How to Administer the Mental Status Examination (MSE)

• Perform hand hygiene

• Identify the patient according to facility protocol
• Establish privacy by closing the door to the patient’s room and/or drawing the curtain surrounding the
patient’s bed; the room should be well-lit and quiet so that patient and the examiner can hear each other
clearly
• Introduce yourself to the patient and family member(s), if present; assess the coping ability of the patient
and family and for knowledge deficits and anxiety regarding the MSE
• Determine if the patient/family requires special considerations regarding communication
(e.g., due to illiteracy, language barriers, or deafness); make arrangements to meet these
needs if they are present
• Use professional certified medical interpreters, either in person or via phone,
when language barriers exist
• Explain the purpose and function of the MSE and what outcome to expect from the test;
answer any questions and provide emotional support as needed
• Assess the patient’s appearance, behavior, and speech by observing the patient’s
• appearance (e.g., ethnicity, age in appearance, hygiene, build, grooming, dress)
• speech (e.g., loud or hushed, pressured or hesitant, aphasic or excessive, sing-songy or
monotone, presence of abnormal speech patterns [e.g., echolalia, word salad])
• attitude toward examiner (i.e., interpersonal style [e.g., hostile, withdrawn, guarded,
congenial, open, gregarious, flirtatious])
• Assess the patient’s mood and affect, identifying
• depression (e.g., characterized by slumped or limp posture, sad or blank expression, delayed
motor activity, weight loss, anorexia, sleep disturbance, fatigue, feelings of worthlessness,
and depressed intellectual ability [e.g., due to loss of sleep, poor concentration])
• elation (e.g., exhibited by hyperactivity, euphoria, optimism, anxiety, sleeplessness, feelings
of grandiosity)
• euthymia (e.g., demonstrated by absence of emotion or mood tone, resulting in a flat, robotic,
or indifferent affect)
• appropriateness (e.g., when discussing the death of a loved one, it is appropriate for the
patient to have a sad affect)
• range (e.g., normal, labile, limited)
• Assess the patient’s sensorium by evaluating the patient’s
• level of consciousness (LOC), identifying whether the patient is alert, clouded, drowsy,
stuporous, or fluctuating
• orientation to person, place, and time. For example, ask the patient his or her name; the day
of the week, date, month, season, or year; where he or she is, or the name of the facility,
town, state, or country
• long-term memory. For example, ask the patient to state his or her date of birth or state the
name of the previous president in office
• short-term memory. For example, perform a 3-word recall by stating 3 words and asking the
patient to recall the 3 words 5 minutes later
• concentration. For example, ask the patient to count backwards from 100 in increments of 7
(100, 93, 86, 79, 72, 65, etc.). If this is too challenging, ask the patient to calculate how much
money he/she would have left if he/she started with $1.00 and spent $0.25 cents
• constructional ability. For example, ask the patient to draw a clock indicating a specific time
that you select
• Evaluate the patient’s intellectual function by asking questions to determine his or her general knowledge
base, and then characterizing the patient’s level of function as average, below average, or above average.
For example, ask the patient to
• name two wild animals
• identify four uses of electricity
• name the current president and vice-president in office
• identify the state capital
• identify which unit of measurement is smaller: 1 inch (2.54 cm) or 1 foot (0.30 meters)
 Mental Status Exam: Assessing Intellectual Function. Copyright ©2016, EBSCO Information
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• Assess the patient’s thought patterns by evaluating for
• coherency (i.e., organization of thoughts in a way the listener can understand)
• logic (i.e., reasoning produces sound conclusions)
• associative ability (i.e., the ability to connect thoughts in a way the listener can understand)
• presence of false perceptions (e.g., visual, tactile, gustatory, olfactory, or auditory hallucinations or
illusions)
• presence of delusions (i.e., firmly held false beliefs, including delusions of persecution)
• thought content or themes (e.g., recurrent thoughts about suicide in a patient who is depressed)
• goal-directedness (i.e., whether thoughts move progressively toward a point)
• normal or impaired judgment (i.e., ability to make good decisions and foresee consequences of
decisions)
• abstract reasoning ability (i.e., ability to generalize). For example, ask the patient to explain the
meaning of a proverb (e.g., “a stitch in time saves nine,” or “every dark cloud has a silver lining”) or
ask the patient to identify a similarity between two objects (e.g., “How are cars and trains similar?”)
• danger to self or others (e.g., homicidal or suicidal thoughts; see Red Flags, below)
• Update the patient’s plan of care, as appropriate, and document the examination according to facility protocol
in the patient’s medical record, including the following information:
• Date and time the MSE was administered
• Evaluation findings, using descriptive language to provide detailed information about observations
and patient responses
• Patient’s response to the evaluation
• Any unexpected patient events or outcomes, interventions performed, and whether the treating
clinician was notified
• Patient/family member education, including topics presented, response to education
provided/discussed, plan for follow-up education, and details regarding any barriers to
communication and/or techniques that promoted successful communication
•
Red Flags
• A patient who is acutely agitated, aggressive, or verbalizes homicidal or suicidal thoughts
requires immediate psychiatric assessment and constant supervision
• A sudden deterioration from baseline mental status can indicate the presence of a serious and rapidly
evolving neurologic problem such as stroke. Report these changes to the treating clinician immediately
• Incorrect responses to questions asked during the MSE should be considered in the context of the
patient’s unique circumstances. For example, a patient who is institutionalized can easily lose track of the
date and time

What Do I Need to Tell the Patient/Patient’s Family?

• Explain the purpose of the MSE and what to expect as you conduct it. Encourage and answer any
questions
• If further testing is required, explain to the patient/family the purpose of the testing and when the results
will likely become available
• If the patient is being cared for at home, perform the following:
• Educate the patient/family about clinical signs and symptoms that indicate worsening
neurologic problems that should be reported immediately to the treating clinician. These
signs and symptoms include sudden changes in gait, sudden slurring of speech, and rapid
deterioration from baseline mental status
• Provide the family with information for contacting the treating clinician if questions or
problems arise

References
Brackley, M. H. (1997). Mental health assessment/mental status examination. Nurse Practitioner Forum, 8(3), 105-
113.
Brannon, G. E. (2016, March 31). History and Mental Status Examination. Medscape.
http://emedicine.medscape.com/article/293402-overview
Fuller, D. S. (1998). The AMSIT (student handout). San Antonio, TX: University of Texas Health Science Center at San
Antonio, Department of Psychiatry.
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Levitas, A. S., Hurley, A. D., & Pary, R. (2001). The mental status examination in patients with mental retardation and
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