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Mental Status Examination
Department of Psychiatry and Behavioral Sciences
The Mental Status Exam is analogous to the physical exam: it is a series of observations and examinations at one point in time. Focused questions and observations can reveal "normal" or pathological findings. Although our observations occur in the context of an interview and may therefore be ordered differently for each patient, the report of our findings is ordered and "paints a picture" of a patient's appearance, thinking, emotion and cognition. The data from the Mental Status Exam, combined with personal and family histories and Psychiatric Review of Systems, forms the data base from which psychiatric diagnoses are formed.
Mental Status Exam
A synopsis of the four MSE sections is presented below. In following pages, there are elaborations of each section, with sample descriptors.
General Observations
Appearance
Speech
Behavior
Cooperativeness
Thinking
Thought Process
Thought Content
Perceptions
Emotion
Mood
Affect
Cognition
Orientation/Attention
Memory
Insight
Judgment
MSE Components in greater detail: these adjectives and descriptors may be helpful in describing your mental status exam findings. Usually some apply more than others and you may find your own descriptors that fit your patient best.
General Observations
Appearance
Hygiene: clean, body odor, shaven, grooming
Dress: clean, dirty, neat, ragged, climate appropriate anything unusual?
Jewelry: rings, earrings anything unusual?
Makeup: lipstick, nail polish, eye makeup anything unusual?
Other: prominent scars, tattoos
Speech
General: accent, clarity, stuttering, lisp
Rate: fast (push of speech) or slow
Latency (pauses between questions and answers): increased or decreased
Volume: whispered, soft, normal, loud
Intonations: decreased (monotone), normal
Behavior
General: increased activity (restlessness, agitation), decreased activity
Eye Contact: decreased, normal, excessive, intrusive
Mannerisms, stereotypies, posturing
Cooperativeness
Cooperative, friendly, reluctant, hostile
Thinking
Thought Processes
Tight, logical, goal directed, loosened, circumstantial, tangential, flight of ideas, word salad
Thought Content
Future oriented, suicidal ideation, homicidal ideation, fears, ruminative ideas
Perceptions
Hallucinations (auditory, visual, olfactory)
Delusions (paranoid, grandiose, bizarre)
Emotion
Mood
(Patient describes in own words and rates on a scale 1-10)
Affect
(You describe)
Type: depressed/sad, anxious, euphoric, angry
Range: full range, labile, restricted, blunted/flattened
Appropriateness to content and congruence with stated mood
Cognition
Memory
Immediate recall, three and five minute delayed recall of three unrelated words
Orientation/Attention
Day, date, month, year, place, president; Serial 7's (or 3's), WORLD DLROW, digit span
Insight/Judgment
Good, limited or poor (based on actions, awareness of illness, plans for the future)
Psychiatric Review of Systems
Signs and symptoms of psychiatric illness are often described in the history of present illness. The ROS in psychiatry "covers all the bases" and queries for important signs and symptoms that have not been discussed during the first part of the history. Similar to the ROS in other fields of medicine, the ROS in psychiatry is a systematic inquiry, searching for pertinent positives and negatives over a period of time preceding the time of interviews.
Cognitive: memory or concentration changes
Psychosis
Substance Abuse
Mood: depression, mania, suicidal ideation, guilt
Neurovegetative: sleep, appetite, libido, interests, energy
Anxiety: anxiety symptoms, panic/agoraphobia, obsessions/compulsions, flashbacks/hypervigilance
Eating Disorder: anorexia, bulimia
Violence: rages, assaults, homicidal ideation
Impulse Control: pathological gambling, trichotillomania, kleptomania
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