1

MENTAL STATUS EXAMINATION

Definition
A mental status examination (MSE) is an assessment of a patient's level of cognitive
(knowledge-related) ability, appearance, emotional mood, and speech and thought patterns at
the time of evaluation.

CONTENTS OF MSE
1. General appearance and behavior:
• Physical appearance: (approximate age, height, weight)
• Dressing: (Adequate, appropriate, any peculiarities)
• Grooming, bodily hygiene and self care:
• Touch with surroundings:
• Eye contact: (maintains gaze- anxious patients, Avoids gaze- Schizo, excessive -
manic patients, hesitant eye contact or normal eye contact).
• Facial expression: (Appropriate or not, is it changed with the subject or not,
Comfortable/ uncomfortable, attentive/ indifferent, elation of mood, fear, anger, sad)
• Posture: (relaxed- Obsessive, Guarded- Paranoid)
2. Psychomotor activity:
• Inactive
• Hyperactive
• Restlessness, Compulsive acts, rituals or habits ( nail biting)
3. Speech
• Document information on all aspects of the patient's speech, including tone, volume
and reaction time of speech during the interview.
• Relevance and coherent
• Some things to keep in mind during the interview are whether patients raise their
voice when responding, whether the replies to questions are one-word answers or
elaborative, and how fast or slow they are speaking.

4. Thought
a. Disorders of Tempo.
• Tangentiality
• Circumstantiality
• Flight of ideas
b. Disorders of continuity of thinking:
1. Perseveration
2. Thought blocking
c. Form:
Give sample and comment on loosening of associations and neologism
d. Possession:
Obsessions (elicit their nature of obsessions)
1
Page

1|Page
e. Content:
Delusions or Overvalued Ideas
• Depressive ideation: ideas of worthlessness, guilt, hopelessness, helplessness and
suicidal ideas

5.AFFECT

Description should be given regarding the following components:

• Range
• Appropriateness to situation
• Communicability
• Congruence to thought

6. Perception
• Illusions
• Hallucinations: Auditory, visual, gustatory (taste), tactile (touch), Olfactory (Smell).
1. Auditory:
• first person/ second person/ third person
• Single voice or multiple
• Commenting or commanding/ abusive/ threatening
Can be
➢ Audible thoughts - 1st person auditory hallucinations
➢ Arguing voices in their head - 2nd person auditory hallucinations (if talking directly
to the patient)
➢ Running commentary in their head - 3rd person auditory hallucinations
• Familiar or unfamiliar
• Pleasant or unpleasant
7. Cognitive functions:
Cognitive or higher mental functions are an important part of the MSE. Their significant
disturbance commonly points to the presence of an organic psychiatric disorder.

a. Attention and Concentration:

To assess attention and concentration, tests used are;

1. Digit Span Test:

A.Forward: Patient is given the following instructions:

• I will be saying some digits, listen to me carefully
• When I finish saying them, you will have to repeat them in the same order
• Give an example ( if I say 3, 7 you say 3.7)
• Read digits at the rate of one per second to the patient
• Notes whether the immediate responses of the patient is correct or incorrect but don’t
reveal it to the patient.
• The following digits may be used:
• 4-2-5
• 6-1-5-8
3

• 1-4-8-3-9
• The digit span is the highest number of digits repeated correctly.
• The same digits should not be presented more than once

If the patient can not repeat a particular number of digits on one trial, a second trial
with the same number of digits is given and credit is given if the response is correct
B.Backward: The patient is instructed as follows:

• I will be saying some digits. Listen to me carefully and repeat them after me in a reverse
order, for example if I say 6-3, you have to say, 3-6
• The procedure is the same as for digits forward
• The same digits should not be used as for the forward test.
• No digits should be presented in a series
o The digits backward score is the highest number of the digits correct recalled
backward after a maximum of 2 trials.

• Increasingly difficult tests are presented.

• The examiner a) instructs the patient b) gives an example of how to perform the task
c) notes the responses verbatim and d) notes the time taken in seconds.
• 20-1 20-0 reversed in 15 seconds
• 40-3 40, 37, 34, 31, etc in 60 seconds
• 100-7 100, 93, 86, 79 etc in 120 seconds
• Days or months may be asked for in backward or forward to the patient who is
familiar with the correct order.

Orientation:To elicit responses concerning orientation, ask the patient questions, as

follows.

• "What is your full name?" (ie, person).

• "Do you know where you are?" (ie, place).
• "What is the month, date, year, day of the week, and time?" (ie, time).
• "Do you know why you are here?" (ie, situation).
• This frequently looks at whether the person knows the time (including the date), place
(where he/she are), person (who he/she is), and situation (that he/she is in).\

Memory
Assessment includes immediate, recent and remote memory.
1. Immediate memory - tested by digit span test
2. Recent memory- tested by
• Address test: An address consisting of about 4-5 facts which is not known to the patient
is slowly read to the patient after instructing him to attend to the examiner. He is
engaged in conversation and the response is noted verbatim. Recall is asked for after 3-
5 minutes.
3
Page

3|Page
 • Asking the patient to recall events in the last 24 hours eg. Details of the time and
amount of a meal or visitors to the hospital from an inpatient. Responses given by the
patient should be noted of and cross checked from reliable source.

3. Remote memory: Information on life events

• Date of birth or age

• Number of children
• Names and number of family members
• Time since marriage or death of any family member
• Year of completing education
• 4-5 facts may be asked for, relevant to the patients’ background and answers should
bcross checked.

Abstract ability

➢ Is tested by similarities, differences and proverbs.

A .Similarities: The patient is given the following instructions

➢ I will give you some pair of words. You have to tell me in what way they are alike, what
is common between them or what the similarity between them is.

➢ Orange and Banana (fruits)

➢ Dog and Lion (animals)
➢ Car and Bus (modes of transportation)

b.Differences: The instructions are as follows: I will be presenting to you some pairs of words.
Listen carefully and tell me in what way they are different from each other.
• Stone and potato( not eatable- eatable/ hard- soft)
Cinema and Radio( audiovisual- audio)
c. Proverbs: The patient is asked the following questions:
• Whether he knows what a proverb is
• An example of a proverb and what it means
• If it is clear that the patient has the concept of a proverb, the following may be asked;
• “A bird in the hand is worth 2 in the bush”
• “A barking bog never bites”
• The responses of the patient are to be noted verbatim and the answer is judged to be
correct or incorrect.
General information
The interviewer always should take into consideration the patient's educational background
and other training in evaluating answers and assigning scores.
For literates:
• Name of the Prime minister
• Capitals of countries
• 5 rivers, cities or states
5

For illiterates:
• Seasons
• Crops or fruits grown in particular seasons
• Prices of land
Calculation
• The following questions may be asked with increasing time units.
• How much is 4 rupees and 5 rupees?
• I borrowed 6 rupees from a friend and returned 2 rupees, how much do I still owe
to him?

Intelligence
• Intelligence: Based on the information provided by the patient throughout the
interview, estimate the patient's intelligence quotient (ie, below average, average,
above average).
Judgments
➢ Personal J: is assessed by inquiries about the patients future plans
➢ Social J: is assessed by observing behavior in social situations
➢ Test J: Fire Problem-If the place where you are sitting catch fire?
Insight
➢ Insight refers to a person's ability to recognize a problem and understand its nature
and severity. Assess the patients' understanding of the illness. To assess patients'
insight to their illness, the interviewer may ask patients if they need help or if they
believe their feelings or conditions are normal.
➢ Clinical rating of insight: It is rated on 6 point scale from one to six.
1. Complete denial of illness
2. Slight awareness of being sick, but denying it at the same time
3. Awareness of being sick, blaming it on external factors
4. Awareness that illness is due to something unknown in the patient
5. Intellectual insight:
Awareness of being ill and that the symptoms in social adjustment are due to own particular
irrational feelings/thoughts; yet does not apply this knowledge to the current/future
experiences.
1. True emotional insight:
It is different from intellectual insight in that the awareness leads to significant basic
changes in the future behavior and personality.
5
Page

5|Page