AN INTRODUCTION TO THE MENTAL STATUS EXAM

APPEARANCE
• Alert? Drowsy? Sedated?
• Signs of medication side effects/catatonia
• Overweight? Underweight?
• Signs of medication side effects/eating disorder
• Disheveled? Malodorous?
• Signs of poor self-care
• Face tattoos? Fresh cuts/scars?
• Signs of gang affiliation/self-injurious behavior
• Diaphoretic? Distressed?
• Signs of withdrawal

BEHAVIOR
• Ability to engage? Cooperativity?
• Signs of personality pathology/severity of illness
• Relatedness?
• Signs of psychosis/severe pathology
• Eye contact? Posture? Remain seated?
• Signs of severe pathology/interpersonal dysfunction
• Childlike? Manipulative? Demanding? Flirtatious? Overly apologetic? Evasive? Guarded?
• Signs of personality pathology/paranoia

MOTOR
• Gait
• Signs of medication side effects
• Tremors?
• Signs of withdrawal/medication side effects
• Involuntary movements?
• Signs of medication side effects/tics
• Psychomotor retardation?
• Signs of neurological dysfunction/severe depression or psychosis/catatonia
• Psychomotor agitation? Restlessness?
• Signs of akathisia/withdrawal/anxiety

SPEECH
• Volume?
• Loud
• Signs of agitation/mania
• Soft, mumbling
• Signs of depression
• Slurred
• Signs of intoxication/medication side effects
• Rate and rhythm?
• Latency
• Signs of psychosis/depression
• Pressured
• Signs of mania
 AN INTRODUCTION TO THE MENTAL STATUS EXAM

• Spontaneous? Fluent?
• Only answers questions
• Signs of psychosis/severe depression
• Hyperverbal
• Redirectable? Interruptible?
• Signs of mania/anxiety

MOOD
• Patient’s stated mood in quotes

AFFECT
• Observed mood
• Signs of depression/anxiety/mania
• Is this congruent with stated mood?
• Intensity?
• Signs of mania or severe pathology
• Reactivity?
• Would they laugh and smile in a socially appropriate manner?
• Signs of psychosis/severe pathology
• Range?
• Are they capable of only positive emotions or only negative?
• Spectrum from restriction to lability
• Elevated, expansive

 Constricted range

• Stability vs. Lability

 AN INTRODUCTION TO THE MENTAL STATUS EXAM

THOUGHT PROCESS
• Organized vs. disorganized
• Signs of psychosis/delirium
• Linear?
• Tangential?
• Signs of psychosis/cognitive impairment
• Circumstantial?
• Signs of cognitive impairment/personality pathology
• Flight of ideas?
• Signs of mania/intoxication
• Latency?
• Signs of psychosis/severe depression
• Poverty?
• Signs of psychosis/severe depression
• Blocking?
• Signs of psychosis/severe depression
• Future-oriented?
• Concrete?
• Associations?
• Intact vs loosening
 AN INTRODUCTION TO THE MENTAL STATUS EXAM

THOUGHT CONTENT
 AN INTRODUCTION TO THE MENTAL STATUS EXAM

• Suicidal ideation?
• Passive vs. active
• Plan?
• Intent?
• Self-injurious behavior?
• Homicidal ideation?
• Target?
• Plan?
• Intent?
• Auditory hallucinations?
• Signs of psychosis
• Visual hallucinations?
• Signs of delirium/withdrawal
• Tactile hallucinations?
• Signs of delirium/withdrawal
• Appear internally preoccupied?
• Signs of psychosis
• Delusions?
• Paranoid?
• Somatic?
• Persecutory?
• Grandiose?
• Reference to the self?
• Reality testing
• Intact vs impaired
• Obsessions?
• Compulsions?

SENSORIUM AND COGNITION

• Orientation
• Self
• Place
• Time
• Circumstance
• Attention
• Attend to immediate environment and conversation?
• Concentration
• List days of the week backwards
• Spell “world” backwards
• Serial 7s
• Memory
 AN INTRODUCTION TO THE MENTAL STATUS EXAM

• Immediate and delayed recall of 3 words

• Clues or choices needed?
• Language
• Aphasia
• Word salad
• Abstraction
• Interpret metaphor
• Fund of knowledge
• Current president
• Basic arithmetic

INSIGHT AND JUDGMENT

• Intact vs impaired
• Improving?
• Understanding of diagnosis, treatment plan, impact of behavior?
• Medication compliance?
• Behavioral control?