STUDENT NAME: ______Joshua R.

Canja_______________________________________________________

Block: ____NR-42____________________ Date: ___August 22, 2021_____

MENTAL STATUS EXAMINATION WORKSHEET

(Skills Laboratory Activity)

INSTRUCTIONS: Watch the video shared to you. Given the following criteria, document your assessment findings
and conclusion considering that the person in the video is your patient.

ASSESSMENT CRITERIA ASSESSMENT FINDINGS & CONCLUSION

I. GENERAL APPEARANCE AND BEHAVIOR
A. Facial Expression animated, excited
(animated, fixed or immobile, sad or depressed,
angry, pale or reddened)
B. Gestures, Posture Hyperactive, leaning away on the chair, feeling of
(relaxed, tense, erect, slouching, leaning away) excited
C. Dress Well groomed , neat,
(neat, careless, eccentric, soiled)
D. Physical Characteristics None
(document anything that is unusual or stands out,
such as unkempt, bearded)
E. Apraxia (-) Apraxia
(inability to carry our purposeful movement to
achieve a goal)
F. Akathesia (+) Akathesia
(extreme restlessness, possibly a side effect of
some antipsychotic medications)
G. Akinesia (-) Akinesia
(complete or partial loss of muscle movement,
may be a side effect of antipsychotic medications
or a symptom of schizophrenia)
H. Dyskinesia (-) Dyskinesia
(excessive movement of the mouth, protruding
mouth, facial grimacing; possibly a side effect of
an antipsychotic medication)
I. Parkinsonian movement (-) Parkinsonian movement
(fine tremor accompanied by muscular rigidity;
possibly a side effect of an antipsychotic
medication
J. Reaction to caregiver Friendly
(friendly, hostile, suspicious)
II. ATTITUDE
(foster how the client reacts to certain situations: Slightly Cooperative
positive or negative)
 Think of a scenario.
 What will you do/ How will you act given the
situation?

III. SPEECH AND COMMUNICATION Rate: Rapid

(evaluate how the client is communicating, rather Volume: loud
than what the client is telling you) Modulation: fine-turning of the tone
Flow: lively
 Rate
 Volume (quietness or loudness)
 Modulation
 Flow (lively or dispirited)
IV. AFFECT AND MOOD Affect: appropriate
(Affect: a person’s display of emotion or feelings; Mood: full of energy, euphoric, labile
Mood: subjective way a client explains feelings)
*Inappropriate, Pleasurable, Unpleasurable
 What has your mood been like lately?
 Are you more or less emotional than usual?
V. CONTENT OF THOUGHTS/ THINKING
(the way the person functions intellectually. The process or way of thinking or analysis of the world;
way of connecting or associating thoughts; and overall organization of thoughts)
A. THOUGHT PROCESS DISTURBANCE Hallucination: seeing God as a big bloke with a big
(how a person thinks: loose association, beard.
circumstantiality, tangentiality, flight of ideas, thinking about cure for cancer
perseveration, blocking) Circumstantiality
B. THOUGHT CONTENT DISTURBANCE
(what the client is thinking: delusions, *Thoughts of making cure for cancer
preoccupation of thoughts) * The patient use news papers and book for clues
* Believe that he is a doctor
 Do you find that there are thoughts that you
* Flight of ideas: patient jump from one topic to
cannot get out of your mind? another.
 Do you keep returning to the same idea?
 Are your thoughts moving more slowly or
quickly than usual?
 Does it seem as if your mind just goes blank
lately?
 Do you have trouble keeping up with your
thoughts or understanding your thoughts?
C. PHOBIA Not observed
(strong fear of a particular situation or thing)
D. THOUGHT RECALL * He recall that his name is john.
(ability to recall thoughts: amnesia, confabulation, * The patient says that he is a doctor and a part time
déjà vu, intellectual fund) car mechanic.
 What is your mayor’s name?
 Can you think of one big item in the news
lately?
 Would you please subtract 7 from 100 and
keep going with that until I ask you to stop?
E. ABSTRACT ABILITY Circumstantiality
 What does it mean when people say, “Don’t
cry over a spilled milk”?
 How are apples and orange alike? How are
trees and frogs alike?
VI. ORIENTATION Not having trouble in recognizing things and places.
(level of awareness, person’s ability to identify Able to answer the question of where he is now.
who and where they are, the date and approximate
time)
 Have you been having trouble recognizing
where you are or what’s around you?
 Can you tell me where you are now?
 What time is it now?
 What date is it?
VII. JUDGMENT Talking and hearing God's voice in his ear.
(the final outcome of the processes described Not able to perform valid conclusion.
above. A person’s ability to form valid
conclusions and behave in a socially appropriate
manner)
 What would you do if a policeman stopped you
for speeding?
 What would you do if you received a cheque
worth a million in the mail, just for you to
use?
VIII. INSIGHT The patient keep talking about cure for cancer
(awareness of one’s own responsibilities and
concerns, especially regarding the illness. A Not aware of his problem.
person’s ability to objectively analyze the
problem)
 What do you think the real problem is that
resulted in your being here today?
 How do you make sense of this whole situation
now?
IX. MEMORY Recalled his name
(the mind’s ability to recall earlier events.
Recent: events that happened during the previous Recalls if he had a good sleep.
few days. Remote: events that occurred from the Recalls about his job as a doctor and a partime
mechanic.
first recollection of childhood through
adolescence, adulthood, and up until the current
week)
 Can you remember what you had for breakfast
today?
 What did you do yesterday?
 Can you remember what I said my name was?
 What was the name of the high school from
which you graduated?
X. SENSORIUM Mania
(wakefulness or consciousness, drowsiness or
somnolence, normal alertness, hyper alertness,
suspicious or mania)
 Do you have trouble concentrating or focusing
on thoughts?
* Write 7-9 numbers. Let the client read and
memorize the numbers for 30 seconds.
Remove the list and let the client repeat the
numbers how it was written.
 Can you watch a movie or read a book and
follow it through?
 Do you have trouble keeping up in
conversations?
XI. HISTORY The patient says that he is a doctor.
(including the developmental and family history) Has a part time job as a car mechanic.
 Where were you born? Live with his grandparents.
Cannot sleep for more than a week.
 What were your parents like when you were
He is a 36 years old
young?
 How many brothers and sisters do you have?
 What is your earliest memory?
 Did you enjoy grade school?
 How were your grades?
 Did you keep your friends from grade school?
 Did you play with other children a lot?
 What was it like at home?
 What was it like in high school?
 How were your grades?
 What kinds of things did you like to do?
 Did you get into any trouble at school?
 Did you date?
 Did you get into any substance like drugs or
alcohol?
 Did you get into trouble at home?
 What did you do after graduation?
 When was your first significant intimate
relationship?
 What was your first real job?
 What kinds of jobs have you had?
 What did you do with your jobs?
 Have you ever had this sort of problem
before?
 Have you ever had any other emotional
problems severe enough to warrant you
seeking help?
 Have you had any hospitalizations?
 Do you have contact with your family now?
 Do any of you family members have a history
of psychiatric illness? If so, what are those
illnesses?