Pres. Diosdado Blvd.

, Metropolitan Park, Pasay City

Mental Status Examination

A. General Description

Appearance
Grooming/dress ____________________________ Hygiene ____________________________________
Eye contact ________________________________ Posture ____________________________________
Gait ______________________________________ Identifying features (marks/scars/tattoos)
_____________________________________________________________________________________
Appearance versus stated age _________________ Overall appearance __________________________

Motor Behavior/Activity (check if present and describe further)

Hyperactive _____ Agitated _____ Psychomotor retardation _____ Calm _____ Tremors _____Tics ___
Unusual movements/gestures _______________________________ Catatonia _____ Akathisia _______
Rigidity _____ Facial movements (jaw/lip smacking) _____
Others: _____

Speech
Rate: Slow/rapid _______ Amount: Paucity/ Mute/Pressured _________ Volume (loud/soft) _________
Characteristics: Fluency (mute/hesitation/latency of response) __________________________________

Attitude during the Interview

Is the client:
Cooperative/ Uncooperative _____________________ Warm/friendly /Distant ___________________
Suspicious /Combative __________________________ Guarded /Aggressive ______________________
Hostile/ Aloof ____________________ Apathetic __________________ Others: __________________

Mood and Affect

Is the client:
Elated (euphoric) /Sad /Depressed (dysphoric) ________ Euthymic _______Irritable/ Anxious _________
Fearful /Guilty ____ Worried/ Angry ____ Hopeless/ Labile ____ Mixed (anxious and depressed) ______
Is the Client’s Affect:
Flat ___ Blunted or diminished ___ Appropriate ___ Inappropriate/incongruent ________Others: ____

Thought Process
Concrete thinking _____ Circumstantiality ______Tangentiality _____ Loose association _____________
Echolalia ____________ Flight of ideas ________ Perseveration ______Clang associations ___________
Blocking _____________ Word salad __________ Derailment_________ Other: ____________________
SN- __________________________________ Pt. _____________________________________________
Thought Content
Does client have:
Delusions (grandiose/persecution/paranoid/somatic/ religious):________________________________
Suicidal/homicidal thoughts ______________ If homicidal, toward whom? ____________
• What thoughts have you had about hurting (person’s name)?
• What is your plan?
• What do you want to do to (person’s name)?
If suicidal, ask the following Suicide Assessment Questions:
Ideations _____Plan ______ Method _______ Access _____ Where _____ When _____ Timing _______

Does the client have?

Obsessions ___________ Paranoia ____________ Phobias ____________ Magical thinking ___________
Poverty of speech ______________ Other __________________________________________________

Perceptual Disturbances
Is client experiencing:
Visual Hallucinations ___ Auditory Hallucination, specifically, Commenting, Discussing , or Commanding
_____________________ Other Hallucination (olfactory/tactile/gustatory) ________________________
Illusions ______________ Depersonalization _______________Other ____________________________
SN- ___________________________________ Pt. ___________________________________________
Sensorium and Intellectual Process:
Level of consciousness- confused/ sedated/ stuporous / alert, Orientation: ________________________
(Time) SN- ______________________________ Pt. __________________________________________
(Place) SN- ______________________________ Pt. __________________________________________
)Person) SN- ___________________________________ Pt. ___________________________________
Memory (recent/remote/ immediate) _____________________________________________________
SN- ___________________________________ Pt. ___________________________________________
SN- ___________________________________ Pt. ___________________________________________
SN- ___________________________________ Pt. ___________________________________________
Level of Concentration is ____ Can perform certain task , like?__________________________________
Level of Calculation is ____ Can do simple math, like?__________________________________________
General fund of knowledge is_____ (ask about current events)___ _______________________________
Use of vocabulary is ______ Can define meaning of the word_______ Pt. _________________________
Ability to conceptualize abstract is ____ Knows how to interpret proverbs or identify similarity or
difference between objects t. ____________________________________________________________

Insight and Judgment

Insight is (good, fair, or poor) SN ________________________________ Pt.
_____________________________________________________________________________________
Judgment is (good, fair, or poor)) SN _______________________, Pt. ____________________________
_____________________________________________________________________________________
Impulse control is (good, fair, or poor)) SN _______________________, Pt. ________________________
_____________________________________________________________________________________

Prepared by: Checked by:

______________________ _________________________
Student Nurse Clinical Instructor