This document outlines components of a mental status examination. It discusses examining a patient's appearance, speech, mood and affect, orientation, thought processes, thought content, perceptual problems, judgment, insight, and impulse control. Specific things to note for each component are provided, such as speech rate, rhythm, volume, mood, range and intensity of affect, level of orientation, and signs of confusion, delusions, or hallucinations.

1. Mental Status Examination
DR. JAMES M. ALO, RN,MAN,MAP,PHD

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Appearance
Yes, appearance is just
as straightforward as it
seems. For example
how does your patient
look, smell, behave, or
speak .
What can you say about
this patient?
Age Grooming
Sex Dress
Build Activity
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Appearance
How the patient relates
to the interviewer is
also important.
Is the patient
withdrawn, cooperative,
distant, shy, relaxed
cautious, hostile or
FRIGHTENED?
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 Rate and amount
 Normal (culturally derived)
Speech  Pressured –rapid speech
Speech patterns can be  Slow-difficulty finding words
assessed for speed.
Some illness conditions  Impoverished or paucity of speech
have concomitant
speech patterns. One of
those patterns is a
characteristic rate.
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 Rhythm
 Stuttering
Speech  Monotone
Sometimes called  Slurred
prosody-rhythm also
alludes to the quality of  Mumbled
the voice
 Poor articulation
 Clear
 Coherent
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 Volume
 Soft-spoken
Speech  Loud
The softness of  Poor articulation
loudness of voice can
indicate sensory
problems, e.g.,
deafness, mood
problems, e.g.,
depression or mania; or
cognitive problems,
e.g., dementia
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 Spontaneity
 Animated- excited
Speech  Little detail
 No speech
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Eye contact
Usually included in the
Appearance section, be
cautioned to respect the
cultural component
of eye contact.
No eye contact is
considered rude in
some cultures and
direct eye contact is
considered rude in
other cultures
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 Mood
Mood and  Euthymic (normal)
Affect  Euphoric (elated)
Mood- the subjective  Dysphoric (sad)
state of a person or how
the person ―feels‖
.
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 Some other recognized subjective
feelings (mood) are:
Mood
 Anxious
 Calm
 Irritated
 Angry
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 Range
 The degree of variation in emotion
Affect  Expansive
Affect is the outward  Normal
display of mood and
can be judged on four  Restricted – Dull- Blunted
parameters:
 Flat
Range
Intensity
Lability
Appropriateness
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 Intensity
 High Low
Intensity
Emotional power being
emitted from the
patient
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 Labile affect
 Extreme change in a short period of
Lability time
Moodiness or the  Laughing and crying at the same time
―swing‖ of moods
Outside of highly
emotional events such
as weddings, labile
affect can be noted in
some disease
conditions, e.g. chronic
alcoholism, or bipolar
disorder 1.
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 The patient below says, ―I am so
Appropriate happy today.‖ His affect is
ness inappropriate to his mood and
Affect- the outward
display of mood –
circumstance.
should be congruent
with mood and
circumstances.
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 Failure of orientation usually
occurs in the following sequence:
Orientation
Areas of orientation are  Time
Person
Place
 Place
Time
 Person
and
Circumstance Never document person is oriented
times three. Proper
documentation is person is
oriented to person, place, and
time.
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 Confused is the attribute given to
persons who become unaware of
Circumstance the circumstances surrounding
Not understanding that
this presentation is a
them.
lesson on the mental
status exam and
thinking it is a group of
cartoons is a
misunderstanding of
the circumstance or
CONFUSION
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 So, a person can be oriented to
person, place, and time and still
CONFUSION be confused.
Sometimes called
disorientation to
circumstance
Confusion is quite
common in high anxiety
states or in delirium,
dementia, or mood
disordered states
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Intellectual  Intellectual Capacity is based on:
and Cognitive  Vocabulary
Functioning  Ability to understand complex concepts
Two closely related  General fund of information
attributes
Intelligence is
considered to be
Average
Above Average
Below Average
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 Level of Abstraction
 Don’t cry over spilled milk.
Cognition
Cognitive ability is
usually examined by
testing
Level of Abstraction  Does the patient interpret
Executive Function literally?
Memory  How are an orange and a banana
alike?
 Both are fruit or both are in the
world?
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 Executive function- How to study
Executive for an exam in NUR 103
function
The ability to make a
sequence or plan  1. Order a latte grande
 2. Add extra sugar
 3. Sit by the library
 4. Study for the exam
 5. Get a good night’s sleep
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 Memory
 Recent -within the relative past short
Memory time e.g. breakfast
The first memory to be  Remote – not in the relative past short
lost is recent. time e.g. name of first boyfriend
 Recall-ability to say one’s SS #
 Retain- ability to learn and then recall
new information, e.g., nurse’s name.
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 Confabulation
A special case
 ―I went out on a date with Brad
Confabulation is
sometimes used by Pitt last night.‖
persons with brain
damage or dementia.
Confabulation is the
construction of unreal
events which seem real,
even to the person who
construct them, yet the
e vents are unreal.
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 Tangentiality– digressing, often
Thought multiple times, during the
Processes relating of an episode or story.
The only way to
examine is by analyzing
Noted in states of high anxiety
speech:
Tangentiality
Circumstantiality
Flight of Ideas
Blocking
Loose Associations
Perseveration
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 Circumstantiality- an unnecessary
Thought telling of details when relating an
Processes episode or story.
Circumstantiality is
note d with persons
who are highly anxious,
suffer from Bipolar
disorders, or from
Dementia
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 Blocking---train of thought stops
Thought in mid sentence.
processes
Blockng is noted in high
anxiety states,
depressive states, and
in thought disordered
conditions
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 Flight of Ideas
Flight of Ideas
Moving quickly from
one idea to another in a
very short period of
time. Often noted in
persons with Bipolar
disorder
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 Loose Associations- words spoken
Thought at random and not in sentences
Processes
Loose associations are
most often noted in
persons suffering from
Schizophrenia
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 Perseveration
Thought  Now is the time for every good
Processes man to come to the aid of the
Perseveration- the country. Now is the time for every
inability to move on to
another topic or the
good man to come to the aid of
continual return to the the country. Now is the time for
same topic
every good man to come to the aid
of the country. Now is the time for
every good man to come to the aid
of the country. Now is the time for
every good man to come to the aid
of the country. Now is the time for
every good man to come to the
aide of the country
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 Delusions—false beliefs
Thought  --Ideas of reference
Content
 (People are talking about me)
Delusions- false beliefs
 --Paranoid
 (People are after me)
Life themes-recurrent
beliefs  --Grandeur
 (I am the President of ..)
Control-degree of  --Nihilistic
control over one’s
thoughts  (My muscles are disappearing)
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 Life themes-Recurrent beliefs
 --Loss
 --Anger
 --Victimization
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 Thought Control
Thought  Thought broadcasting (thinking one’s
Control thoughts are being heard by others)
These disorders of
thought are often found
in persons who suffer  Thought insertion (thinking one’s
from schizophrenia thoughts are being inserted by
someone or something else)
 Thought withdrawal (thinking one’s
thoughts are being stolen)
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 Hallucinations- the experiencing
Perceptual of a perception in the absence of a
Problems stimulus
All senses can be
involved in sensory  Auditory (hearing voices)
perceptual problems
 Visual (seeing people of objects)
Hallucinations
 Tactile (feeling things)
Illusions
 Gustatory (tasting things)
 Olfactory (smelling aromas)
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 Illusions --the experiencing of a
mis-perception
 Auditory (hearing a sound and
Illusions- common in thinking it is a knock on the door)
fatigue and delirium
 Visual (seeing a towel and
thinking it is a cat)
 Tactile (feeling a touch and
thinking it is a burn)
 Gustatory (tasting onions and
thinking they are chocolate)
 Olfactory (smelling fish and
thinking it is apple pie)
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Final  Judgment- stable quality of
components of persons decision making
the MSE
Judgment
Insight
Impulse control
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 Insight- the ability for one to
understand his or her condition.
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 Impulse control-the ability to talk
Impulse out rather than act out.
control
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“Learners’ are learning from experiences they have
experienced which cannot be taught by teachers except
themselves.”- Dr. James M. Alo
Thank you.
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