MENTAL STATUS EXAMINATION

MENTAL STATUS EXAMINATION > is a cross section of the patient’s psychological life and represents the sum of the
nurse’s observation and impression AT THE MOMENT. It also serves as a basis for future comparison to follow track the
progress of the patient’s condition.

5 Categories of MSE:

1.General Description 2. Emotional State 3. Experiences

4.Thinking 5. Sensorium and Cognition

1. General Description – physical characteristics of the patient.

1.1 APPEARANCE

 Apparent age – older or younger than age stated?

 Manner of dress – appropriately dressed?
 Grooming or cleanliness- neat or unkempt?
 Posture - sit up straight or stoops?
 Gait – unusual or unsteady gait?
 Facial expression – looks sad or happy?
 Eye contact – maintained
 Pupil- dilated or constricted

1.2 SPEECH

 Rate – rapid or slow

 Volume – loud or soft
 Amount – paucity, mute or pressured
 Characteristics – stuttering, slurring words or unusual accent

1.3 MOTOR ACTIVITY – concerning patient’s physical movement

 Level of activity – lethargic, tense, restless or agitated

 Type of activity - tics, grimaces, or tremors
 Unusual gesture or mannerism- repeated motor movement

1.4 INTERACTION DURING THE INTERVIEW – how the patient relates to the nurse during the interview.

Hostile, uncooperative, irritable, guarded, apathetic, defensive, suspicious, seductive

2. EMOTIONAL STATE
2.1 MOOD – self report of the patient’s prevailing emotional state and is a reflection of the patient’s life situation.

- Sad, Fearful, Hopeless, Euphoric, Anxious

2.2 AFFECT- prevailing patient’s emotional tone observed by the nurse during the interview.

 Flat – no reaction
 Labile- shifts from one affect to another abruptly
 Restricted or blunted reaction is limited
 Congruent

3. EXPERIENCES
2 TYPES OF PERCEPTUAL PROBLEMS
3.1 Hallucinations – false sensory impression or experience

- Auditory, Visual, Tactile, Gustatory, Olfactory

3.2 Illusions – false perception or false responses to sensory stimulus

4. THINKING
4.1 Thought content

 refers to the specific meaning express in the patient communication.

 refers to the what of the patient’s thinking’

4.2 Thought processes

 refers to how of the patient’s self expression which is observe in the patient’s speech.

Thought Content Descriptors

 DELUSION – false belief that is firmly maintained even though it is not shared by others and is contradicted by
social reality.
 Religious
 paranoid
 Somatic
 thought broadcasting
 grandiose, thought insertion
 Depersonalization – the feeling of having lost self identity and the things around the person are different,
strange or unreal.
 Hypochondriasis – somatic over concern and morbid attention to details of body functioning.
 Ideas of Reference -incorrect interpretation of casual incidents and external events as having direct personal
references.
 Magical Thinking- belief that thinking equates with doing, characterized by lack of realistic relationship
between cause and effect.
 Nihilistic Ideas – feelings and thoughts of non existence and hopelessness.
 Obsession – an idea, emotion or impulse that repetitively and insistently forces itself into consciousness,
although it is unwelcome.
 Phobia – a morbid fear associated with extreme anxiety.

Thought Processes Descriptors

 Circumstantial – thought and speech associated with unnecessary details that is usually relevant to a question
and an answer is ultimately given.
 Flight of ideas – over productive speech characterized by rapid shifting from one topic or another and
fragmented ideas.
 Loose of Associations – lack of logical relationships between thoughts and ideas that render speech and
thought in exact, vague, diffuse and unfocused.
 Neologism – new words or words created by the patient which is often a blend of words.
 Perseveration – involuntary, excessive continuation or repetition of single response, idea, or activity, may apply
to speech or movement but most often verbal.
 Tangential – like circumstantial but the person never returns to the central point or never answer to the
original question.
 Thought blocking- sudden stopping in the event of thought or in the midst of the sentence.
 Word salad– series of words that seem totally unrelated.

5.SENSORIUM AND COGNITION

5.1 Level of Consciousness

Orientation –time, place, person

5.2 Memory – ability of the patient to recall present experiences

 Remote – recall of people , events and information from the distant past
 Recent – from past 24 hours to past week
 Immediate -info or data to which a person was just exposed.

5.3 Level of Concentration and Calculation

 Information and Intelligence

 Educational attainment
 General fund of knowledge
 Use of Vocabulary
 Ability to conceptualize abstract
 interpretation of proverbs
 ask for similarity of objects

5.4 Judgement – how does patient makes decision.

 Good
 Poor
 Impaired

5.5 Insight – refers to the patient’s understanding of the nature of problem or illness

 Good
 Poor
 Impaired