The prevalent emotional state the
patient tells you they feel
Often placed in quotes since it is what
the patient tells you
Examples “Fantastic, elated, depressed,
anxious, sad, angry, irritable, good”
Affect
The emotional state we observe
Type: euthymic (normal mood), dysphoric
(depressed, irritable, angry), euphoric (elevated,
elated) anxious
Range: full (normal) vs. restricted, blunted or flat,
labile
Congruency: does it match the mood-(mood
congruent vs. mood incongruent)
Stability: stable vs. labile
Orientation
Time
Person
Place
Thought Process
Describes the rate of thoughts, how they flow
and are connected.
Normal: tight, logical and linear, coherent and
goal directed
Abnormal: associations are not clear,
organized, coherent. Examples include
circumstantial, loose, flight of ideas, word
salad, harsh, thought blocking.
Thought Process: examples
Circumstantial: provide unnecessary
detail but eventually get to the point
Tangential: Move from thought to
thought that relate in some way but
never get to the point
Loose: Illogical shifting between
unrelated topics
Flight of ideas: Quickly moving from one
idea to another- see with mania
Thought blocking: thoughts are
interrupted
Perseveration: Repetition of words,
phrases or ideas
Word Salad: Randomly spoken words
Thought Content
Refers to the themes that occupy the
patients thoughts and perceptual
disturbances
Examples include preoccupations,
illusions, ideas of reference,
hallucinations, derealization,
depersonalization, delusions
Thought Content: examples
Preoccupations: Suicidal or homicidal
ideation (SI or HI),obsessions or compulsions
Illusions: Misinterpretations of stimulus
Ideas of Reference (IOR): Misinterpretation of

incidents and events in the outside world
having direct personal reference to the
patient
Hallucinations: False sensory perceptions.
Can be auditory (AH), visual (VH), tactile or
olfactory
Derealization: Feelings the outer environment
feels unreal
Depersonalization: Sensation of unreality

concerning oneself or parts of oneself
Delusions: Fixed, false beliefs firmly held in spite of
contradictory evidence
Control: outside forces are controlling actions

Grandiose: inflated sense of self-worth, power or wealth
Somatic: patient has a physical defect
Reference: unrelated events apply to them
Persecutory: others are trying to cause harm
Cognition
Level of consciousness
Attention and concentration: the ability
to focus, sustain and appropriately shift
mental attention
Memory: immediate, short and long
term
Abstraction: proverb interpretation
Mini-Mental State Exam
Insight/Judgment
Insight: awareness of one’s own illness
and/or situation
Judgment: the ability to anticipate the
consequences of one’s behavior and
make decisions to safeguard your well
being and that of others
Sample initial MSE of a patient
with depression and psychotic
features
Appearance: untidy, drowsy, slouched
down in chair, uncooperative
Behavior: psychomotor retarded, poor
eye contact
Speech: soft, slow with lack of content
Mood: “really down”
Affect: blunted, mood congruent
MSE continued
Thought Process: linear and goal
directed with lack of content
Thought Content: +SI, +AH, +paranoia,
-VH, -IOR, -HI
Cognition: Alert, focused, MMSE:24-
missed recall of 2 objects, 2 orientation
questions, 2 on serial sevens
Insight: fair
Judgment: poor

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Mental Status Examination

Illusions: Misinterpretations of stimulus

Ideas of Reference (IOR): Misinterpretation of

Depersonalization: Sensation of unreality

Control: outside forces are controlling actions

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