MENTAL STATUS EXAMINATION
WHAT IS THE IMPORTANCE OF ASSESSING COGNITION & OBSERVING BEHAVIORS AS PART OF A MENTAL STATUS EXAM?
 Assessment starts the moment you walk in the door
 Need to assess:
o Patient’s appearance, behavior, mood, thought processes, speech & cognitive functions
o If patient is suffering from psychosis
o If patient is suicidal
WHAT ARE THE COMPONENTS OF A MENTAL STATUS EXAM & WHAT ARE THE CHARACTERISTICS THAT REQUIRE FURTHER EVALUATION?
 General Presentation
o Appearance – look @ posture, grooming,
appearance for age & clothing
 Characteristics that need further
evaluation:
 Hunched-over posture
 Unshaven
 Appears older than actual age
 Wearing heavy coat on a hot day
o Behavior – look @ mannerisms, psychomotor, tics
 Characteristics that need further
evaluation:
 Unusual facial expressions or
hand movements
 Agitated or slow
 Repetitive, non-productive
movements
o Attitude toward Examiner – are they cooperative?
Acting seductively? Hostile? Defensive?
o Level of Consciousness – look @ if they are
conscious, lethargy, & sleepiness
 Characteristics that need further
evaluation:
 Not fully alert
 Mentally slowed down
 Dozes off
 Cognition
o Orientation – do they know who they are, where
they are, what time it is, what situation are they in?
o Memory:
 Can they recall 3 words after 5 minutes?
(Immediate)
 Can they recall activities that happened
over the last 12 hours? (Recent)
 Need to rule out confabulation
 Can they remember where they were
born? (Remote)
o Attention & Concentration:
 Attention – can they pay attention w/o
being distracted?
 Concentration – can they repeat a string of
#’s forward & backward?
o Cognition:
 Verbal ability – can they read a simple
paragraph of text?
 Spatial ability – can they copy a simple
drawing?
 Abstraction ability – can they describe how
a pear & an apple are alike? Can they
explain a proverb?
o Speech:
 Volume
 Speed
 Articulation
 Language
 Emotional State
o Mood – describes feeling depressed; think of
“season” – overall general feeling
o Affect – shows decreased external expression; think
of “weather” – can see it
o Congruence – described mood & visible affect are
not the same
o Appropriateness – laughs when telling a sad story
 Thought & Perception
o Form or Process (Associations b/w Thoughts)
 Flight of Ideas – thoughts that move from
one to the other
 Perseveration – repeats thoughts a lot
 Echolalia – repeats another person’s
words
 Clang Associations – associates words
based on sounds rather than meaning of
words
o Content:
 Compulsions – can’t stop from doing an
act
 Obsessions – can’t get a thought out of
their head
 Phobias – irrational fear
 Free-floating Anxiety – fright not
associated w/ specific cause
 Delusions – false belief
 Ideas of Reference – believes that things in
outside world refer to them
 i.e. actor in a movie is talking
about them
o Perception:
 Illusions – misinterprets reality
 Hallucinations – false sense of perception
(i.e. feels bugs crawling on skin)
 Judgement & Insight
 o Judgement – gives an unusual response to a o Truthfulness – does not give accurate info about
hypothetical situation previous hospitalizations
o Insight – doesn’t know their thoughts are irrational o Aggressive & Sexual Impulses – cannot control
impulses

WHAT TERMINOLOGY IS RELEVANT TO A MENTAL STATUS EXAMINATION?

WORD DEFINITION ASSOCIATED W/?
Euthymic Normal mood Mood
Euphoric Strong feelings of elation Mood
Dysphoric Unpleasant feeling Mood
Labile Alternates b/w euphoric & dysphoric moods Mood
Anhedonic Cannot feel pleasure from activities that are usually enjoyable Mood
Irritable Easily annoyed & quick to anger Mood
Expansive Feelings of self-importance & grandiosity Mood
Broad/Normal Normal variability in facial expression, vocal pitch & use of Affect
gestures
Restricted ↓ display of emotional responses Affect
Blunted HUGE ↓ of emotional responses Affect
Flat COMPLETE lack of emotions Affect
Labile Changes in emotional responses w/o environmental events Affect
Circumstantial Focus of conversation drifts but comes back to point Thought Process
Tangential Train of thought wanders w/o focus Thought Process
Flight of Ideas Fragmented & unrelated thoughts Thought Process
Word Salad Random words & phrases Thought Process
Neologisms Newly created words w/ unknown meaning Thought Process
Thought Blocking Stops talking & followed by silence Thought Process
Magical Thinking Adds a new meaning to something when it does not exist Thought Process
WHAT ARE THE SCREENING MEASURES OF GROSS COGNITIVE FUNCTIONING & MOOD SYMPTOMS?
 Mini-Mental State Exam (MMSE) & Montreal Cognitive Assessment (MOCA):
o Reliable estimates of gross cognitive function
o Low scores=higher deficit
o Help tell difference b/w normal cognition & dementia
o MOCA may be more sensitive to mild cognitive impairment
o Context is needed to be considered
o NEED TO BUILD RAPPORT & FACILITATE COOPERATION FROM PATIENT
o Does not test intelligence
 Mood Questionnaires
o Beck Depression Inventory (BDI-II)
Beck Anxiety Inventory (BAI)
o Hamilton Rating Scale for Depression (HAM-D)
o Geriatric Depression Scale (GDS)
o Great for screening & has useful quantitative scores
 But need to look @ items & ask follow-up Q’s

WHAT ARE THE ISSUES RELEVANT TO SUICIDE ASSESSMENT?

 Instead ask:
o “Do you feel life isn’t worth living?”
o “Have you had thoughts about taking your life?”
 Follow Up Q’s:
o “Do you have a plan?”
o “Have you told anyone about it?”
o “Do you have access to pills, firearms, etc.?”
 Risk factors for suicide:
o Hx of prior suicide attempts
o Age (increased risk if they are older)
o Gender
 Women try more often, but men try more lethal ways
o Mood disorders, substance abuses, psychotic disorders, PTSD, cluster B personality disorders, conduct disorders
o Precipitating events associated w/ humiliation, shame or despair
o Hx of abuse, social isolation
o Caucasian  DO NOT ASK ARE YOU FEELING SUICIDAL
 Some protective factors:
o Internal – religious beliefs, frustration tolerance
o External – responsibility to children or pets, + relationships & social support