The document provides an overview of the components of a mental status examination (MSE). It describes the MSE as an assessment of a person's current mental state and behavior, including objective observations by the clinician and subjective reports from the patient. The MSE evaluates general appearance, mood, thought processes, cognition, and insight/judgment. It is used to inform diagnosis, assess treatment response, and allow comparison over time or between providers. The document outlines each component of the MSE in detail.

1. Mental Status Examination
Course Instructor
Aimen Zafar Butt/Ambreen Fatima
(Courtesy: Ms. Erum)

2. What it is it?
The Mental Status Exam (MSE) is the
psychological equivalent of a physical
exam that describes the mental state
and behaviors of the person being seen.
It includes both objective observations
of the clinician and subjective
descriptions given by the patient.

3. The mental status examination is
an assessment of current mental
capacity through evaluation of
general appearance, behavior, any
unusual or bizarre beliefs and
perceptions (eg, delusions,
hallucinations), mood, and all aspects of
cognition (eg, attention, orientation,
memory).

4. Why do we do them?
The MSE provides information for diagnosis
and assessment of disorder and response to
treatment.
A Mental Status Exam provides a snap shot
at a point in time
If another provider sees your patient it allows
them to determine if the patients status has
changed without previously seeing the patient

5. To properly assess the MSE information
about the patients history is needed
including education, cultural and social
factors
It is important to determine what is
normal for the patient. For example
some people always speak fast!

6. Components of the Mental
Status Exam
Appearance
Behavior
Speech
Mood
Affect
Thought process
Thought content
Cognition
Insight/Judgment

7. Appearance: What do you
see?
Build, posture, dress, grooming,
prominent physical abnormalities
Level of alertness: drowsy, alert
Emotional facial expression
Attitude toward the examiner:
Cooperative, uncooperative

8. Behavior
Eye contact: poor, good, piercing
Movements: tremor, abnormal
movements i.e.. stereotypes,tics, gait

9. Psychomotor activity:
Retardation
Psychomotor retardation involves a
slowing down of thought and a
reduction of physical movements in
an individual. Psychomotor retardation
can cause a visible slowing of physical
and emotional reactions, including
speech and affect.(reaction time)

10. Psychomotor agitation
hand wringing, mood related engage in
moments which serve no purpose,
pacing around the room ,toe taping
,rapid talking, thought racing or
crowding ,moving object with no
reasons ,

11. Speech
Rate: increased/pressured,
decreased/monosyllabic,( using brief or few
words to signify reluctance to engage in
conversation)
latency:Response Latency is the time span
between a stimulus and a response or
reaction. shorter response latencies can
mean quicker brain processing or better
memory.
Rhythm: articulation, monotone, slurred
Volume: loud, soft, mute

12. Mood
The prevalent emotional state the
patient tells you they feel
Often placed in quotes since it is what
the patient tells you
Examples “Fantastic, elated, depressed,
anxious, sad, angry, irritable, good”
Type: euthymic (normal mood),
dysphoric (depressed, irritable, angry),
euphoric (elevated, elated) anxious

13. Affect
The emotional state we observe
Range: full (normal) vs. restricted, blunted or flat,
labile
Congruency: does it match the mood-(mood
congruent vs. mood incongruent)
Stability: stable vs. labile

14. Orientation
Time
Person
Place

15. Thought Process
Describes the rate of thoughts, how they flow
and are connected.
Normal: logical and linear, coherent and goal
directed
Abnormal: associations are not clear,
organized, coherent.
Examples include circumstantial, loose, flight
of ideas, word salad, harsh, thought blocking.

16. Thought Process: examples
Circumstantial: provide unnecessary
detail but eventually get to the point
Tangential: Move from thought to
thought that relate in some way but
never get to the point
Loose: Illogical shifting between
unrelated topics

17. Flight of ideas: Quickly moving from one
idea to another- see with mania
Thought blocking: thoughts are
interrupted
Perseveration: Repetition of words,
phrases or ideas
Word Salad: Randomly spoken words

18. Thought Content
Refers to the themes that occupy the
patients thoughts and perceptual
disturbances
Examples include preoccupations,
illusions(an instance of a wrong or
misinterpreted perception of a sensory
experience), ideas of reference(false
belief that irrelevant occurrences or
details in the world relate directly to
oneself.),
hallucinations:auditory,tactile,somatic,olf
actory,visual.

19. depersonalization include:
Feelings that you're an outside observer
of your thoughts, feelings, your body or
parts of your body — for example, as if
you were floating in air above yourself
Feeling like a robot or that you're not in
control of your speech or movements
The sense that your body, legs or arms
appear distorted, enlarged or shrunken,
or that your head is wrapped in cotton
Emotional or physical numbness of your
senses or responses to the world

20. Derealization Symptoms:
Feelings of being alienated from or unfamiliar with
your surroundings — for example, like you're living
in a movie or a dream
Feeling emotionally disconnected from people you
care about, as if you were separated by a glasswall
Surroundings that appear distorted,blurry,colorless,
two-dimensional or artificial, or a heightened
awareness and clarity of your surroundings
Distortions in perception of time, such as recent
events feeling like distant past
Distortions of distance and the size and shape of
objects

21. Thought Content: examples
Preoccupations: Suicidal or homicidal
ideation (SI or HI),obsessions or compulsions
Illusions: Misinterpretations of stimulus
Ideas of Reference (IOR): Misinterpretation of
incidents and events in the outside world
having direct personal reference to the
patient

22. Hallucinations: False sensory perceptions.
Can be auditory (AH), visual (VH), tactile or
olfactory
Derealization: Feelings the outer environment
feels unreal
Depersonalization: Sensation of unreality
concerning oneself or parts of oneself

23. Delusions: Fixed, false beliefs firmly held in spite of
contradictory evidence
Control: outside forces are controlling actions
Grandiose: inflated sense of self-worth, power or wealth
Somatic: patient has a physical defect
Reference: unrelated events apply to them
Persecutory: others are trying to cause harm

24. Cognition
Level of consciousness
Attention and concentration: the ability
to focus, sustain and appropriately shift
mental attention
Memory: immediate, short and long
term
Abstraction: proverb interpretation
Mini-Mental State Exam

25. Insight/Judgment
Insight: awareness of one’s own illness
and/or situation
Judgment: the ability to anticipate the
consequences of one’s behavior and
make decisions to safeguard your well
being and that of others