The Mental Status Exam

Note Writing Guide

© PsychGuides 2022

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 Table of Contents
Appearance...................................................................................... 4
Behaviour.......................................................................................... 6
Rapport & Cooperation .............................................................. 10
Mood & Affect ................................................................................. 12
Speech............................................................................................... 15
Thought Form/Process ...............................................................18
Thought Content ........................................................................... 21
Perception ...................................................................................... 26
Consciousness & Orientation .................................................. 30
Memory ............................................................................................ 32
Attention & Concentration ....................................................... 34
Insight & Judgement .................................................................. 36
Motivation....................................................................................... 38

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 Appearance
Helpful Terms
Age Weight Clothes Posture
Appeared Obese Casually Slouched
older than Overweight dressed Erect
stated age Under- Well dressed Closed
Appeared weight Bright Open
younger Emaciated Dull Slumped
than stated Dark Rigid
age Clean Stooped
Appeared Wearable Relaxed
stated age Unclean Stiff
Unkempt Shaky
Grooming/ Dress Other Hair
Hygiene Features
Well Casual Wounds Brightly
groomed Stylish Scars coloured
Dishevelled Dirty Skin texture Dyed
Soiled Bizarre Tattoos
Body odour Militaristic Body shape
Halitosis Appropriate Jewellery
Shaved or for weather Glasses
unshaved Undressed Dental
Neglected Under- braces
Good dressed
Satisfactory Overdressed
Adequate
Poor
Clean
Neat

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Specific Definitions

Halitosis – bad breath

Questions

N/A

Examples

• XXX is a 19-year-old male that appears older than his

stated age. He presented to the emergency
department unshaven with unkempt hair, wearing
a soiled collared shirt, dirty khaki pants and no
shoes. He was underdressed for the cold climate. He
appeared to have scars on his forearms.
• XXX appeared overweight for her height. She
apologised for her body odour and halitosis at
multiple times throughout the interview. Her body
posture was rigid, and at times, shaky.
• XXX, a 34-year-old African American woman of
average weight and height, was dressed in a floor-
length floral gown at time of review. Her grooming
was adequate.
• At time of examination, XXX was well groomed and
dressed in a hospital gown.
• XXX was neatly dressed and well-groomed. S/he
appeared slightly underweight for his age and
height. While s/he had difficulty meeting the
clinician’s eye contact, s/he would smile when the
therapist attempted to engage with them.

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 Behaviour
Helpful Terms
Gait Expressions Eye Contact
Normal/no difficulties Bland Intermittent
Abnormal Flat Fleeting
Awkward Mobile Avoidant
Staggering Mask-like Sporadic
Shuffling Good
Rigid Appropriate
Brisk Average
Slow Normal
Ataxic (abnormal, Intense
uncoordinated
movements)
Hesitant
Uncoordinated
Some clumsiness
Psychomotor Other
Repetition
Activity Movements
Psychomotor Gestures Involuntary or
retardation Twitches abnormal
Psychomotor slowing Stereotypies movements
Bradykinesia Automatism Foot tapping
Rapid talking Mimicry Hand wringing
Pacing Echopraxia Mannerisms
Foot tapping Tremors Compulsion
Fidgeting Tics Lip smacking
Psychomotor elation Grimaces Catatonia
Psychomotor Catalepsy
agitation Stupor
Hyperactivity Posturing
Akathisia (inner Cerea Flexibilitas
restlessness) Waxy flexibility

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Specific Definitions

Agitation – a sense of physical restlessness, normally with a

heightened state of inner tension
Automatism - involuntary actions or bodily movements
that are not under the control of the conscious mind (e.g.,
breathing)
Bradykinesia - decreased movement
Echopraxia - involuntary imitation of another person’s
movements
Psychomotor agitation - a clinically significant increase in
action or movement due to psychological rather than
organic/physical reasons (e.g., pacing, tapping foot, rapid
talking)
Tic - part of the body moves repeatedly, quickly, suddenly,
and uncontrollably (e.g., blinking repeatedly, repeated
grunting sound)
Tremor - involuntary rhythmic contraction/movements of
some part of the body (e.g., shaky hands due to underlying
neurological issue)
Hyperactivity - increased level of physical activity (normally
goal-directed)
Compulsion - repetitive ritualistic behaviour or mental
activity

Catatonia
Catatonia - a neuropsychiatric disorder that is
characterized by abnormal movements and behaviours
(e.g., immobility/rigidity, mutism, staring, and withdrawal)
Catalepsy – trance-like state characterised by decreased
responsiveness and muscle rigidity (where limbs remain in
whatever position they are placed despite being against
gravity)

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Cerea flexibilitas - the capacity (as in catalepsy) to maintain
the limbs or other bodily parts in whatever position they
have been placed
Waxy flexibility – resistance to movement when
repositioning limbs (similar to bending a wax candle)
Stupor - an alteration of consciousness marked by
decreased responsiveness to external stimuli and
hypoactive behaviour (i.e., absence of spontaneous
movement)
Posturing - person able to maintain an unnatural posture
despite the direction of gravity

Questions

N/A

Examples

• XXX made very little eye-contact during the

assessment interview. He appeared quite
withdrawn and gave minimal or no responses to the
questions asked. He remained slumped in the chair
throughout the interview.”
• XXX exhibited significant psychomotor agitation and
appeared agitated and restless. She appeared to
have difficulty sitting still and tapped her foot
throughout the interview. Eye contact was sporadic.
• XXX demonstrated an awkward and staggered gait.
Expressions were mask-like and immobile, with eye
contact generally avoidant. XXX exhibited
occasional motor and vocal tics (lip smacking,
grunting).
• XXX’s behaviour was appropriate to the context, but
he fidgeted with his shirt at times. Eye contact was
normal.
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 • XXX demonstrated significant psychomotor
agitation, foot taping and constant fidgeting
throughout the interview. While her eye contact was
generally appropriate, she would occasionally break
eye contact – when she did, she appeared to be
inspecting the room.

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 Rapport & Cooperation
Helpful Terms
Rapport & Cooperation
Uncooperative Somewhat Cooperative Playful
Contemptuous shy Compliant Seductive
Hostile Quiet Focused Overfamiliarity
Demanding Withdrawn Engaged Clinging
Suspicious Uncertain Motivated Manipulative
Secretive Cautious Focused Dependent
Resistant Guarded Patient Highly
Defensive Distant Friendly agreeable
Apathetic Disengaged Polite
Careless Evasive Open
Annoyed Easily Candid
Irritable distracted Thoughtful
Negativistic Interested
Critical Conscientious
Relaxed
Unconcerned

Specific Definitions

Negativism - opposition or resistance to outside

suggestions or advice

Questions

N/A

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Examples

• XXX was calm and cooperative with the clinician.

• XXX was alert and agreeable to psychological
review.
• XXX was generally collaborative and cooperative
with the clinician.
• XXX did not appear interested in interacting with
the clinician.
• XXX was initially resistant and suspicious of the
clinician, repeatedly asking ‘Why do you want to
know?’
• XXX was initially difficult to engage; however, they
became more cooperative as the interview
progressed.
• XXX exhibited overfamiliarity with the clinician that
was inappropriate for the setting and context.
• XXX was generally overinclusive and highly
agreeable with the clinician.

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 Mood & Affect
Helpful Terms
Type
Depressed Anxious Euthymic
Dysphoric Fearful Content
Miserable Panicked Happy
Sad Tense At ease
Bored Agitated Calm
Dysthymic Afraid Relaxed
Anhedonic Alarmed Ecstatic
Apathetic Distressed Euphoric
Tired Angry Expansive
Shameful Annoyed Elevated
Defeated Frustrated Irritable
Excited
Facial Expressions Range/Variability Intensity
Relaxed Narrow Flattened
Tense Restricted Constricted
Smiled Appropriate Detached
Laughed Appropriate Blunted
Insulting Normal Appropriate
Yelled Expressive Responsive
Happy Expansive Adequate
Sad Exaggerated Normal
Alert Broad Exaggerated
Daydreaming Dramatic
Angry Passionate
Smiling Hyper-energised
Distrustful
Suspicious
Tearful
Congruency Appropriateness Lability/Stability
Congruent Appropriate Labile
Consistent with Inappropriate Stable
reported mood Fatuous Supple
Incongruent Silly Sluggish
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Specific Definitions

Alexithymic – difficulty identifying or expressing emotions

Anhedonic - inability to enjoy anything, even things
enjoyed in the past
Apathy – decreased interest, energy, and reaction to the
environment
Dysphoric - feeling unwell or unhappy
Ecstatic - a feeling of being overwhelmed by delight
Euphoric - an exaggerated feeling of well-being
Euthymia - mood in the normal range, neither depressed
or elevated
Labile - repeated and rapid shifts from one extreme to
another

Questions

• How would you describe your mood?

• Have you felt discouraged/low/blue lately?
• Have you felt angry/irritable/on edge lately?
• Have you felt anxious/nervous/apprehensive lately?
• Have you felt energized/high/out of control lately?

Examples

• XXX described her mood as “anxious”, which was

consistent with her affect.
• XXX’s affect was depressed, and her range of mood
reduced. XXX also appeared anxious and irritable.
• XXX described their mood as ‘on top of the world’
and affect was elevated and euphoric. Affect was
not appropriate to context.

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 • Affect was within normal range of intensity and
range, and congruent with stated mood.
• XXX’s affect was characterised by a mix of irritability
and sadness. His affect was appropriate to given
context and congruent with his stated mood and
thought content.

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 Speech
Helpful Terms
Quantity Rate Volume Rhythm
Expansive Fast Loud Appropriately
Talkative Pressured Strong placed
Abundant Rapid Monotone inflections
Excessive Variable Weak Pauses
Garrulous Normal Dull Dysprosody
Voluble Slow Soft Normal
Rambling Low prosody
Spontaneous Whispered Response
Responsive latency
Paucity
Poverty
Impoverished
Little detail
Mutism
Intelligibility & Response
Quality Conversation
Fluency Latency
Slurred Hesitant Could initiate Increased
Mumbled Unspontaneous and hold Decreased
Stuttering Emotional Unwilling to None
Accented Monotonous engage
Hard to Echolalia Hesitant
understand Appeared No difficulties
Clutter thoughtful Difficulty
Difficult to follow Overly friendly finding words
Confusing Simple/soft- Unable to
Poor articulation spoken comprehend
Coherent Included questions
Clear profanity
Hesitant Critical/sarcastic
Understandable Difficulty
Clear finding words
Fluent Lacking in
Logical needed detail
Coherent Overly detailed
Meaningful
Animated
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Specific Definitions

Alogia - poverty of speech

Global aphasia - the loss of ability to communicate
Dysarthria - difficulty producing speech (often due to
difficulty controlling voice box or tongue)
Garrulous – excessive, trivial, or rambling talk
Voluble - a ready and continuous flow of speech that
dominates conversation
Mutism - unable or unwilling to speak
Dysprosody - a loss of control of intonation and rhythm of
speech
Clang association - speech whereby words are chosen
because of their sounds rather than their meanings
Condensation - speech whereby separate concepts fused
together or not differentiated
Word salad - speech that is an incomprehensible mix of
words and phrases
Glossolalia – fabricated speech
Neologism - the use of a made-up word or an everyday
word used in an idiosyncratic way
Jargon aphasia - incoherent, meaningless speech that
appears to make sense to the individual
Echolalia - the repetition or echoing of words or sounds
made by another person
Verbigerative - involuntarily and continual repetition of
certain words and/or phrases

Questions

N/A

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Examples

• XXX demonstrated some difficulty pronouncing

words and articulating themselves clearly. Their flow
of speech was generally halted and restricted to
one- or two-word answers.
• XXX’s speech was slow, halted, and soft.
• XXX’s speech was difficult to follow and relatively
impoverished in quantity.
• XXX demonstrated significant difficulty finding
words and paused for several seconds prior to each
phrase.
• XXX articulated themselves clearly. They answered
questions spontaneously, although at slow rate and
speed.
• XXX’s speech was spontaneous, goal-directed and
fluent.
• XXX responded to questions spontaneously and with
sufficient detail.
• XXX’s speech was predominantly slow and halting.
She generally answered questions that she
understood directly, but there was significant
latency in her responses.

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 Thought Form/Process
Helpful Terms
Tightness of Thought Flow of Ideas
Well-organized Logical
Tangential Illogical
Loosely connected Variable
Incoherent Restricted
Repetitive
Vocabulary Reply Directness
Descriptive Informative
Restrictive Relevant/Irrelevant
Idiosyncratic use of words Embellished
Neologisms Overinclusive

Goal-directed – logical thought that both addresses the

point and answers the question directly
Circumstantiality – ideas are tightly linked, but
overinclusive of detail and takes some time to reach goal
Tangentiality – ideas are tightly linked but does not reach
goal (i.e., does not answer question)
Flight of ideas – rapid and frequent shifts between
connected ideas, often accompanied with pressured
speech
Rambling – thought is goal-directed, but interspersed by
phrases and ideas that are irrelevant
Loosening of associations/derailment – connections
between ideas is unclear or nonsensical; difficult to remain
goal-directed and on-topic
Blocking – sudden halt or interruption in speech in pursuit
of goal
Fragmentation – words are intact, but phrases become
disconnected
Verbigeration – repetition of certain words and phrases

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Word salad/incoherence – words remain intact, but mix of
seemingly random words and phrases
Incoherence – words and phrases are completely
unintelligible

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Questions

N/A

Examples

• XXX exhibited flight of ideas, rambling and loose

associations. She frequently and unpredictably
shifted between topics of conversation. Flow of ideas
was generally illogical and irrelevant to question
posed.
• No reported or observed thought disorders present.
XXX was able to answer questions spontaneously
and directly, and flow of ideas were tightly
connected and logical.
• XXX’s generally demonstrated normal thought
process and form.
• XXX’s thought process was initially goal-directed,
but occasionally tangential. At one point in the
interview, XXX exhibited though blocking and
derailment when discussing past trauma. Thought
process then deteriorated into fragmentation and
word salad.
• Thought process was disorganised with flight of
ideas primarily connected to grandiose delusional
themes.
• XXX’s thought process was marked by
circumstantiality and tangentiality. The relevance of
her replies to questions were based on the
complexity of questions asked. At times, it was
difficult to follow XXX’s line of thinking as she often
failed to provide context for scenarios she described.

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 Thought Content
Helpful Terms
Delusions Phobias Obsessions
Paranoid Animal Contamination
Grandiose Situational Symmetry
Jealous Blood/injection Precision
Infidelity Agoraphobia Assault
Erotomaniac Surroundings Sexual assault
Somatic Social Homicide
Passivity Other Insults
Control Safety
Magical Catastrophe
Referential Unworthiness
Thought
broadcasting
Thought insertion
Thought
withdrawal
Ideas of reference
Homicidal
Suicidal Ideation Other
Ideation
Reported Reported Overvalued ideas
Denied Denied Preoccupations
Ideation history Previous Ruminations
Previous intimidation Mood-congruent
attempt/s History of violence Mood-
Current ideation Current intent incongruent
Impulsiveness Impulsiveness Ego-syntonic
Viable plan Viable plan Ego-dystonic
Available means Available means
Settling of affairs

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Specific Definitions

Overvalued ideas – ideas that preoccupy a person’s

thinking and alters behaviour (e.g., superstitions)
Obsessions – a repetitive, persistent, intrusive, and
unpleasant thought or urge that causes severe distress and
anxiety
Compulsion - ritualistic, repetitive behaviours or mental
acts completed to decrease obsession-related distress
Preoccupations - repeated return to thinking about a topic
Ruminations – negative thought patterns whereby a
person repetitively thinks about content without reaching
a resolution or a plan of action

Delusions - fixed, false beliefs that are maintained in spite

of evidence that they are not real or true (unrelated to
cultural or religious beliefs)

• Bizarre delusion - delusion about completely

impossible or implausible situations (e.g., alien
abduction)
• Non-bizarre delusion – delusion about possible
situations (e.g., infidelity)
• Capgras syndrome (“Imposter syndrome”) –
delusion where person believes that someone they
know has been replaced by an imposter
• Control delusion – delusion that a person’s thoughts,
feelings, impulses, and actions are under some
external control
• Doppelganger delusion - delusion where person
believes they have a double
• Dorian Gray syndrome – delusion where person
believes they stay the same age while everyone else
ages

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 • Infidelity delusion – delusion where person believes
that their partner is sexually unfaithful.
• Ideas of reference/Referential delusion – delusion
where person believes that random, irrelevant, or
innocuous events in the world directly relates to
them
• Magical thinking - the illogical belief that one's
thoughts, words, or actions will cause or prevent a
specific outcome (often seen in OCD)
• Somatic delusion - a delusion which primarily
focuses on the appearance or functioning of a
person’s body
• Thought broadcasting – delusion where person
believes that their thoughts are being broadcast out
loud so that they can be heard by others
• Thought insertion – delusion where person believes
that their thoughts are inserted into their mind (e.g.,
by aliens)
• Thought withdrawal – delusion where person
believes that their thoughts are being removed from
their mind by someone or something

Questions

General
• What’s been on your mind recently?
• Are you worried about anything?
• Are there thoughts that you have a hard time
getting out of your head?

Delusions
• Do you spend a lot of time thinking about one or two
things?

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 • Do you have some ideas that you hold very strongly?
• Do others frequently disagree with your point of
view?
• What is that is most important to you?
• Do you have personal beliefs that are not shared by
others?
• Does it ever seem like people are stealing your
thoughts, or perhaps inserting thoughts into your
head? Does it ever seem like your own thoughts are
broadcast out loud?

Obsessions
• Do you experience repetitive thoughts that you just
can’t stop?
• Do your thoughts feel like they are your own?
• Are you ever forced to think about something
against your will?

Phobias
• Are there objects or situations that make you
intensely anxious if you cannot avoid them?
• Do you make special effort to avoid certain objects or
situations?

Suicidality/Harm
• Do you ever feel that life is not worth living?
• Have you ever thought about cutting yourself?
• Have you ever thought about killing yourself? If so,
how would you do it?

Homicidality
• Have you ever thought about killing others or
getting even with those who have wronged you?
• Do you feeling like acting on your anger?
• Do you feel like hurting someone?
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Examples

• XXX’s thought content included mood-congruent

grandiose delusions about being able to “turn
invisible”. He also reported instances of thought
insertion (“The agency put my thoughts in my head”)
and ideas of reference (“The TV tells me what the
agency wants me to do next”). No hallucinations
were reported.
• XXX denied suicidal or homicidal ideation.
• XXX’s thought content predominantly focused on
obsessions and intrusive thoughts around death
and the prevention of harm to herself and/or others.
• XXX expressed some thoughts of paranoia (fears of
danger befalling him), but these were without
delusional content.
• XXX’s thought content focused primarily on social
phobia and fear of others judging and/or hurting
him.

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 Perception
Helpful Terms
Hallucinations Dissociation Agnosia Other
Auditory De- Visual agnosia Re-
Visual personalisation Auditory experiencing
Derealisation Mood-
Olfactory Tactile congruent
Gustatory Dissociative Visuospatial Mood-
Somatic amnesia dysgnosia incongruent
(tactile) Fugue Prosopagnosia Ego-syntonic
Multiple Ego-dystonic
Sleep Autopagnosia
Other (see personality
below) Macropsia
Micropsia

Specific Definitions

Hallucinations
Reality testing - the inability to objectively evaluate the
external world and to differentiate between the external
and the internal world
Gustatory hallucination - hallucination of taste
Hallucinosis - person has persistent, recurrent, or continual
hallucinations
Hypnagogic hallucinations - hallucinations while falling
asleep.
Hypnopompic hallucination - hallucinations while waking
from sleep
Lilliputian hallucination – visual hallucination whereby
people, animals or object appear smaller than they are
Mood-congruent hallucinations - hallucinations which
reflect current mood (e.g., hearing berating voices in
depressive episode)

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Mood-incongruent hallucinations – hallucinations which
do not reflect current mood (e.g., hearing voices telling
them they are a superhero during a depressive episode)
Tactile hallucination - hallucination of touch (e.g., feeling
insects are crawling beneath the skin)
Macropsia - visual objects appear to be larger than they
actually are
Micropsia - visual objects appear to be smaller than they
actually are

Dissociation
Dissociation - a mental process of disconnecting from
one’s thoughts, feelings, memories, or sense of identity
Depersonalization - a state where a person feels detached
from themselves or their surroundings
Derealization – a state where a person feels that either they
themselves or the outside world is not real
Dissociative amnesia – inability to remember important
information about themselves, their life, and/or a traumatic
or stressful event
Dissociative fugue – a person suddenly and temporarily
loses their sense of personal identity

Agnosia
Agnosia – inability to recognise objects, people, smells or
sounds
Visual agnosia - inability to recognize visual objects despite
normal vision
Auditory agnosia – inability to recognize sounds despite
intact hearing
Tactile agnosia (astereognosis) – inability to recognise
objects through touch
Visuospatial dysgnosia – inability to localize and orient
oneself and/or identify relationships between objects in the
environment
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Prosopagnosia - inability to recognize familiar faces, while
the ability to name parts of the face (e.g., nose, mouth) or
identify individuals by other cues (e.g., clothing, voices) is
left intact
Autopagnosia - inability to recognise different parts of own
body

Questions

Hallucinations
• Do you see things that upset you?
• Do you ever see/feel/hear/smell/taste things that are
not really there? If so, when does it occur?
• Have you had any strange sensations in your body
that others do not seem to have?
• Do you sometimes misinterpret real things that are
around you, such as muffled shadows or noises?

Dissociation
• Do things seem unnatural/unreal to you?
• Do you ever feel
detached/removed/changed/different from others
around you?
• Do you ever feel detached from yourself or others?
Does the world around you sometimes feel
unnatural?

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Examples

• No perceptual disturbances were reported or

observed.
• XXX reported auditory hallucinations consistent with
her depressive mood.
• XXX reported mood-incongruent tactile/somatic
hallucinations, describing the sensation of bugs
crawling on her.
• XXX described hypnagogic and hypnopompic visual
and auditory hallucinations (figures telling her to kill
her father).
• XXX reported symptoms of dissociation, describing
feeling as if the world is “not real” (derealization) and
occasionally struggling to recognise herself in the
mirror (depersonalisation).
• Perception consisted of auditory hallucinations,
which were command in nature with homicidal
instruction.

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 Consciousness & Orientation
Helpful Terms
Consciousness Orientation
Alert Intact
Lethargic Impaired
Drowsy
Somnolent
Obtundation
Stupor
Fluctuating

Specific Definitions

Oriented – the person is oriented to who they are, where

they are and when it is
Lethargy – person has difficulty remaining alert and
appears to want to drift off to sleep, but can be aroused
Somnolent – abnormally sleepy or drowsy
Obtundation – reduced level of consciousness and
decreased responsiveness to stimuli
Stupor - an alteration of consciousness marked by
decreased responsiveness to external stimuli and
hypoactive behaviour (i.e., absence of spontaneous
movement)

Questions

• How would you describe the situation we’re in?

• Person
o What is your name?
o What is your date of birth?
o How old are you?

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 • Time
o What is today’s date?
o What time is it?
o What is the year/season/date/day/month?
• Place
o What is the name of this place?
o Where are we?
o What state/city/hospital/floor are we in?

Examples

• XXX was alert and oriented to time and place.

• XXX was oriented to person and place; however, they
were not oriented to time. XXX was not entirely sure
of why they were in the emergency room.
• Orientation was not formally assessed but appeared
intact.

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 Memory
Helpful Terms
Memory
Below average Intact Above average
Impaired Average Superior
Low
Poor

Specific Definitions

Short-term memory – immediate recall; limited to about

seven items, lasts for approximately one minute
Long-term memory - rehearsal allows material in short-
term memory to convert to long term memory
Amnesia – inability to remember
Anterograde amnesia – cannot learn new material
Retrograde amnesia – cannot recall recent past events
Transient global amnesia – sudden confusion, loss of
memory and disorientation, and cannot recall what
happened during time in question

Questions

Immediate Memory
• “I am going to ask you to remember three words
(colour, object, animal – e.g., blue, table, and horse)
and I will ask you to repeat them to me in 5 minutes.
Please repeat them now after me: blue, table, and
horse.” à Five minutes later “What were those three
words I asked you to remember?”

Recent Memory
• What did you have for breakfast this morning?
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 • Where did you park the car?
• What time was your appointment with me today?
• Can you remember my name?

Remote Memory
• Ask for information about the person’s childhood
that can be later verified, such as:
o When and where did you get married?
o What school did you go to?
o What were the dates of your graduation from
high school, college, and graduate school?

Examples

• XXX demonstrated poor memory for recent events of

the last few hours/for remote events of the past year.
• XXX appears to have compromised immediate
memory. For example, he requires the therapist to
speak in sentences and ask questions that are very
short (approximately 10 words maximum).
• Memory was not formally assessed, but XXX was
able to give timelines to recent events.
• XXX appears to have difficulty with long-term
memory. On the second consultation, the clinician
asked XXX about what they discussed last session
and she stated she couldn’t remember.

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 Attention & Concentration
Helpful Terms
Attention & Concentration
Satisfactory Distractable Poor
Adequate Mildly deficient Deficient
Sufficient Variable Short span of
No significant Adequate, with attention
impairment occasional Preoccupation
distractions
Mild to moderate
impairment
Difficulty staying
on topic or
attending to a task

Specific Definitions

Attention - ability to focus on a task or subject

Concentration – ability to maintain attention for a period of
time

Questions (from MMSE)

Digit Span
• I will recite a series of numbers to you, and then I will
ask you to repeat them to me, first forwards and then
backwards. (begin with 3 numbers, and then
advance to 7-8 numbered sequence)

Spelling Backwards
• Spell the word WORLD. Now spell it the world
WORLD backwards.
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Calculations
• Starting with 100, subtract 7 from 100, and then keep
subtracting 7 from that number as far as you can go.
• Starting with 20, subtract 3 from 20, and then keep
subtracting 3 from that number as far as you can go.

Examples

• XXX demonstrated a mild deficiency in his attention

abilities. The clinician had to redirect him to
questions at multiple times throughout the
interview.
• Attention and concentration was adequate and
within normal ranges.
• XXX’s concentration abilities appeared to be
deficient. The clinician had to redirect XXX to the
task at multiple times during assessment.

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 Insight & Judgement
Helpful Terms
Insight
Poor Denial Good
Deficient Satisfactory
Impaired

Specific Definitions

Insight – person’s degree of awareness and understanding

that they have a mental health problem
Judgement – a person’s ability to understand the
consequences of their behaviour and to make decisions
that protect their wellbeing; problem-solving skills

Levels of Insight
1. Complete denial of illness
2. Some awareness of mental illness and needing help,
but denying simultaneously
3. Awareness of mental illness but blaming it on others,
or external factors like physical illness (external locus
of control)
4. Awareness of mental illness, but is unaware of cause
5. Intellectual insight – awareness of mental illness and
its current consequences, but not applying this
knowledge to future experiences
6. Emotional insight – emotional awareness of mental
illness, the underlying meaning of symptoms and
demonstrates ability to modify behaviour
accordingly
From: Reddy M. S. (2015). Insight and Psychosis. Indian Journal of Psychological
Medicine, 37(3), 257–260. https://doi.org/10.4103/0253-7176.162909

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Questions

Insight
• What brings you here today?
• What do you think is causing your problems?
• How do you understand your problems?
• Do you think that these thoughts, moods,
perceptions, etc., are abnormal?
• How do you plan to get help for this problem?

Judgement
• If you were in a crowded movie theatre and noticed
there was a fire off the side in the hallway, what
would you do?
• If you found a fully addressed and stamped envelope
on the sidewalk, what would you do?

Examples

• XXX’s insight appears impaired. He demonstrates

difficulty reflecting upon his internal experiences
and drawing connections between events and his
behavioural, emotional or cognitive responses.
• Insight and judgement were poor, as XXX was
brought in by the police after running through
traffic. He reported that he does not see this as a
problem, citing his “superhero powers” (grandiose
delusions).
• Judgement appeared intact and sufficient for day-
to-day functioning.
• XXX demonstrated unrealistic decision-making skills
and an inability to come to appropriate conclusions.
• XXX showed fair insight and judgement, as she
demonstrated awareness that ‘something is wrong’.
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 Motivation
Helpful Terms
Stages of Change
Precontemplation No intention to change or take
action in the near future. Due to:
• Reluctance (unwilling to
change)
• Rebellion (valuing
independence)
• Resignation (feels helpless
and overwhelmed)
• Rationalizing
Contemplation Intent to change within the
coming months, with awareness of
negative and positive effects of
change.
Preparation Planning to take action in the near
future, with a plan of action.
Action Implementing plan of action and
making significant modifications to
behaviour.
Maintenance Sustaining behaviour change, and
working to prevent a relapse.
From: Diclemente, C., & Velasquez, M. (2002). Motivational Interviewing and the Stages of
Change. In In Motivational interviewing: Preparing people for change, 2nd edition (pp. 201–
216).

Questions

• On the scale of 0 to 100, how much do you want to

make this change right now?
• Have you tried anything previously to make progress
towards your goals?
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 • What, specifically, has stopped you in the past from
reaching your goals?

Examples

• XXX appeared to be in a pre-contemplative stage of

change. She stated that she did not see a problem
with her drug use and was confused about her
mother’s concern for her health.
• XXX explained that he knows he “needs to stop”,
indicating that he is in the contemplation stage of
change.
• XXX reported a preliminary plan to manage his
anxiety symptoms.
• XXX appeared motivation for change and interested
in engaging in treatment. She was able to
objectively identify the pros and cons of alcohol use.

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