Mental Status Examination No.

Date: Day:

Note: Put a check mark in the appropriate box of significant observed descriptor/s.

1. General Description
1.1. Appearance
Descriptors Yes No Remarks
Congruent apparent age  ✓    
The patient
appears dishelved
Appropriate dressing    ✓ or untidy
Clean / Hygienic    ✓  He appears dirty
Good posture  ✓    
Good gait  ✓    
Appropriate facial expression  ✓  
  He acts
suspicious and
avoiding eye
With eye contact  ✓ contact
With pupil dilatation ✓    
With pupil constriction ✓    
Normal state of health & nutrition ✓    
1.2. Speech
Descriptors Yes No Remarks
Rapid speech   ✓ During the
assessment, the
Slow speech   ✓ patient is yelling
Loud volume  ✓   and his speech is
difficult to follow
Soft volume   ✓
and he mumbles to
Minimal speech   ✓ himself.
Pressured speech   ✓  
 
Stuttering   ✓  
Slurring of words  ✓  
 
 
 
Unusual accents    ✓  
1.3. Motor Activity
Descriptors Yes No Remarks
Lethargic   ✓
Tensed   ✓
Restless   ✓
Agitated  ✓  
 
With observed tics   ✓  
Grimaces   ✓  
 
Tremors   ✓  
Compulsive   ✓  
 1.4. Interaction During Interview
Descriptors Yes No Remarks
Hostile   ✓  
 The patient
refuses to engage
in much of the
interview and
refuses to give
contacts to gather
collateral
Uncooperative  ✓ information.
Irritable   ✓  
Guarded  He acts
suspicious and
 ✓ guarded.
Apathetic   ✓  
Defensive   ✓  
Suspicious  ✓  
Seductive    ✓  

2. Emotional State
2.1. Mood
Descriptors Yes No Remarks
Sad   ✓
Fearful  ✓ He thinks that
someone will get
Hopeless   ✓ him and he asked
Euphoric   ✓ to let him go.
 
Anxious   ✓  
Happy    ✓  

2.2. Affect
Descriptors Yes No Remarks
Congruent / Appropriate    ✓
Flat   ✓  
Labile   ✓  

3. Experiences
3.1. Perceptions
Descriptors Yes No Remarks
Hallucinations: Auditory   ✓  
Visual   ✓  
Tactile   ✓  
Gustatory   ✓  
Olfactory   ✓  
Illusions   ✓  
4. Thinking
4.1. Thought content
Descriptors Yes No Remarks
Delusion: Religious   ✓  
Somatic   ✓  
Grandiose   ✓  
Paranoid   ✓  
Thought broadcasting   ✓  
Thought insertion   ✓  
Depersonalization   ✓  
Hypochondriasis   ✓  
Ideas of reference   ✓  
Magical thinking   ✓  
Nihilistic ideas   ✓  
Obsession   ✓  
Phobia   ✓  
4.2. Thought process
Descriptors Yes No Remarks
Circumstantial   ✓  
Flight of ideas   ✓  
Loose associations   ✓  
Neologisms   ✓  
Perseveration   ✓  
Tangential   ✓  
Thought blocking   ✓  
Word salad   ✓  
REFERENCES:

Videbeck, S. L. (2004). Psychiatric Mental Health Nursing Second Edition (2nd ed.). Lippincott Williams
& Wilkins.

Townsend, M. C. (2015). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based

Practice Eighth Edition (8th ed.). F. A. Davis Company.