GEETANJALI COLLEGE OF NURSING

GEETANJALI UNIVERSITY, UDAIPUR RAJASTHAN

MENTAL STATUS EXAMINATION

The mental status examination of psychiatric patients is analogous to the physical examination in
physical medicine. It provides a format for the systematic observation and recording of information
about a person’s thinking, emotions, and behaviour. These data combined with information from the
history are the basis for formulating a differential diagnosis.

DATE

TIME

IDENTIFICATION DATA OF THE PATIENT

PHYSICAL EXAMINATION

 Head to toe examination

 Neurological examination
 Vital signs

MENTAL STATUS EXAMINATION (MSE)

1. GAAB (GENERAL ATTITUDE, APPEARANCE AND BEHAVIOUR)

 Awareness of the surroundings
 Cooperation with the examination
 General appearance: (looking one’s age/ looks older/ younger than his or her age/
underweight/ overweight/ physical deformity).
 Level of consciousness: ( fully conscious and alert/ drowsy/ stuporous/ comatosed).
 Eye to eye contact: (maintained/ difficult/ not maintained).
 Rapport: ( Spontaneous/ difficult/ not established).
 Facial expression: (Anxious/ blunted/ pleasant/ fearful).
 Level of grooming: (Normal/ shabbily dressed/ overdressed/ idiosyncratically dressed).
 Level of cleanliness: (Adequate/ inadequate/ overtly clean).
 Gestures: (Normal/ exaggerated/ odd).
 Posturing: (Normal posture/ catatonic posture/ stooped/ stiff/ guarded).
 Psychomotor activity: (Normal/ increased/ decreased).
 Other movements: (Normal/ stereotype/ tremor/ extrapyramidal symptoms/ abnormal
involuntary movements).

Any oddities in behavior:

 catatonic phenomena: (Automatic obedience/ negativism/ excessive cooperation/ waxy

flexibility/ echopraxia/ echolalia).
 Conversion and dissociative signs: (Pseudo seizures/ possession states/ any other).
 Compulsive acts or rituals or habits: (e.g. nail biting).
 Hallucinatory behavior: (Smiling or crying without reason/ muttering or talking to self,
odd gesturing).
 2. PSYCHOMOTOR ACTIVITY AND SPEECH

PMA

 Level of activity- lethargic, tense, restless or agitated.

 Type of activity- grimace, or tremors.
 Unusual gestures, mannerisms or compulsions.

SPEECH

 Initiation: (Spontaneous/ speaks when spoken to/ minimal/ mute).

 Reaction time: (Normal/ delayed/ shorten/ difficult to assess).
 Rate: (Increases/ decreased/ Average).
 Productivity: (Monosyllabic/ elaborate replies/ pressured).
 Volume: ( Increased or loud/ decreased or soft).
 Tone: (Normal variation/ high pitch/ low pitch/ monotonous).
 Relevance: (Fully relevant/ sometimes off target/ irrelevant).
 Stream: (Normal/ circumstantial/ tangential/ blocking/ verbigeration/ stereotypies verbal/
flight of ideas/ clang association).
 Coherence: (Fully coherent/ loosening of associations or incoherent).
 Others: (Echolalia/ Perseveration/ neologism).
 Tonal infections: (Present/ absent).
 Spontaneity: (Spontaneous/ non spontaneous).

INFERENCE:

3. MOOD AND AFFECT

Mood

 Facial expression (anxious, depressed).

 Elated (dull) subjective mood (as stated by the patient).
 Emotional blunting.
 Emotional, incongruity.

Affect:

 Appropriateness: (Appropriate or congruent/ inappropriate or incongruent).

 Intensity: (Normal/ blunted/ exaggerated/ flat/ heightened/ overly dramatic).

 Mobility: (mobile/ constricted/ fixed/ immobile/ labile).

 Range: (Full range/ restricted range).
 Reactivity: (Reactive or responsive/ non- reactive or non- responsive).

INFERENCE:
4. THOUGHT

A. At formation level: (Autistic behaviour or self absorption in own world, self muttering, self
smiling, self mumbling, impairment in productivity/ continuity/ language).

B. At progression level: (Normal/ not understandable/ circumstantiality/ tangentiality/

neologism/ flight of ideas/ incoherence/ perseveration/ thought retardation/ thought block/
clang association/ loosening of association/ word salad/ ambivalence.

C. At content level: Preoccupations/ thought disturbances (delusions/ideas).

 DELUSIONS: (Persecutory delusion, Delusion of reference, delusion of influence or

passivity, delusion of grandeur, nihilistic delusion, delusion of infedility, delusion of control,
bizzare delusions.
 IDEAS: (Worthlessness/ hopelessness/ hopelessness/ guilt/ hypochondriacal/ death wishes or
suicidal ideation.
 THOUGHT ALIENATION PHENOMENA: (Thought insertion/ thought withdrawal/ thought
broadcasting).
 PHOBIAS
 OBSESSION

INFERENCE:

5. PERCEPTIONS
 Hallucinations: (Auditory/ visual/ olfactory/gustatory/ tactile).
 Illusions
 Somatic passivity
 Deja vu/ jamis vu
 Depersonalization/ derealization

INFERENCE:

6. INSIGHT
Do you think you have anyillness ?
Is it mental or physical?
Does it require treatment?
Cause for the illness?
Insight is rated on 6 point scale from 1-6
I. Complete denial of illness.
II. Slight awareness being sick.
III. Awareness of being sick attributed it to external or physical factor.
IV. Awareness of being sick but attribute to unknown cause.
V. Intellectual insight.
VI. True emotional insight.

INFERENCE:
7. ORIENTATION
 TIME: (Appropriate time/ day/ night/ date/ month/ year).
 PLACE: (Kind of place/ area/ city).
 PERSON: (Self/ close associates/ hospital staff).

INFERENCE:

8. MEMORY
 IMMEDIATE: Tree, car, lake, sky (4 words, ask after 5min.) (normal: < 60 year, 3-4
words after 5min).
 RECENT: (orientation to time and place also measures recent memory. Example:
breakfast, lunch, dinner).
 REMOTE: (Important event in his/her life. Example: personal, impersonal and illness
related events).

INFERENCE:

9. ATTENTION AND CONCENTRATION

ATTENTION: (Normaly aroused/ aroused with difficulty/ digit forward/ digit backward).
 Digit forward (<5 inattention score)
 Digit Backward (<4 inattention score)

CONCENTRATION: (Normally sustained/ sustained with difficulty/ distractable).

 Names of month ( forward and backward), names of week days (forward and
backward).
 Serial 7 subtractions:
100- 7 (normal: 2 mistakes in 2 ½ min.)
40-3 (normal: 1 mistake in 1 ½ min.)
20-1 (normal: no mistakes in 30 sec.)

INFERENCE:

10. JUDGEMENT
 TEST:
a. Letter story: ( letter attached with stamp lying on the street).

Response:

b. Fire story: ( If the room set on fire where you are sitting).

Response:

 PERSONAL (future plans): Preserved/ impaired.

 SOCIAL (plan for immediate future/ perception of the society): preserved/

impaired.
INFERENCE:
 11. ABSTRACT ABILITIES
 Interpretation of proverbs (Give a proverb and ask the inner meaning)
 Similarities between two paired objects
 Dissimilarities between paired objects

12. GENERAL INFORMATION AND INTELLIGENCE

 GENERAL FUND OPF INFORMATION
 ARITHMATIC ABILITY: MENTAL ARITHMETIC/ MENTAL SUMS

13. SPECIAL POINTS

 Appetite
 Bowel
 Bladder
 Sleep
 Libido

IMPRESSION: