The Mental Status Exam, Page 1 of 15

The Mental Status Examination

This is the primary type of examination used in psychiatry. Though psychiatrists do not
use many of the more intrusive physical examination techniques such palpation,
auscultation, etc.!, psychiatrists are expected to "e expert o"servers, "oth of significant
positive and negative findings on examinations. This o"servation should ta#e place
throughout the patient encounter$ it is not limited to any one point. %o&ever, the
o"servations are then recorded into a specific structured format that is la"eled the Mental
Status Examination MSE!. 'hen properly done, the MSE should give a detailed
(snapshot( of the patient as he presented during the intervie&.
)ften "eginners "ecome confused a"out the difference "et&een this and other
parts of the history. * simple &ay to #eep it apart is to remem"er that this is, as the title
says, an examination, therefore it should "e limited to &hat is o"served. The rest should
go in the history. *s an example, if a patient reports that they have "een hearing voices
throughout the day, "ut deny hearing them during the intervie& and do not seem to "e
responding to internal stimuli, one &ould not report the hallucinations as part of the MSE,
"ut rather include it earlier in the history. +onversely, if the patient denies any history of
hallucination, "ut seems to "e responding to internal stimuli throughout the examination,
one &ould report the phenomenon on the MSE.
The MSE can "e divided into the follo&ing ma,or categories- 1! .eneral *ppearance,
/! Emotions, 0! Thoughts, 1! +ognition, 5! 2udgment and 3nsight. These are
descri"ed in more detail in the follo&ing sections.
General Description
*s implied, this is a general description of the patient4s appearance. 5eing detailed and
accurate is important, and such o"servations can "e of great use to the next examiner.
3magine, for example, if a patient presents loo#ing disheveled, poorly groomed &ith poor
hygiene to an emergency department, "ut a note from only a month ago reports the same
patient to have "een &ell dressed and groomed. Something is going on6
Some of the areas that might "e commented on, particularly if they have significant
negative or positive findings include-
Appearance
)ne should descri"e the prominent physical features of an individual. *t least one &riter
on the su",ect has suggested this should "e detailed enough (such that a portrait of the
person could "e painted that highlights his or her unique aspects7 "ut that is pro"a"ly
as#ing a lot. Some aspects of appearance once might note include a description of a
patient4s facial features, general grooming, hair color texture or styling, and grooming,
s#in texture, scar formation, tattoos, "ody shape, height and &eight, cleanliness and
neatness, posture and "earing, clothing type, appropriateness! or ,e&elry.
The Mental Status Exam, Page / of 15
Motor Behavior
The examination should incorporate any o"servation of movement or "ehavior.
Some aspects of motor "ehavior that might "e commented on include gait,
freedom of movement, firmness and strength of handsha#e, any involuntary or a"normal
movements, tremors, tics, mannerisms, lip smac#ing or a#athisias
Speech
This in not an evaluation of language or thought save that for later!, "ut a
"ehavioral8mechanical evaluation of speech. 3tems that might "e commented on include
the rate of speech, the spontaneity of ver"ali9ations, the range of voice intonation
patterns, the volume of speech, and any defects &ith ver"ali9ations stammering or
stuttering!.
Attitudes
)ne should comment on ho& the patient related to the examiner. This usually includes a
discussion of the patient4s degree of cooperativeness &ith the examiner. 'hen
appropriate, a recording of the evaluator4s attitude to&ard the patient might "e
appropriate, as &e "elieve such reactions :countertransference7! may "e useful
information. Such discussions should "e done &ith the understanding that the patient
has a legal right to read the record, and any strong emotions or reactions should "e
recorded in a diplomatic manner.
Emotions
;or the sa#e of consistency, the o"servation of a patient4s emotions is divided into a
discussion of mood and affect.
Mood is usually defined as the sustained feeling tone that prevails over time for a
patient. *t times, the patient &ill "e a"le to descri"e their mood. )ther&ise, evaluator
must inquire a"out a patient4s mood, or infer it from the rest of the intervie&. <ualities
of mood that may "e commented on include the depth of the mood, the length of time that
it prevails, and the degree of fluctuation. +ommon &ords used to descri"e a mood
include the follo&ing- *nxious, panic#y, terrified, sad, depressed, angry, enraged,
euphoric, and guilty. )nce should "e as specific as possi"le in descri"ing a mood, and
vague terms such as :upset7 or :agitated7 should "e avoided.
The Mental Status Exam, Page 0 of 15
*ffect is usually defined as the "ehavioral8o"serva"le manifestation of mood.
Some aspects of a mood that &e might comment on include the follo&ing- the
appropriateness of the affect to the descri"ed mood does the person loo# the &ay they
say they feel=!$ the intensity of the affect during the examination is their too much>>
heightened or dramatic>>or too little blunted or flat!$ the mobility of the affect does the
affect change at an appropriate rate, or does there seem to "e too much variation?a labile
affect>> or too little>>constricted or fixed$ the range of the affect is there an expected
range of affect?usually intervie& &ill have light and heavier moments?or does the affect
seem restricted to a limited range$ and the reactivity of the patient is the response to
external factors, and topics as &ould "e expected for the situation. *lternatively, is there
too little change>>nonreactive or nonresponsive?!.
Thought
@sually, a description of a patient4s thoughts during the intervie& is su"divided
into at least! / categories- a description of the patient4s thought process, and the content
of their thoughts.
Thought process descri"es the manner of organi9ation and formulation of
thought. +oherent thought is clear, easy to follo&, and logical. * disorder of thin#ing
tends to impair this coherence, and any disorder of thin#ing that affects language,
communication or the content of thought is termed a formal thought disorder.
Some aspects of thought process that are usually commented on include the
stream of thought and the goal directedness of a thought. * discussion of the stream of
thought might include a discussion of the quantity of thought- does there seem to "e a
paucity of thoughts, or conversely, a flooding of thoughts= *lso, it might include a
discussion of the rate of thought- do the thoughts seem to "e racing= Retarded=
Most commonly, examiners comment on the goal directedness or continuity of
thoughts. 3n normal thought, a spea#er presents a series an ideas or propositions that
form a logical progression from an initial point, to the conclusion, or goal of the thought.
Aisorders of continuity tend to distract from this goal or series, and the relatedness of a
series of thoughts "ecome less clear. *s the thought disorder gets more serious, the
logical connectedness of different thoughts "ecomes &ea#er. Some examples of
disorders of thought process include- Circumstantial thought: a lac# of goal
directedness, incorporating tedious and unnecessary details, &ith difficulty in arriving at
an end point$ Tangential thought: a digression from the su",ect, introducing thoughts
that seem unrelated, o"lique, and irrelevant$ Thought blocking: a sudden cessation in the
middle of a sentence at &hich point a patient cannot recover &hat has "een said$ and
Loose associations- a ,umping from one topic to another &ith no apparent connection
"et&een the topics. 3n the other direction, a perseveration refers the patientBs repeating
the same response to a variety of questions and topics, &ith an ina"ility to change his or
her responses or to change the topic.
)ther less common a"normalities of thought process include the follo&ing-
Neologisms: &ords that patients ma#e up and are often a condensation of several &ords
that are unintelligi"le to another person. Word salad: incomprehensi"le mixing of
The Mental Status Exam, Page 1 of 15
meaningless &ords and phrases. Clang associations: the connections "et&een thoughts
"ecome tenuous, and the patient uses rhyming and punning.
Aistur"ances of thought content include such a"normalities as Perceptual
isturbances and elusions.
The most common perceptual distur"ances are !allucinations, &hich are
perceptual experiences that have no external stimuli. %allucinations can "e auditory i.e.,
hearing noises or voices that no"ody else hears!$ visual i.e., seeing o",ects that are not
present!$ tactile i.e., feeling sensations &hen there is no stimulus for them!$ gustatory
i.e., tasting sensations &hen there is no stimulus for them!$ or olfactory i.e., smelling
odors that are not present!. They are not necessarily pathonogmonic of any specific
disorder. ;or example hypnagogic i.e., the dro&sy state preceding sleep! and
hypnopompic i.e., the semiconscious state preceding a&a#ening! hallucinations are
experiences associated &ith normal sleep and &ith narcolepsy.
*nother disorder of perception is an "llusion, &hich is a false impression that
results from a real stimulus. )ther examples of a"normal perceptions include
epersonali#ation$ &hich is a patientsB feelings that he is not himself, that he is strange,
or that there is something different a"out himself that he cannot account for, and
ereali#ation$ &hich expresses a patientsB feeling that the environment is someho&
different or strange "ut she cannot account for these changes.
elusions can "e defined as false fixed "eliefs that have no rational "asis in
reality, "eing deemed unaccepta"le "y the patientBs culture. Primary delusions are
unrelated to other disorders. Examples include thought insertion, thought "roadcasting,
and "eliefs a"out &orld destruction. %econdary delusions are "ased on other
psychological experiences. These include delusions derived from hallucinations, other
delusions, and mor"id affective states.
Types of delusions include those of persecution, of ,ealousy, of guilt, of love, of
poverty, and of nihilism. The most common are persecutory delusions, in &hich one
"elieves, erroneously, that another person or group of persons it trying to do harm to
oneself. Cote that this is often referred to as a paranoid delusion, "ut that is a misuse of
the &ord paranoid, &hich is a more generic in meaning and does not imply a specific
type of delusion. )ther a"normal thoughts sometimes found as part of a delusion
include ideas of reference and ideas of influence. "deas of reference are erroneous
"eliefs that an unrelated event in fact pertains to an individual. Thus, if a patient
o"serves a car on a street ma#e a sudden turn, and assumes that it is "ecause the driver is
follo&ing the patient, that &ould "e an idea of reference. Such ideas can "ecome even
more impro"a"le, such as a "elief that something an announcer is saying on the television
is actually a coded message intended for the patient. "deas of influence are similar in
that the patient may "elieve that someho& they caused an unrelated event to happen for
example, "elieving that through one4s &ill one &as a"le to cause an accident, even
though one &as not directly involved in any &ay!.
3n addition to descri"ing the type of delusion a patient has, one &ants to comment
on other aspects of the delusion, such as the quality of the delusion, or the degrees of
organi9ation of the delusion.
There are other types of a"normal thoughts. Examples include o"sessions and
compulsions, &hich, though irrational, are not as severe a disorder as hallucinations or
delusions. &bsessions are repetitive, un&elcome, irrational thoughts that impose
The Mental Status Exam, Page 5 of 15
themselves on the patientBs consciousness over &hich he or she has no apparent control.
They are accompanied "y feelings of anxious dread and are thought to "e ego alien
coming from :outside7 one4s normal self or desires!, unaccepta"le, and undesira"le.
They are often resisted "y the patient. Compulsions are repetitive stereotyped "ehaviors
that the patient feels impelled to perform ritualistically, even though he or she recogni9es
the irrationality and a"surdity of the "ehaviors. *lthough no pleasure is derived from
performing the act, there is a temporary sense of relief of tension &hen it is completed.
These are usually associated &ith o"sessions.
Some other specific thoughts to as# a"out, &hich may "e of great practical
concern, suicidal and homicidal. These should "e inquired a"out on any examination, as
patients &ith such thoughts commonly present to medical settings, "ut often do not
spontaneously reveal these thoughts.
The Mental Status Exam, Page D of 15
The Cognitive Exam
Cognition refers to the a"ility to use the higher cortical functions- thin#ing, logic,
reasoning, and to communicate these thoughts to others. @nli#e the rest of the mental
status examination, examinations of cognition often involve the administering of specific
tests of cognitive a"ilities. %o&ever, much can also "e deduced from the &hole of the
examination. The cognitive examination is usually divided into the follo&ing domains-
1. +onsciousness
/. )rientation
0. *ttention and +oncentration
1. Memory
5. Eisuospatial a"ility
D. *"stractions and conceptuali9ation.
Consciousness should "e assessed early on. +onsciousness may range from
normal alertness to stupor and coma. )"viously, this affects the rest of the examination
and should "e noted early on.
&rientation refers to the a"ility to understand one4s situation in space and time.
.enerally, orientation to place and time is tested. Place may include as#ing a"out the
"uilding and floor a person is in, as &ell as the city and state. )rientation to time is
tested "y as#ing a person to give the day and date. Though an ill person &ho has spent a
good deal of time convalescing may not "e clear on the exact date, a cognitively intact
person generally can give an approximate date, and it &ould "e unusual for a cognitively
intact person to not #no& the month or year, or &hat part of the month they are in.
)rientation to person generally remains intact except in the most severe of cognitive
disorders. 3n fact, a patient &ho presents disoriented to person, "ut other&ise cognitively
intact almost assuredly is almost never displaying a cognitive disorder, "ut is most li#ely
suffering from some other pro"lem for example a dissociative disorder, or perhaps
malingering!.
The Mental Status Exam, Page F of 15
'ttention and Concentration. 'ttention refers to the a"ility to focus and direct
one4s cognitive in a physiologically aroused state. +oncentration refers to the a"ility to
maintain attention for a period. They need not go together- one can imagine a person
&ho is attentive, "ut cannot concentrate on any one thing- for example a patient &ith
early *l9heimer4s disease &ho is easily distracted. The patient4s attention and
concentration during the intervie& should "e noted. Most screening tests for dementia
include a test of these items. ;or example, on the ;olstein Mini>Mental Status
Examination "elo&!, a patient is as#ed to do serial seven4s descri"ed "elo&!. Though
this does involve some mathematical s#ill a"out a 0
rd
grade level!, the a"ility to sustain
the tas# over time implies a reasona"le degree of attention and concentration.
*n example of a specific attentional tas# is the digit span, in &hich a patient is
as#ed to repeat increasing lengths of num"ers for&ards, and then "ac#&ards. * normal
person should "e a"le to recite a"out F num"ers for&ards. * person usually can recite a
reverse series that is / less than their for&ard series thus, 5 for most people!. 3t is
important to recite the num"ers in a relatively monotone &ay, put an equal interval
"et&een the num"ers to avoid potential cues.
* simple test of concentration is to as# a person to count "ac#&ards starting at D5
and stopping at 1G. The instructions should "e given only once, &ith no cuing during the
tas#. *nother example is the serial sevens tas#, in &hen a patient is as#ed to start at 1HH
and su"tract F, then #eep su"tracting F from each ans&er. @sually a person is as#ed to
perform 5 su"tractions, and each correct interval of F scores 1 point.
Memory. Though variously defined, for the purposes here, memory &ill refer to
the process of learning involving the registering of information, the storage of that
information, and the ability to retrieve the information later. Thus, there are
separate component of memory, and the "oundaries "et&een them are some&hat
controversial. * simple approach to testing &ill "e used here, and memory &ill "e
divided into registration, short(term memory, and long(term memory.
)egistration refers to the a"ility to repeat information immediately. 3t is usually
limited in capacity to a"out seven "its of information. Iegistration is usually tested "y
as#ing a patient to repeat a series of items for example, three unrelated &ords!. 3f the
patient cannot do on the first try, the &ords should "e repeated until the patient can do it,
and the num"er of tries should "e recorded more than / trials for 0 &ords &ould "e
a"normal!. Iegistration should al&ays "e ascertained "efore testing other parts of
memory- an inattentive patient &ho cannot register properly may appear to have a deficit
of short or long>term memory, &hen in fact the memory items &ere never incorporated
properly for information storage.
%hort(term memory refers to the storage of information "eyond the immediate
registration! period, "ut prior to the consolidation of memory into long>term memory.
Practically spea#ing, it lasts from a fe& seconds to a fe& minutes, and may or may not "e
temporary depending on the purpose of the memory!. 3t is limited in capacity, though
the specific limits are very individual. Short>term memory can "e tested "y as#ing a
patient to recall 0 or 1 &ords after a five>minute delay. *fter the initial test, a patient can
"e cued, or given multiple changes, &hich su"sequent performance "eing recorded
although if the patient &ere "eing scored, these correct ans&ers &ould not add to the
The Mental Status Exam, Page J of 15
score!. )ther typical tests of short>term memory include reading a paragraph to a patient
and as#ing them to recall as much information from the story as possi"le in 5 minutes.
Long(term memory is usually divided into procedural and declarative memory.
Procedural memory refers to the a"ility to remem"er a specific set of s#ills. *s one
thin#s of any tas# one has learned?say, driving a car?it is clear that there is a point at
&hich one no longer has to thin# a"out the specific steps in the tas#Kit has "ecome
unconscious and automatic. Procedural memory is generally not assessed during a
standard mental status examination, "ut can "e specifically tested &hen indicated. ;or
example, a person may "e as#ed to act out a specific tas# :sho& me ho& you "rush your
teeth7!.
eclarative memory refers to the retention of data or facts, &hich can "e ver"al
or nonver"al i.e., sounds, images!. 3n contrast to short>term memory, it is not temporary
though it can decay over time!, and it has no #no&n limit.
Long>term declarative! memory is usually tested "y as#ing a patient to recall past
details. These details may "e personal &edding dates, graduations, past medical history?
all of &hich &ould have to then "e independently confirmed!, or historical important
historical dates that a patient &ould reasona"ly "e expected to #no&, "ased on their o&n
up"ringing and culture!. Typically, a patient is as#ed to name past presidents, "ut some
patients ex. recent immigrants! may no& #no& politics. )ne can usually assess
appropriate questions after learning of a patient4s "ac#ground. Some events are fairly
universal- Pearl %ar"or, for example, at least for people living in the @S &ho are old
enough to have "een old enough in 1G11. Similarly, one can expect, at least in this
general area, that as#ing &hen the Ied Sox &on the 'orld Series &ill "e pretty relia"le,
at least for a &hile.
Constructional 'bility refers to the a"ility to recogni9e the relationship of
different o",ects in the &orld. Though occasionally neglected during cognitive testing, it
is of great practical significance, particularly if a person &ishes to drive, or live alone.
+onstructional tas#s require reasona"le vision, motor coordination, strength, praxis and
tactile sensation, and in cases in &hich patient4s appear to have a deficit in this a"ility,
these other domains should "e tested as &ell. @sually, constructional a"ility is tested "y
having a person copy a design, such as a transparent cu"e, or a cloc#. The ;olstein Mini
Mental Status examination includes a constructional tas# in &hich a person is as#ed to
dra& intersecting pentagrams- a patient is expected "oth to dra& the correct num"er of
sides on "oth polygons as &ell as the t&o intersection points.
'bstraction and Conceptuali#ation refer to higher intellectual functions. *"straction
involves the a"ility to understand the meanings of &ords "eyond the literal interpretation.
+onceptuali9ation involves a num"er of intellectual functions, including the a"ility to "e
self>a&are- of one4s existence, one4s thoughts, and one4s "ehaviors. Aeficits in these
areas may "e inferred during an examination, especially from overly concrete ans&ers to
questions example- doctor- :&hat "rought you to the hospital7 patient- :an
am"ulance.7!. These a"ilities can "e tested through such tas#s as as#ing a patient to
identify similarities "et&een o",ects example- :ho& are an apple and an orange "oth
ali#e.7 )ne &ould expect an a"stract ans&er such as :fruit7, as opposed to a concrete
ans&er such as that they are "oth round!. )ften, patients are as#ed to interpret prover"s
The Mental Status Exam, Page G of 15
as a test of a"stract reasoning. Examples of prover"s typically used including :The grass
is greener on the other side7 and :Aon4t count your chic#en4s "efore they hatch.7 %arder
ones include :People &ho live in glass houses shouldn4t thro& stones7 and :* rolling
stone gathers no moss.7 3n each case, it should first "e explained &hat a prover" is :a
saying that has a "roader meaning7! and an example might "e given. * num"er of things
can impair prover" interpretations "esides deficits in a"stract functioning- lo&er
education usually at least J years of education is expected for prover" interpretations!, or
a lac# of cultural applica"ility, and these should "e investigated as possi"ilities in a
person &ho is having trou"le &ith prover"s.
%tandardi#ed tests. There are a num"er of tests designed to examine various domains of
cognitive a"ility. *n example of a commonly used one is the ;olstein Mini>Mental
Status exam, and this is sho&n "elo&.
The Mental Status Exam, Page 1H of 15
*igure +(,. The Mini(Mental %tate
-.amination /MM%-0
Ma.imum %core
&)"-NT'T"&N
5 !
'hat is the year! season! date! month!=
5 !
'here are &e state! country! to&n or city! hospital! floor!=
)-1"%T)'T"&N
0 !
Came 0 common o",ects e.g. :apple7, :ta"le7, :penny7!.
Ta#e 1 second to say each. Then as# the patient to repeat all 0 after you have
said them. .ive 1 point for each correct ans&er.
Then repeat them until they lean all 0. +ount trials and record.
Trials-
'TT-NT"&N 'N C'LC2L'T"&N
5 !
*s# patient to count "ac# "y sevens, starting at 1HH. *lternately, spell
:&orld7 "ac#&ards. The score is the num"er of num"ers or &ords in the
correct order.
G0MMMJDMMMFGMMMF/MMMD5MMM!
AMMMMLMMMIMMMM)MMM'MMMM!
)-C'LL
0 !
*s# for the 0 o",ects repeated a"ove. .ive 1 point for each correct ans&er.
Cote- Iecall cannot "e tested if all 0 o",ects &ere not remem"ered during
registration.
L'N12'1-
/ !
Came a :pencil7 and :&atch7
1
!
Iepeat the follo&ing- :Co ifs, ands, or "uts.7
0
!
;ollo& a 0>stage command-
:Ta#e a paper in your right hand,
;old it in half, and
Put it on the floor.7
1
!
Iead and o"ey the follo&ing
+lose our eyes.
1
!
'rite a sentence.
1
!
+opy the follo&ing design.
Total %core MMMMMMMM compare this score against norms for education and age.
The Mental Status Exam, Page 11 of 15
1
*igure +(3. Normative ata for MM%-.

'ge

-ducation

,+(34

35(36

78(74

75(76

48(44

45(46

58(54

55(56

98(94

95(96

:8(:4

:5(:6

+8(+4

;+4

4th grade //

/5

/5

/0

/0

/0

/0

//

/0

//

//

/1

/H

1G

+th grade

/F

/F

/D

/D

/F

/D

/F

/D

/D

/D

/5

/5

/5

/0

!igh %chool

/G

/G

/G

/J

/J

/J

/J

/J

/J

/J

/F

/F

/5

/D

College

/G

/G

/G

/G

/G

/G

/G

/G

/G

/G

/J

/J

/F

/F
These num"ers can "e used to compare a patientBs performance on the MMSE against norms for
their age and education.
Source- +rum IM, *nthony 2+, 5assett SS and ;olstein M; 1GG0! Population>"ased norms for the
mini>mental state examination "y age and educational level, 2*M*, 1J- /0JD>/0G1.
The Mental Status Exam, Page 1/ of 15
Insight And Judgment.
"nsight and <udgment refer to complex tas#s that require a good deal of cognitive
functioning including conceptual thin#ing and a"stract a"ility!, though intact cognitive
functioning alone is not adequate for good ,udgment and insight. )ne could spend a
good deal of time de"ating &hat these terms really mean. ;or the purposes here, suffice
it to say that these concepts are much more approacha"le &hen seen in specific
circumstances. Thus, rather than discussion these are overarching functions :2udgment
and insight- intact7!, it is more useful to discuss them as they relate to a particular activity
or question. 3n context, one can specifically discuss a patient4s insight into a particular
pro"lem, or their a"ility to use ,udgment to arrive at a particular decision. ;or example, a
patient4s a"ility to ma#e a particular medical decision requires "oth insight into their
specific malady, as &ell as the ,udgment to &eigh alternatives in the service of arriving at
an appropriate decision.
Insight in the medical context! refers to the capacity of the patient to understand that he
or she has a pro"lem or illness and to "e a"le to revie& its pro"a"le causes and arrive at
tena"le solutions. Self>o"servation alone is insufficient for insight. 3n assessing a
patient4s insight into their medical situation, the examiner should determine &hether
patients recogni9es that they are ill, &hether they understand that the pro"lems they have
are not normal, and &hether they understand that treatment might "e helpful. 3n some
situations, it may also "e important determine &hether a patient reali9es ho& their
"ehaviors affect other people.
<udgment in the medical context! refers to the patientBs capacity to ma#e appropriate
decisions and appropriately act on them in social situations. The assessment of this
function is "est made in the course of o"taining the patientBs history, and formal testing is
rarely helpful. *n example of testing &ould "e to as# the patient, ('hat &ould you do if
you sa& smo#e in a theater= +learly, a meaningful ,udgment first requires appropriate
insight into one4s situation. There is no necessary correlation "et&een intelligence and
,udgment.

The Mental Status Exam, Page 10 of 15
Reliability
@pon completion of an intervie&, the psychiatrist assesses the relia"ility of the
information that has "een o"tained. ;actors affecting relia"ility include the patientBs
intellectual endo&ment, his or her perceived! honesty and motivations, the presence of
psychosis or organic defects and the patientBs tendency to magnify or understate his or her
pro"lems. 3n cases in &hich there is a strong reason to question a patient4s relia"ility ex.
significant dementia!, the assessment of relia"ility should "e discussed early in the
examination, rather than &aiting to the end to reveal that much of the information
reported already is unrelia"le6
The Mental Status Exam, Page 11 of 15
*igure +(7. The Mental %tatus -.am
*ppearance- *ttitude Cormal
+ooperative
*"normal
@ncooperative, %ostile, .uarded, Suspicious
Mood Euthymic
calm, comforta"le, euthymic, friendly, pleasant,
unremar#a"le
*ngry
angry, "ellicose, "elligerent, confrontational,
frustrated, hostile, impatient, irasci"le, irate, irrita"le,
oppositional, outraged, sullen
Euphoric
cheerful, ecstatic, elated, euphoric, giddy, happy,
,ovial
*pathetic
apathetic, "land, dull, flat
Aysphoric
despondent, distraught, dysphoric, grieving, hopeless,
lugu"rious, over&helmed, remorseful, sad
*pprehensive
anxious, apprehensive, fearful, frightened, high>stung,
nervous, over&helmed, panic#ed, tense, terrified,
&orried.
*ffect *ppropriatene
ss
normal
appropriate, congruent
a"normal
inappropriate incongruent
3ntensity normal
normal
a"normal
"lunted, exaggerated, flat, heightened, overly dramatic
Earia"ility8
Mo"ility
normal
mo"ile
a"normal
constricted, fixed, immo"ile, la"ile.
Iange normal
full
a"normal
restricted range
Ieactivity normal
reactive, responsive
a"normal
nonreactive, nonresponsive
Speech
;luency, repetition,
comprehension, naming,
&riting, reading, prosody,
quality of speech.
+omment specifically
Thought Process Aisorders of
+onnectedness
circumstantiality, flight of ideas, loose associations,
tangentiality, &ord salad
)ther
clanging, echolalia, neologisms, perseveration,
thought "loc#ing
+ontent thoughts
delusions, homicidal ideation, magical thin#ing,
o"sessions, overvalued ideas, paranoia, pho"ia,
poverty of speech, preoccupations, ruminations,
suicidal ideation, suspiciousness.
The Mental Status Exam, Page 15 of 15
perceptions
autoscopy, dN,O vu, depersonali9ation, dereali9ation,
hallucinations, illusion, ,amais vu.
+ognition See description in text
2udgment and
3nsight
Ielia"ility