Mental Status Examination (MSE) is a standardized evaluation of a psychiatric patient's behavior, emotions, and cognitive functions. It involves interviewing the patient and relatives, taking a history, and conducting a physical exam and investigations. The MSE assesses elements like psychomotor activity, speech, mood and affect, thought content and form, perception, cognitive functions, insight, sleep patterns, and orientation. The examiner makes detailed notes of their observations to understand the patient's symptoms and make a clinical diagnosis.

1. BY:K.CHITRA
MENTAL STATUS EXAMINATION

2. Evaluation of psychiatric patients
• Interview of the patient
• Interview of the relatives
• History taking
• MSE
• Physical Examination and investigations

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4. DEFINITION:
Mental Status Examination (MSE) is defined as the systematic evaluation of
behavior, emotion and cognitive functions of individual. • It is a standardized form
at in which the clinician records the psychiatric signs and symptoms present at the
time of the interview.

6. PSYCHOMOTOR ACTIVITY:
• Increased/ decreased .
• Excitement/ stupor .
• Abnormal involuntary movements like tremors, tics.
• Social withdrawal, autism.

7. SPEECH.
• Coherence: Speech is coherent or not.(LOGI)
• Relevance: Relevant/ irrelevant
• Volume: Increased/decreased
• Tone: Low/high/ normal pitch
• Manner: Formal/ Informal.
• Reaction time: Normal/ late reaction

8. MOOD(SUBJECTIVES) & AFFECT(OBJECTIVES):
• Appropriate/ inappropriate
• Pleasure affect
• Unpleasurable affect
• Other affects: – Anhedonia may occur in both schizophrenia and depression.

9. THOUGHT:
a) Form of thought: – Relevant or not
– loosening of association,
– Tangentiality or circumstantiality,
– illogical thinking
– perseveration
– verbigeration.

10. THOUGHT:
B) Stream of thought/ flow of thought:
– productivity
– flight of ideas
– poverty of content of speech
– thought block
c) Content of thought
– Delusions
– Obsession
– Phobia (irrational fear)
– Preoccupation
– Fantasy

16. a) Illusions: – whether visual, auditory or in other sensory fields,
– whether occur in clear consciousness or not
a) Hallucinations:
– whether auditory, visual, olfactory, gustatory or tactile domains.
– what was heard, how many voices were heard & in which part of the day
– male or female voices
– whether this are second person or third person hallucinations
DISORDERS OF PERCEPTIONS:

17. a) Attention and concentration:
• Attention:
– easily aroused and sustained
– repeat digits forward and backwards
– start with two digit numbers, increasing gradually up to eight digit numbers or
till failure occurs on three consecutive occasions.
– ask to list the months of the year forward and backward
COGNITIVE FUNCTIONS:

18. • Concentration:
– easily distractible or not;
– ask to subtract serial sevens from hundred(100- 7test), or serial threes from fifty
(50-3 test), or
– to count backwards from 20, or – enumerate the names of the months in the
reverse order

19. b) Memory: – Immediate Retention and Recall(IR and R)
: Use the digit span test to assess the immediate memory; digit forward and back
wards subtests.
– Recent Memory:
• Ask how the patient come to the room/hospital;
• what he ate for breakfast the same morning
– Remote Memory:
• Ask for the date and place of marriage, name and birthdays of children, any other
relevant questions from the person’s past.
• Note any amnesia or confabulation, Dejavu if present.

20. c) Orientation:
– Time
– Place
– Person
d) Abstraction:
– Proverb Testing: The meaning of simple proverbs should be asked. (e,g features of
bird flock together/rolling stones gather no mass)
– Similarities between familiar objects should be asked, like: table/ chair; banana/
orange etc.

21. e) Intelligence:
– about general information,
– e.g.; ask about the current or past prime minister and president of India, the
capital of India and the name of various states.
• Judgment: :
-Personal (future plans)
-Social (perception of the society.)
-Test (Present a situation and ask their response to the situation).

22. g) Insight:
Ask patient’s attitude towards his present state;
whether there is an illness or not;
if yes which kind of illness;
is any treatment needed;
is there hope for recovery;
what is the cause of illness.

23. a) Sleep:
– Insomnia
– Hypersomnia
– Early Morning Awakening
b) Episodic Disturbance
GENERAL OBSERVATIONS:

24. • General assessment of the patient should be written along with:
– Patient’s history starting from admission history,
– Reason of admission,
– Diagnosis,
– Treatment etc.
IX. SUMMARY & CLINICAL DIAGNOSIS:

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