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.

  1. General Observations
    1. Appearance
    2. Speech
    3. Behavior
    4. Cooperativeness
  2. Thinking
    1. Thought Process
    2. Thought Content
    3. Perceptions
  3. Emotion
    1. Mood
    2. Affect
  4. Cognition
    1. Orientation/Attention
    2. Memory
    3. Insight
    4. 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.

  1. Cognitive: memory or concentration changes
  2. Psychosis
  3. Substance Abuse
  4. Mood: depression, mania, suicidal ideation, guilt
  5. Neurovegetative: sleep, appetite, libido, interests, energy
  6. Anxiety: anxiety symptoms, panic/agoraphobia, obsessions/compulsions, flashbacks/hypervigilance
  7. Eating Disorder: anorexia, bulimia
  8. Violence: rages, assaults, homicidal ideation
  9. Impulse Control: pathological gambling, trichotillomania, kleptomania

Mental Status Examination Template

Suggested Texts and references for the Clerkship In Psychiatry: (suitable for in-depth reading on a patient problem or formulation in a write-up)

  • Bernstein: On Call Psychiatry 1997 UNR Bookstore
  • DSMIV: Quick Reference Guide to the Diagnostic Criteria 1994 UNR Bookstore
  • Goldman: Review of General Psychiatry 1995 Dept. of Psychiatry, (also-may be available from upperclassmen)
  • Grohol: Insider's Guide to Mental Health Resources (an online guide) UNR Main Lib RC437.2.0.78
  • Hales and Yudofsky: The American Psychiatric Press Textbook of Psychiatry Savitt Medical Reference Section
  • Hyman: Manual of Clinical Problems in Psychiatry UNR Bookstore
  • Kaplan and Saddock: Comprehensive Textbook of Psychiatry, 1995 Savitt WM 100.C73 vs.\ and II
  • Kaplan and Saddock: Synopsis of Psychiatry, 1998 (can be ordered from the bookstore).
  • Stoudemire: Clinical Psychiatry 1998 - Dept. of Psychiatry (also may be available from upperclassmen)
  • Clinical Manuals (helpful for day to day use In the clinical setting although the drug Information is usually outdated)
  • Psychiatry Clerkship Guide Myrl R.S. Manley Mosby 2003
  • Internet Searches on topics in Psychiatry (for up-to-date information on medications as well as published research in psychiatry)
  • Advanced PubMed search: (at University or with special access)