1.

Mental Status Examination

The Mental Status Examination (MSE) is a
standardized procedure used to evaluate the
patient’s mental and emotional functioning at the
time of examination. It involves a precise series of
observations as well as some specific questions.
1. General appearance
 Built- state of health. nutritional status
 Dressing and self-care.
 Posture.
 Facial expression& eye to eye contact.
 Cleanliness and Self Hygiene.
 Appearance for age.

2.Behaviour
A) Social behaviour:
i) eye to eye contact
ii) cooperativeness
iii)inhibition & disinhibition- seduction.
B) Motor behavior:
The degree and quality of activity: -
Hyperactive, hypoactive agitation,
purposeless movements
Obstruction – seen in catatonia and consisting of irregular
hindrance and blocking of movements.
Mannerisms—tics, tremors, Stereotypies
C) Physiological behavior:
appetite
Sleep
sex

3. Speech
 Dysarthria – disorder of articulation of
speech.
 Spontaneous or not (needs to be asked)
 To the point or not
 Perseveration – inappropriate repetition of
a previous name, word, theme or act.
 Coherent or not word salad
 Quantity:
 i)little
 ii)Much

 Pressure
 Volume
i) high : - mania
ii) moderate: - average
 iii) low: anxiety, depression – telegraphic
answers
iv)Tone

4.Thinking
 Form
loose associations-- incoherent --off point
Some Disorders Affecting the Thought Process (FORMAL
THOUGHT DISORDER)
Loosening of No logical connection from one
associations thought to another
Flight of ideas A fast stream of very tangential
thoughts
Neologisms Made up words
Clang Word connections due to
associations phonetics rather than their
actual meanings
Thought Abrupt cessation of
blocking communication before an idea
is expressed completely
Tangentiality The patient does not make a
point because of a lack of goal-
directed associations between
idea
Circumstantiality The patient reaches the point
after a circuitous path
  Control:
Passivity phenomena: insertion—broad casting
–withdrawal—reading. ‘Made actions’
 Stream( speed) tempo :
average –rapid—slow, Block
Accelerated tempo: pressure of talk, flight of ideas
Decreased tempo – psychic retardation; retarded
depression
 Content:
i) delusions ii) obsessions iii) preoccupation
(somatization)

DELUSIONS
1. A delusion is a fixed false idea held in the face
ofevidence to the contrary,
2. Out of keeping with the patient’s social milieu.
3. Held unshakably.
4. Not modified by experience or reason.
5. Content often bizarre.
6. Not dependent on disintegration of general
intellectual functioning or reasoning abilities.

Types:
 1. Autochthonous or primary delusions have no discernible
connection with any previous interactions or experiences. They
arise fully formed as sudden intuitions, like sudden ‘brainwaves’.
2. Secondary delusions emerge understandably from other
psychic experiences or current preoccupations; e.g. prevailing
affect, fears, personal stress, habitual attitudes of mind.
3. Overvalued ideas are intense preoccupations with marked
associated emotional investment. The patient holds tenaciously to
the idea, demonstrably false, with virtual certainty but not
unshakeable conviction.

Example of Delusions 
i) Persecutory delusion. ...
ii) Delusion of grandeur. ...
iii) Delusional jealousy. ...
iv) Erotomania or delusion of love. .(De Clerambault
syndrome)..
v) Somatic delusional disorder. ...
vi) Induced delusional disorder or folie a' deux. ...
vii) Bizarre delusion – Refers to delusion that is implausible
(difficult to believe or failing to convince) such as alien
invasion.
• Obsessions :-are repetitive, intrusive and stereotyped
thoughts, images or impulses.

Abstraction = The patient’s ability to determine

similarities between two things is known as abstract
thought. E.g. similarity between watch and ruler Or ask
interpretation of a proverb ( use familiar proverb)
 5. Cognitive function

 CONSCIOUSNESS is the state of awareness of the

self and its environment.
 Reduced levels of consciousness are seen in:
Clouding of consciousness – disorientation in time,
place, person, disturbances of perception and attention
and subsequent amnesia.
*Drowsiness further reduction in level of consciousness,
with unconsciousness if unstimulated, but can be
stimulated to a wakeful state.
*Stupor further loss of responsiveness, which can be only
aroused by considerable stimulation.
*Coma – profound reduction of conscious level with very
little or no response to stimulation.( Glasgow coma scale).
1.eye opening response 2. best verbal response 3.best
motor response total= 15 8 or lese coma 3 totally
unresponsive.
Orientation: Time -Place -Person
Ask the patient to state his or her full name, location, the
current date and time, and why he/she is in the office
attention& concentration
Ask the patient to subtract 7 from 100 sequentially ( it is
difficult you can use subtract 5 from 100. This tests the
patient’s ability to concentrate and pay attention. to test the
patient’s concentration e.g., count from one to ten or say
days of the weak forward and backward
Memory: immediate, recent, & remote
The patient’s memory should be also checked. Short-term and long-
term memory might be impaired in a depressed patient. This is known
as depressive pseudo-dementia.
Phobias
The psychiatrist should ask the patient about phobias and
document any expressed/noted phobias as part of the mental
status examination.
Suicidal ideation
Suicidal ideation should be documented during the mental status
examination. Asking the patient about suicidal ideation directly is
recommended. If the patient has positive suicidal ideation, ask
about specific plans. If the patient describes a plan, his/her
readiness to carry out that plan should be assessed. These are
the main risk factors for a true suicidal attempt. The physician
should also ask the patient about homicidal ideation, especially
psychotic patients or those with suicidal ideation. Patients who
blame someone else for their depression might eventually
become homicidal instead of suicidal.

Judgement: It is the ability to identify the consequences of

actions e.g., you ask the patient; What will you do if you found a
stamped envelope……this is called test judgement and proper
judgement can be deduced from the information you collect from
history. e.g., if your patient came alone to OPD using public
transport

6. Perception
 SENSORY DISTORTIONS: changes in the quality,
intensity or spatial form of a perception. Examples are:
 • Hyperacusis – in mania, hyperthyroidism.
• Hypoacusis – in some acute organic states.
• Xanthopsia, micropsia – produced by psychedelics and
temporal lobe lesions
 Hallucinations are actual sense deceptions:
Auditory
visual
tactile
gustatory
olfactory
You have to ask about the Content, frequency and
reaction to hallucinations
Hallucinations:
 perceptions which arise in the absence of any external
stimulus (Esquirol, 1833).
 They are actual sense deceptions, not distortions of real
perceptions.
 Hallucinations are perceived as being located in the
external world.
 They are perceived as having the same qualities as
normal perceptions – i.e. vivid, solid.
 Hallucinations are not subject to conscious manipulation,
in the same sense that normal perceptions cannot be
produced or dismissed at will
 Auditory hallucinations are among the most common
symptoms of schizophrenia. The voices sometimes give
instructions to the patient who may or may not act upon
them; these are termed ‘imperative hallucinations.
( second person- you yours-). In some cases the voices
speak about the person in the third person (he, his, her,
 hers, they, their….) and may give a running commentary
on their actions.
Illusions
are distortions of perceptions of real objects; wrongly
perceived or interpreted e.g. flowery wallpaper is perceived as
swarming snakes.
Pseudo hallucinations:
are not perceived by the actual sense organs, but
experienced as emanating from within the mind. They are a
form of imagery. are located in subjective rather than objective
space.

7.Emotions
 Affect: cross sectional: visible or observed reaction of
the person towards events, a short-lived feeling state.
described as:
 i)Type( quality): depressed, anxious(fear with no
adequate cause),apathy (loss of all feeling), euphoric
(excessive and unrealistic cheerfulness), angry.
ii)Range: labile, restricted, blunted, flattened
iii)Appropriateness: to content, congruent or incongruent.
 Mood: longitudinal: sustained inner feeling-emotions- to
be explained by the patient own words, and is described
by such terms as anxious, depressed, dysphoric,
euphoric, angry, and irritable.

8.Insight
  Ask the patient whether he is ill or not
 Ask the patient whether he needs treatment or not
 Ask the patient whether his symptoms are due to his
illness or not
 The patient may be insightful or having partial insight
or lacks insight

9. Reliability
Upon finishing the mental status examination of the patient, the
psychiatrist should determine whether the patient was reliable,
unreliable, or impossible to tell. This is important since it
increases the credibility of the obtained history and can determine
the need to interview other individuals close to the patient in
addition to the patient. The patient’s reliability can be assessed
from the mental status examination as well as the patient’s
compliance with the treatment plan.