MENTAL

STATUS
EXAMINATION
(MSE)
INTRODUCTION-
● The mental status examination is the psychiatrist/psychologist’s version of the
physical examination.
● In 1918, Adolf Meyer developed an outline for a standardized method to evaluate a
patient’s “mental status” for psychiatric practice.
● It combines information gathered from passive observation during the interview with
data acquired through direct questioning to determine the patient’s mental status at
that moment.
● This approach is used to identify, diagnose, and monitor signs and symptoms of
mental illness. Each part of the mental status examination is designed to look at a
different area of mental function to thoroughly capture the objective and subjective
aspects of mental illness.
FUNCTION-
The mental status examination is organized differently by each practitioner but contains the same main areas
of focus. The mental status examination can be divided into the broad categories of

Appearance Behavior

Motor activity Speech

Mood Affect

Thought process Thought content

Perceptual disturbances Cognition

Insight Judgment

Each section below will detail the definition, the proper method of assessment, and how that information has
a use in the diagnosis and monitoring of mental illness.
APPEARANCE-
This is a description of how a patient looks during observation. It can be determined within
the first seconds of clinical introduction as well as noted throughout the interview.
1. PATIENT DEMOGRAPHICS- Age, gender, DOB etc.
2. CLOTHING- Are they dressed appropriately for the setting? Are their clothes in wearable
condition?
3. POSTURE- Is their posture slouched/closed or open? Is their any sign of postural
instability?
4. GAIT- Is it slow/brisk/uncoordinated?
5. GROOMING, SELF CARE, HYGIENE- Grooming and hygiene can give an idea of a
patient’s level of functioning. Those with poor hygiene and grooming generally denote that
in the context of their mental illness that they currently have poor functioning.
BEHAVIOUR-
This is a description obtained by observing how a patient acts during the interview.

First, it is essential to note whether or not the patient is in distress. If a patient is in distress it may be due to
underlying medical problems causing discomfort, a patient having been brought against their will to the hospital for
the evaluation, or due to the severity of their hallucinations or paranoia terrifying the patient.

Next, a description of their interaction with the interviewer should be noted. For example, is the patient cooperative,
or are they agitated, avoidant, refusing to talk, or unable to be redirected? A patient that is not cooperative with the
interview may be reluctant if the evaluation was involuntary or are actively experiencing symptoms of mental illness.

Lastly, it is important to note if the behavior the patient is displaying is appropriate for the situation. For example, it
can be considered appropriate for a patient who was brought in via police for involuntary evaluation to be irritable
and not cooperative. However, if in that same scenario, the patient was laughing and smiling throughout the
interview, it would be considered inappropriate.
SPEECH-
Speech is evaluated passively throughout the interview. The qualities to be noted are the amount of
verbalization, fluency, rate, rhythm, volume, and tone. It is of key importance to note the amount a patient
speaks.

Quantity - • Talkative, spontaneous, expansive, paucity, poverty.

Rate - • Fast, slow, normal, pressured.

Volume (Tone) - • Loud, soft, monotone, weak, strong.

Fluency and Rhythm - • Slurred, clear, with appropriately placed inflections, hesitant, with good articulation.
MOOD-
Mood is the patient’s pervasive and sustained emotional state and usually shows the underlying
emotion of the person.Both subjective and objective aspects of mood should be assessed.
SUBJECTIVE (As reported by the patient and observed by the examiner):
● Ask the patient how are they feeling and note it in the exact verbatim.

OBJECTIVE (How we observe and describe their mood)

● Nature of mood/moods?
● Constancy
● Congruity
THOUGHT PROCESS-
Thought Processes or Thought Form (Inquired/Observed): logic, relevance,
organization, flow and coherence of thought in response to general questioning
during the interview.

• Linear, goal-directed, circumstantial, tangential, loose associations, incoherent,

evasive, racing, blocking, perseveration, neologisms.
THOUGHT CONTENT-
This is essentially the subject matter of the thoughts that are in the patient’s
mind. It is determined by listening throughout the interview and through
direct questioning. If a patient has a particular preoccupation, they may have
a perseveration-type thought process for which it is important to document
the topic. When assessing a patient’s thought content, it is imperative to
determine suicidal ideations, homicidal ideations, and delusions.
PERCEPTION-
This section describes some of the various kinds of hallucinations that a patient may be experiencing.
This is assessed by asking a patient what they are perceiving.

Hallucinations can be divided on the basis of-

Complexiety:

● Elementary- refers to experiences such as whistles, bangs, flashes.

● Complex- refers to voices, music, faces,

Sensory modality involved;

● Auditory
● Visual
● Olfactory
● Gustatory
COGNITION-
The most common areas of cognition evaluated on a mental status examination are alertness, orientation,
attention/concentration, memory and abstract reasoning.

● Alertness is the level of consciousness of a patient. This can be described as alert, somnolent, obtunded, in a stupor, or
comatose.
● Orientation refers to the patient’s awareness of their situation and surroundings. This is assessed by asking the patient
if they know their name, current location (including city and state), and date.
● Attention/concentration is assessable throughout the interview by observing how well a patient stays focused on the
questions asked. Alternatively, this can be directly tested in a multitude of ways. One way is to ask a patient to tap their
hand every time they hear a certain letter in a string of random letters. If they have good math skills, then another
method is to ask the patient to count back from 100 by 7.
● Memory subdivides into immediate recall, delayed recall, recent memory, and long-term memory. A practitioner can
choose to assess one or all types of memory during evaluation. Immediate recall is asking the patient to repeat
something back to you.The delayed recall is asking the patient to repeat the same thing to you after a certain amount of
time (usually 1 to 5 minutes) after performing another task that prevents the patient from doing repetitions to practice
the answer.Recent memory is an assessment of how well a patient remembers recent events. Long-term memory
assesses a patient’s memory of long-past events.
INSIGHT-
This refers to a patient’s understanding of their illness and functionality. It is usually described as
poor, limited, fair, or if there is a previous comparison worsening versus improving.

Six levels of insight are-

1. Complete denial of illness.

2. Slight awareness of the illness or needing help but still denying it.
3. Aware of being sick but blaming it on external factors or others.
4. Awareness that illness is caused by something unknown.
5. Intellectual insight- awareness that there is a mental illness without applying this knowledge to
future experiences.
6. Emotional insight- awareness to emotions and illness and the ability to modify behaviour
accordingly.
JUDGEMENT-
This refers to a patient’s ability to make good decisions. A way to directly assess
judgment is to ask a patient what they would do in specific scenarios. Often this is
assessed through a patient’s history during an interview and their observed
actions. This, like insight, is also rated as poor, limited, fair, or if there is a
previous evaluation to compare to, worsening versus improving.