COLLEGE OF NURSING

DEPARTMENT OF PSYCHIATRIC NURSING

MENTAL STATUS EXAMINATION FORMAT

IDENTIFICATION DATA
Name :
Age :
Sex :
Spouse/Father name :
Religion :
Education :
Occupation :
Income :
Marital status :
Informant :
Information (Relevant or not) adequate or not :
Address :
IP. No. :
Date of admission :
Ward :
Diagnosis :
Date of assessment :

CHIEF COMPLAINTS:
- According to patient in his own words.
- According to relatives/ Informant.

PRESENT PSYCHIATRIC HISTORY:

- Onset
- Duration
- Course
- Intensity
- Precipitating factors – yes/no (if yes explain)
- History of current episode
- Associated disturbances – includes present medical problems

MENTAL STATUS EXAMINATION

I. General appearance and behavior:

- Facial expression (E.g. Anxiety, pleasure, confidence, blunted, pleasant)
- Posture (stooped, stiff, guarded, normal)
- Mannerisms (stereotype, negativism, tics, normal)
- Eye to eye contact (maintained or not)
- Rapport (built easily or not built or built with difficulty)
- Consciousness (conscious or drowsy or unconscious)
- Behavior (includes social behavior, E.g. Overfriendly, disinherited, preoccupied,
aggressive, and normal)
- Dressing and grooming – well dressed/ appropriate/ inappropriate (to season and
situation)/ neat and tidy/ dirty.
- Physical features:- look older/ younger than his or her age/ under weight/ over weight/
physical deformity.
- Hallucinatory behaviour ( self talk/ self smile)

II. PsychomotorActivity:
(Increased/decreased/ Compulsive/echopraxia/ Stereotypy/ negativism/automatic
obedience)

III. Speech: One sample of speech (verbatim in 2 or 3 sentences)

- Initiation (Spontaneous/ stimulated)
- Reaction time (time taken to answer the question) – increased, decreased or normal
- Coherence (Coherent/ incoherent)
- Relevance (answer the questions appropriately) – relevant / irrelevant.
- Rate and quantity (Mutism/ pressure of speech/ poverty of speech)
- Flow and rhythm (Loosening of association/ flight of ideas/ incoherence of speech/
echolalia/ verbigeration)
- Volume (soft, loud or normal)
- Tone (high pitch, low pitch, or normal/ monotonous)

IV. Thought:
- Form of thought (not understandable /normal/ circumstantiality/ tangentiality/
neologism/ word salad/preservation/ ambivalence).
- Stream of thought (Normal/ pressure of speech/ flight of ideas/thought retardation/
mutism/ aphonia/ thought block/ Clang association.)
- Content of thought ( Delusions- specify type and give example- Persecutory/ delusion
of reference/ delusions of control/ hypochondracal delusions/ delusions of grandeur/
nihilistic- Derealization/ depersonalization/ delusions of infidelity/worthlessness/
Hopelessness/ Suicidal/ Homicidal/ Obsession/ Phobia/ preoccupation/ Fantasy.

V. Mood (subjective) and Affect (objective):

- Appropriate/ in appropriate(Relevance to situation and thought congruent.
- Pleasurable affect- Euphoria / Elation / Exaltation/ Ecstasy
- Un pleasurable affect- Grief/ mourning / depression.
- Other affects- Anxiety / fear / panic/ apathy/ blunt/ aggression/ moods swing/ emotional
liability

VI. Perception:
- Hallucinations- (specify type and give example) – auditory/ visual/ olfactory/ gustatory/
tactile
- Others- hypnologic/ hypnopombic/ 2illiputian/ kinesthetic/ macropsia/ micropsia

VII. Cognitive functions:

Consciousness (Conscious/ Stupor/ clouding of conscious/ coma)

Attention:
- Method of testing (asking to list the months of the year forward and backward/ digit
forward and backward)

Concentration:
- Serial subtractions (100-7)
Memory:
- Immediate (Teach an address or phone number & after 5 mts. Asking for recall)
- Recent memory – 24 hrs. recall
- Remote : Asking for dates of birth or events which are occurred long back
- Others (Amnesia/ paramnesia/ retrograde amnesia/ anterograde amnesia/ Confabulation/
‘Déjà Vu’/ Jamaes Vu/ Hypermnesia

Orientation :
- Time approximately without looking at the watch, what time is it?
- Place – where he/she is now?
- Person – who has accompanied him or her?

Abstraction: Normal/ concrete (proverb testing/ similarities/ dissimilarities)

Intelligence: Test by carry over sums / general information. (Consider educational

background)

VIII Insight:
- Complete denial of illness
- Slight awareness of being sick
- Awareness of being sick attribute it to external / physical factor.
- Awareness of being sick, but due to some thing unknown in himself.
- Intellectual insight
- True emotional insight

IX Judgment:
- Personal (future plans)
- Social (perception of the society)
- Test (present a situation and ask their response to the situation)

X Formulation of diagnosis

Conclusion

Summary