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The Comprehensive Mental Status Examination:

Categories of Mental Functioning, Definitions of Terms, Questions, and Observations

1. Orientation: Level of awareness and orientation. The person’s ability to identify who and where they
are, the date and approximate time.
Have you been having trouble recognizing where you are or what’s around you?
Would you tell me where you are now?
What time is it now?
What date is it?
2. Sensorium: A client’s wakefulness or consciousness. Levels of awareness include unconsciousness
or coma, drowsiness or somnolence, normal alertness, hyperalertness, or suspiciousness to mania.
Do you have trouble concentrating or focusing your thoughts?
Can you watch a movie or read a book and follow it through?
Do you have trouble keeping up in conversations?
3. Appearance and Behavior: Observable characteristics of a person (objective data).
• Facial expression (animated, fixed or immobile, sad or depressed, angry, pale or reddened)
• Gestures, posture (relaxed, tense, erect, slouching, leaning away)
• Dress (neat, careless, eccentric, soiled)
• Physical characteristics (document anything that is unusual or stands out, such as unkempt,
bearded)
• Motor activity (agitation, restlessness, tremors, motor retardation)
• Apraxia (inability to carry out purposeful movement to achieve a goal)
• Akathisia (extreme restlessness, possibly a side effect of some antipsychotic medications)
• Akinesia (complete or partial loss of muscle movement; may be a side effect of antipsychotic
medications or a symptom of schizophrenia)
• Dyskinesia (excessive movement of the mouth, protruding tongue, facial grimacing; possibly a
side effect of an antipsychotic medication)
• Parkinsonian movement (fine tremor accompanied by muscular rigidity; possibly a side effect of
an antipsychotic medication)
• Reaction to caregiver (friendly, hostile, suspicious)
4. Speech and Communication: Evaluate how the client is communicating, rather than what the client
is telling you. Rate, volume (quietness or loudness), modulation, and flow (lively or dispirited).
5. Mood or Affect: Affect (a person’s display of emotion or feelings). Mood (subjective way a client
explains feelings).
• Inappropriate affects: unexpected responses to a situation, discussion of content that does not fit
with accompanying emotions.
• Pleasurable affects: euphoria (excessive and inappropriate feelings of well being), or exaltation
(intense elation accompanied by feelings of grandeur).
• Unpleasurable affects or dysphoria: Depression, anxiety, fear, agitation, ambivalence,
aggression, mood swings or lability.
What has your mood been like lately?
Are you more or less emotional than usual?
6. 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.
• Disturbance in thought process (how a person thinks)
o Loose associations (poorly connected or poorly organized thoughts)
o Circumstantiality (frequent digressions on the way to an eventual conclusion)
o Tangentiality (frequent digression until initial reason for beginning a discussion is forgotten)

Copyright © 2004 by Lippincott Williams & Wilkins, Inc. A Wolters Kluwer Health company.
o Flight of ideas (rapid speaking with quick changes from one thought to another connected
thought; frequently seen in clients with mania)
o Perseveration (repetition of the same word in reply to different questions)
o Blocking (cessation of thought production for no apparent reason)
• Disturbance in thought content (what a client is thinking)
o Delusion (inaccurate or false belief that cannot be corrected by reasoning)
Delusion of grandeur (exaggerated belief about own abilities or importance)
Delusion of reference (false belief that one is at the center of another’s attention and
discussion)
Delusion of persecution (false belief that others are seeking to hurt one or in some way
damage one either physically or by insinuation)
o Preoccupation of thought: (connecting all occurrences and experiences to a central thought,
usually one with strong and emotional overtones) and obsessive thought: (unwelcome idea,
emotion, or urge that repeatedly enters the consciousness)
Do you find that there are thoughts that you cannot get out of your mind?
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?
o Phobia (strong fear of a particular situation or thing)
Claustrophobia (fear of being in an enclosed space)
Agoraphobia (fear of being in an open place, such as outdoors or on a highway)
Acrophobia (fear of high places)
• Other disturbances in thought or memory; any type of change in ability to recall thoughts from the
unconscious into consciousness in an accurate manner
o Amnesia (complete or partial inability to recall past experiences)
o Confabulation (filling in gaps in memory with statements that are untrue; seen in dementia).
o Déjà vu (feeling of having experienced a new situation on a previous occasion)
o Intellectual Fund
What is the governor’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?
o Abstract ability
What does it mean when people say, “Don’t cry over spilled milk”? “How are an apple and an
orange alike? How are a tree and a frog alike?”
7. Perception: The way that a person experiences their environment and how the person perceives his
or her frame of reference within that environment. Equivalent to a sense of reality. Derives from the
senses of vision, hearing, touch, smell, and taste. The information is perceived through the senses
and monitored by the mind and the mind's defenses.
• Hallucination (false sensory perceptions that do not exist in reality)
o Visual hallucination (seeing objects that are not present in reality)
o Auditory hallucination (hearing sounds not present in reality)
o Hypnagogic hallucination (sensing any type of false sensory perception during the twilight
period between being awake and falling asleep)
• Illusion (misinterpretation or distortion of an actual stimulus)
• Depersonalization (feeling detached from one’s surroundings)
• Derealization (ranging from a mild sense of unreality to a frank loss of reality about one’s
environment)
Can you see or hear things that other people do not know are there?
Do you have unusual abilities or experiences often now?
Are there things you believe that other people say are all wrong?
Do you believe people are trying to hurt you?
Does it seem easy lately to mistake one thing for another, like a shadow for a man?

Copyright © 2004 by Lippincott Williams & Wilkins, Inc. A Wolters Kluwer Health company.
8. Memory: The mind’s ability to recall earlier events. Recent: Events that happened during the
pervious few days. Remote: Events that occurred from the 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?
9. Judgment: The final outcome of the processes described 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 $10,000 check in the mail, just for you to use?
10. Insight: Awareness of one’s own responsibilities and concerns, especially regarding this illness. A
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?
11. History: Including developmental and family history.
Where were you born?
What were your parents like when you were 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 junior high?
How were your grades?
What kinds of things did you like to do?
What were you like in high school?
How were your grades?
Did you get into any trouble at school?
Did you date?
Did you get into any substances like drugs or alcohol?
Did you get into trouble at home?
How was it at home?
What did you do after graduation?
When was your first significant intimate relationship?
When was your first real job?
What kinds of jobs have you had?
How 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 seeking help?
Have you had any hospitalizations?
Do you have contact with your family now?
Do any of your family members have a history of psychiatric illness? If so, what are those illnesses?

Copyright © 2004 by Lippincott Williams & Wilkins, Inc. A Wolters Kluwer Health company.