The document provides an overview of the key components assessed in a mental status examination, including general appearance and behavior, speech, mood and affect, thought processes, perceptual changes, cognitive functions, insight, and judgment. It describes how to evaluate each component, such as appearance, level of consciousness, attention, memory, intelligence, and abstract thinking. The mental status examination is a systematic evaluation of an individual's behavior, emotions, thought content, and other psychological functioning.

1. 1
Mental status examination
Systematic evaluation of behaviour, emotion, cognitive function of an individual.
Aspects of MSE
1. General behaviour and appearance
2. Speech or talk
3. Mood and affect
4. Thought process
5. Perceptual changes
6. Cognitive functions
7. Insight
8. Judgment
1. General behaviour and appearance
 Kempt (a person maintained in a neat and clean condition)
 Well, Moderately, Ill, Overly clean
 Conscious level (the state of being aware of and responsive to one's surroundings)
 Conscious, Cloudy, Withdrawn , Stupor (a state of near-unconsciousness) , Drowsy,
Unconscious, Coma
 Dressing
 Adequate, Any peculiarities
 Dressing in terms of place, occasion and time - E.g. Bright/ colorful clothes – mania
 Comprehension(the ability to understand something.)
 Intact
 Impaired - Partially , Fully
 Mode of entry
 Come willingly, Brought by using physical force
 Eye to eye contact
 Maintained, Difficult, Not maintained
 Psychomotor activity
 Attitude towards examiner
 Cooperative, Guardedness( cautious), Hostile(dislike or unfriendly), Attentive
 Rapport( harmonious relation)
 Spontaneous, Difficult, Not established, Empathetic relationship
 Gestures(a movement of part of the body, especially a hand or the head, to express an idea
or meaning)
 Grimace(twisted expression on a person's face)
 Tics(a habitual spasmodic contraction of the muscles, most often in the face)
 mannerisms(a habitual way of doing something, as in behaviour or speech:
 Normal, Odd, Exaggerated, Compulsion
 Posture
 Open, Close, Catatonic posture
Close posture – when the patient is sitting with head down, not talking to any one, leg tightly closed hand
put on the chest or on the lap
Open posture - when the patient maintains eye to eye contact, listens, sits confidently without any hesitation
or reservation
 Physique and body built
 Height in cms, Weight in kgs
 Body type
 Ectomorph (a person with a lean and delicate build of body)
 Endomorph(soft round build of body and a high proportion of fat tissue)
 Mesomorph(a person whose build is compact and muscular)
 Gait(a person's manner of walking)
 Staggering walk ( move unsteadily, as if about to fall), Small steps, Confident walk
 Facial expression

2. 2
 Closed eye, Sad look, Happy look
 Motor activity
 Normal , increased( over active ) , Decreased (retarded)
 Catatonic( immobile or unresponsive)
 Stereotype activity
 Abnormal involuntary movements
 Waxy flexibility
 Extra pyramidal symptoms (also known as extra pyramidal side effects (EPS), are drug
induced movement disorders. These symptoms include
o Dystonia (continuous spasms and muscle contractions),
o Akathisia(motor restlessness),
o Parkinsonism (characteristic symptoms such as rigidity, bradykinesia, and tremor),
and
o Tardive dyskinesia (irregular, jerky movements).
2. Speech or talk
 Initiation
 Spontaneous , Speaks when spoken to , Minimal mute , Hesitant , Mumbled
 Talk
 Relevant , Coherent , Spontaneous, Retarded, Irrelevant, Sometimes off targeted
 Tone and volume
 Tempo(the rate or speed)
 Modulation (modulation is when you control or adjust something, like when you lower
your voice to a loud whisper in order to make what you're saying more dramatic and
mysterious.)
 Increased, Decreased, Low, High, Normal pitch (rate of vibration of the vocal folds),
Variation, Monotonous
 Speech activity
 Unusual pattern , Unusual words
 Rate
 Normal, Rapid, Over talkative, Talking little, Slow
 Productivity
 Monosyllabic(using few words to engage in conversation)
 Pressured speech, Elaborated replies
 Coherence (the quality of being logical and consistent.)
 Fully coherent, Loosening of associations
 Stream
 Normal
 Circumstantiality
 Tangentiality
 Flight of ideas
 Others
 Rhyming(a rhyme is a repetition of similar sounds in two or more words) e.g. I went to
town to buy a gown
 Punning (a humorous substitution of words that are alike in sound but different in meaning)
e.g. an elephant's opinion carries a lot of weight.
 Echolalia(is the automatic repetition of vocalizations made by another person (by the same
person is called palilalia)
 Neologism (a newly coined word or expression.)
 sick: good
 Google: search.
 Clang association
 E.g. Systematic, sympathetic
 Speech pattern

3. 3
 Frighten, Command, Distract, Plead, Seduce
 Sample of speech
3. Mood and affect
 Affect is the external manifestations of a person's internal emotional state.
 Mood as "a person's predominant internal state at any one time.
Mood
 A pervasive and sustained emotion that color the patients perception of the world subjectively
experienced and reported by the patient
 Often placed in quotes since it is what the patient tells you. E.g. “ fantastic, elated, depressed,
anxious , sad, angry, irritable, good”
 Necessary to ask in mood - Depth , Intensity , Duration , Fluctuation
 Consistency of mood related to the topic : shallowness
 Superficial, Absence of mood, Euphoria
 Reactivity
 Diurnal variation
 Congruity
 Liability
 Subjective and objective feeling
 Predominant mood state
Affect
 The expression of emotions expressed by the patient and observed by the others. It varies over the
time in response to changing emotions.
 Type: euthymic (normal mood), dysphoroc (depressed, irritable, angry) euphoric ( elevated ,
elated ), anxious.
 Range: full ( normal )vs. Restricted ( reduced in range and intensity ) , blunted ( sever
reduction in intensity of externalized feeling tone) or flat (no sign of affective expression,
monotonous voice, immobile face ); labile (repeated, rapid and abrupt variability in affective
expression)
 Congruency : does it match the mood (mood congruent vs. Mood incongruent)
 Stability : stable vs. Labile
 Appropriateness: appropriate to situation or, not appropriate to situation.
4. Thought process
The way in which your mind works, or the process of thinking about something
 Stream
 Flight of ideas, Circumstantiality , Tangentiality
 Thought block , Clang associations , Neologism
 Racy thought ( rapid thought ), Poverty of thoughts, Retardation of thoughts
 Muddled or unclear thinking
 Content
 Delusion
o Delusion of control, Delusional jealousy, Delusion of mind being read , Delusion of
reference, Delusion of thought insertion, Erotomania, Grandiose religious delusion,
Somatic delusion, Delusion of poverty
 Phobias
o Acrophobia, Agoraphobia, Mysophobia, Astraphobia, Social phobias
 Guilty (responsible for a specified wrong doing.)
 Hypochondriasis(refers to worry about having a serious illness)
 Religiosity, Obsession, Grandiose
 Ideas
 Hopelessness, Worthlessness
 Suicidal ideas, Homicidal ideas
 Poverty, Reference, Control, Bizarre , Doubts

4. 4
 Persecution ( ill-treatment), Impulsive rituals
 Thought alienation phenomenon
 Thought insertion
 Thought withdrawal
 Thought broadcasting
 Obsession / compulsions
5. Perceptual changes
The ability to see, hear, or become aware of something through the senses.
 Illusion (a false perception of an external stimulus.
 Hallucination( perception in the absence of external stimulus)
o Auditory hallucination ,Visual hallucination , gustatory hallucination , Olfactory hallucination,
Tactile hallucination, Lilliputian hallucination
 Abnormal vestibular sensations like dizziness , vertigo
 De javu (already seen. When it occurs, it seems to spark our memory of a place we have already
been, a person we have already seen, or an act we have already done)
 Jamais vu ("never seen" is the phenomenon of experiencing a situation that one recognizes in some
fashion, but that nonetheless seems very unfamiliar
 Depersonalization (a state in which one's thoughts and feelings seem unreal or not to belong to
oneself.)
 De realization (a feeling that one's surroundings are not real, especially as a symptom of mental
disturbance.)
6. Cognitive functions
The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
a) Level of consciousness
b) Attention
c) Concentration
d) Memory
e) Intelligence
f) Language and reading
g) Abstract thinking
A. Level of consciousness
 Conscious or alert, Confusion, Clouding
 Delirium, Stupor, Coma
 Time – correct time, orientation to date , day, month, year.
 Place – area, location, nation, name of the city .
 Person – himself and recognizing others
B. Attention
It is the ability to focus on the matter in the hand. Attention is assessed by asking the patient to name five
objects that start with particular letter , or spell a word back word .
 Normally reacting to the call , Aroused, Aroused with difficulty, Sustained
C. Concentration
it is the ability to sustain attention. Ask the patient to subtract 7 from 100, then to repeat the task from that
response. This is known as "serial 7s." next, ask the patient to spell the word "world" forward and backward.
Document the patient's reaction times to particular questions because this may provide valuable information
in the overall evaluation.
 Normally sustained, Sustained with difficulty, Distractibility
D. Memory
Something remembered from the past
 Immediate registration and recall- it is tested by the digit span test: ability to repeat 7 digits after an
examiner dictates them slowly, first forward, then backward. A normal person can repeat 7 digits
correctly. This test is also used to asses attention

5. 5
 Short term recall – give the patient 3 things to remember (e.g. Banana clock and a shoe) and ask for
recall after 5 minutes, during which time you distract the patient by doing something else.
 Recent memory – ask questions regarding the last few days in the patient’s life events that you can
verify ( e.g. What the patient did yesterday morning )
 Recent past memory – ability to recall events in the past few months
 Remote memory (long term memory) – ask the patient to recall personal events (e.g. Birthday,
wedding day) or well-known public events from some years.
E. Intelligence
It is the ability to think logically, act rationally and deal effectively with the environment
 Enquire about clients scholastic performance
 General knowledge and general information
 Arithmetic ability
 Add, subtract, multiply and divide
 Interpretation of proverbs ("when in Rome, do as the romans)
 Similarities and dissimilarities between paired objects
 Refer to psychologist to carry out IQ tests
F. Language and reading
 To test the nominal aphasia(inability (or impaired ability) to understand or produce speech, as a
result of brain damage), ask the patient to name two objects ( e.g. Pen and watch )
 To test for expressive aphasia(expressive aphasia (non-fluent aphasia) is characterized by the loss of
the ability to produce language) (spoken or written) , ask the patient to repeat after you certain words
 To test for receptive aphasia(people with the condition are unable to understand language in its
written or spoken form, and even though they can speak with normal grammar, syntax, rate, and
intonation, they cannot express themselves meaningfully using language , ask the patient to carry out
a verbal command .
 To test for reading comprehension , ask the patient to read a sentence with written command ( e.g.
Close your eyes.)
G. Abstract thinking
 It is the ability to deal with the concepts and to make appropriate inferences. It can be tested by
 Similarities – ask the patient to tell you the similarity between two things ( e.g. Car and train ) and
the difference between two things ( book and notebook )
 Proverbs – ask the patient to interpret one or two proverbs
 Interpretation of given situation
7. Insight
It is the degree of awareness and understanding that the patient has regarding his illness. For example, ask
the client about
 His present illness
 What he considers it
if client says he has no problem at all shows complete lack of insight. Client replies that he is physically ill
indicate partial insight . When he says that he has mental illness and he is ready to take treatment it means he
has full insight in to his illness. (Lack of insight/ partial insight / full insight )
Or
 Complete denial of illness
 Slight awareness of being sick and needing help , but denying it at the same time
 Awareness of being sick, due to something unknown in self
 Awareness of being sick but it is attributed to external or physical factors
 Intellectual insight – awareness of being ill and the symptoms or failure in social adjustment are due
to own particular irrational feelings / thoughts, yet does not apply this knowledge to the current /
future experiences
 True emotional insight – the awareness leads to significant changes in the future behavior and
personality
8. Judgment

6. 6
The ability to make considered decisions. Judgment is based on patients knowledge, educational level, and
intelligence . Judgment is made regard to his client and social setting. It is the ability to assess a situation
correctly and act appropriately with in that situation. For example – testing by means of interpreting
proverbs giving a problematic situation and asking for solving of problem .
Types
 Social judgment - social judgment is how we perceive people, how we form impressions about
them and how we think about social things. E.g. -"if you were to find a stamp, addressed envelope
lying on the sidewalk, what would you do?
 Test judgment- assesses your ability to choose the most appropriate action in workplace situations-
e.g. What would you do if you smelled smoke in a crowded theatre.
 Personal judgment – ability for sufficiently realistic future plans in the context of education, job or
life situation.
 Impaired judgment is not specific to any diagnosis but may be prominent feature of
disorders affecting the frontal love of the brain .
 If persons judgment impaired due to mental illness , there might be concern for the
persons safety or the safety of others.
Chandni Narayan
12.4.2021