MENTAL STATUS EXAMINATION

Feb 2024, mini Audi Lipa city

MENTAL STATUS EXAMINATION
 What is Administering the Mental Status Examination
(MSE)?
• Is the portion of the neurologic assessment during
which the clinician broadly evaluates the patient’s
current mental state based on his or her appearance,
mood, sensorium, cognition, and thought patterns.

• The MSE does not alone provide sufficient

information to formulate a diagnosis. Rather, the
data gathered during the MSE is combined with
information gleaned from the physical examination,
medical and social history, and laboratory test results
to derive a neurologic or psychiatric diagnosis
What is Administering the Mental Status Examination (MSE)?

The MSE is conducted as an interview that begins when the patient and examiner first
interact.

There is no set way to complete the MSE; the examiner can vary the pace and direction of the
interview according to the patient’s needs and level of comfort, but all components of the
MSE should be addressed by using a checklist or structural framework.

The examiner then documents his or her findings in a brief written report.
What is Administering the Mental Status Examination (MSE)?

WHERE: The MSE can be administered in any home or healthcare setting.

WHO: Licensed clinicians with special training in mental health (e.g., psychologist, psychiatrist,
neurologist, advanced practice nurse, psychiatric nurse, occupational therapist, social worker)
administer the MSE.

Although clinicians who do not specialize in mental health do not administer the MSE,
individual components of the exam are included in the comprehensive physical examination
and abbreviated MSE checklists have been developed for use in non-psychiatric settings.

With the patient’s permission and cooperation, it is usually appropriate for family members to
be present during the MSE.
What is the Desired Outcome of Administering the Mental Status Examination
(MSE)?

The desired outcome of administering the MSE is to obtain comprehensive

information about the patient’s current mental state to identify the
presence and extent of neurologic and/or psychiatric abnormalities.

Subsequent tests can be administered to detect improvement or

worsening of the patient’s condition and/or to evaluate the patient’s
response to treatment.
 Why is Administering the Mental Status Examination (MSE) Important?

The MSE is a key component of the psychiatric assessment. It is performed as part of the initial
psychiatric evaluation in outpatient and inpatient settings, and can also be performed in an
abbreviated form in emergent medical and psychiatric situations

The initial MSE is necessary to obtain information that helps the treatment team identify a patient’s
potential for violent or suicidal behavior and establish a safe environment for the patient.

The MSE is important in determining the neurologic effects of physical illness (e.g., stroke or other
neurologic injury). Alteration in a patient’s mental status can be among the first clinical indications of
a neurologic problem, while improvements in mental status can signal recovery from a neurological
injury.
FACTS:

Investigators determined that the standard MSE format is usually

suitable for patients with mild to moderate mental retardation but must
be adapted significantly to provide an accurate evaluation of patients
with severe or profound mental retardation (Levitas et al., 2001)
 • Appearance, behavior, and speech
• Physical appearance (e.g., in relation to age, dress, grooming, signs of illness)
• Approachability (e.g., body language, eye contact, attitude toward interviewer)
• Psychomotor activity (e.g., posture, gait, handshake, rate and coordination of
movements, abnormal movements)
• Speech quality and organization (i.e., rate and flow, intensity of volume, clarity,
liveliness, quantity, coherent, relevant, flight of ideas)
• Mood (e.g., predominating mood or affect, range and stability of affect, appropriateness
of affect)
The MSE involves obtaining an overview of the • Sensorium or special senses (e.g., orientation, memory, concentration, constructional
patient’s mental health. A structured ability)
framework or checklist should be used to • Intellect and cognition (i.e., general knowledge base, vocabulary, and understanding of
make sure that each aspect of the basic concepts [e.g., knowledge of who the president is or what states in the U.S. border
examination is addressed and systematically their own state])
AMSIT is an acronym for the following: • Thought patterns (e.g., coherence, logic, perceptions, judgment, insight)
Mental Status Examination (MSE)

Utilizing a framework or checklist does not necessarily mean the MSE will be administered in a linear or formal fashion. This is
because observation rather than direct questioning is used to obtain a significant portion of the data and because aspects of
each component of the MSE are revealed throughout the course of the interview.

Further, the examiner might intentionally administer the MSE in a less structured or formal fashion if the patient is agitated,
anxious, or distrustful, requiring that the examiner spend more time establishing rapport before proceeding with formal
interview questions.

the patient’s condition makes assessment of certain cognitive functions difficult or impossible (e.g., if the patient is sedated or
developmentally impaired)

the examiner wishes to develop a rapport with the patient before proceeding with a formal examination

an abbreviated MSE is being performed and the examiner must focus on the information that is most relevant (e.g.,
suicidality, acute psychosis)
How to Administer the Mental
Status Examination (MSE)
 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
 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
 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
∙ 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)
Assess the patient’s thought patterns
∙ 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)
 Assess the patient’s
thought patterns
∙ 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)
 Documentation
∙ 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
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
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Center at San Antonio, Department of Psychiatry.
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