Mental status examination

MENTAL STATUS EXAMINATION
Mrs.D.Meba Sahaya Sweety
M.Sc Nursing
GIMSAR

INTRODUCTION
The Mental Status Exam (MSE) is the psychological equivalent of a
physical exam that describes the mental state and behaviours of the
person being seen.
It includes both objective observations of the clinician and subjective
descriptions given by the patient.
It includes descriptions of the patient's appearance and general
behaviour, level of consciousness and attentiveness, motor and speech
activity, mood and affect, thought and perception, attitude and insight,
the reaction evoked in the examiner, and, finally, higher cognitive
abilities.

DEFINITION
The mental status examination (MSE) is an
assessment procedure It is a semi-structured
interviewing used to organize clinical
observations pertaining to mental condition
Mental status is the total expression of a
person’s emotional responses, mood, cognitive
function, and personality
It is a standardised format in which the
clinician records the psychiatric signs and
symptoms present at the time of interview.

PURPOSE OF MSE
 The purpose of the MSE is
 To obtain a comprehensive cross-sectional
description of the patient's mental state.
 To allows the clinician to make an
accurate diagnosis and formulation, which are
required for coherent treatment planning.
 It is used to diagnose the general cerebral
functioning
 It is to evaluate, quantitatively and qualitatively, a
range of mental functions and behaviours at a
specific point in time.

COMPONENTS OF MSE
1. Appearance &
behaviour
2. Psychomotor activity
3. Speech
4. Mood
5. Affect
6. Thought
7.Perception
8. Cognitive function
(Attention , Sustained
Attention &
Concentration ,
Memory,Intelligence )
9. Insight
10.Judgement

1. APPEARANCE & BEHAVIOUR
1. Attitude
2. General
appearance &
grooming
3. Facial expression
4. Posture
5. Gait & carriage
6. Body build
7. Rapport
8. Mode of Entry
9.Cooperativeness

1.Cooperative
2. Friendly
3. Trustful
4. Purposefulness
5. Attentive
6. Interested
7. Seductive
7. Seductive
8. Hostile
9. Contentious
10. Playful
11. Defensive
12. Guarded
1.APPEARANCE & BEHAVIOUR
1. ATTITUDE

2. GENERAL APPEARANCE &
GROOMING
• Appearance: looking one's age older/younger
• Level of grooming: normal/ shabbily dressed/
overdressed/idiosyncratically dressed
• Level of cleanliness: adequate/ inadequate/ overtly
clean
• Level of consciousness: fully conscious and
alert/drowsy / stuporous / comatosed
1. APPEARANCE & BEHAVIOUR

3. FACIAL EXPRESSION
• 1. Appropriate or not
• 2. Is it changed with subject or not.
• 3. Look:- a) Attentive b) Apathetic-in
chronic schizophrenia c) Indifferent-
in severely depressive

• 4 . EXPRESSION :-
a) Elation
b) Fears -Mild Anxiety or
Apprehension , Crying, Perplexed or
Frightened.
c) Anger
d) Sad - Omega sign & Veraguth’s
folds in Depressed patients.

e) Blank - in schizophrenic patients.
f) Eye to eye contact:- maintained/
difficult/not maintained ( maintain
gaze in anxious patients , Void gaze
in schizophrenic pts , excessive
scanning )

4. POSTURE
1. Relaxed – In obsessive
2. Guarded - in paranoid patients.
3. Limp and sprawled out in chair.
4. Sitting at edge of chair in
schizophrenic patients.

5. GAIT & CARRIAGE
• Gesturing:- normal/
exaggerated/ odd
• Carriage – Does patient
carry himself erect or bends
down.
• Gait types:- 1. Normal 2.
Brisk 3. Slow- in depressed
patient.
• 4. Desultory-in schizophrenic
patients.
• 5. Dilatory-in manic patients.
• 6. Unsteady – in organic brain
disorders.

6. BODY BUILD
• 1. ASTHENIC - Person narrows in
length with narrow swallow thorax
with narrow sub costal angle.
• 2. PYKNIC - Person with large body
cavities relatively short limbs and large
sub costal angle with rounded head
and short fat neck.
• 3. ATHLETIC - Persons with wide
shoulders and narrow hips and well
developed bones and muscles

7. RAPPORT
• Rapport: spontaneous/
difficult/not established
8.MODE OF ENTRY
• Mode of entry:
came willingly/
persuaded/
brought using
physical force

9.COOPERATIVENESS
• Cooperativeness:
normal/more than
so/less than

Quantity And Quality
2.PSYCHOMOTOR ACTIVITY
• 1.Quantity:-
• a. Normal
• b. Agitation-severe anxiety associated
with motor restlessness.
• c. Retardation:-abnormal physical &/or
psychological slowing as a part of any
psychiatric illness. Ranges from lack of
expression, slow movements , mutism to
stupor.

• 2.Quality:-
• Facial
movements in
oral
dyskinesia
• Tremors
• Tics
•Mannerism
• Posturing
• Rigidity
• Waxy
flexibility
•Perseveration

• Stereotypy
• Gesture
• Grimace
• Restlessness
•Automatic
obedience
• Echolalia
•Echopraxia
•Negativism
•compulsion
2.Quality:-

Tics:-
Def:-short sudden repetitive, rapid movements
of small muscles usually of face & neck.
Types of tics:-
1.Simple motor tics
2. Simple vocal tics
3. Complex vocal tics

• Posturing:
normal posture/
catatonic posture
Def.:- Voluntary
assumption of
inappropriate or
bizarre posture

• Rigidity:-
• Def:- Assumption of rigid posture against all
attempts to move.
• Waxy flexibility:-
• Def:- Waxy flexibility is a decreased response to
stimuli and a tendency to remain in an immobile
posture. Attempts to reposition the patient are met
by "slight, even resistance", and after being
repositioned, the patient will typically remain in the
new position

• Perseveration:-
• Def:- persistent induced
repetition of words, ideas,
subject
• Mannerism:-
• Def:-unusually performed
goal directed , semi-
purposive repetitive
verbal/motor actions.

• Stereotypy:-
Def.:-repetitive, spontaneous non goal
directed movement which is carried
out in uniform way.
Types:-verbal & motor
• Gesture:-
Def.:-a mode of non verbal
communication in which information
is conveyed by movement of hand,
arm, parts of body.

• Grimace:-
Def:- Specific facial expression
which is non goal directed &
spontaneous
• Restlessness:-
Def:-persistent and generalised
diffuse increase in body
movements and inability to relax.
• Automatic
obedience:-
Phenomenon
of undue
compliance
with
instructions

• Echolalia:- Def.:-
repetition of a part of
sentence or whole
sentence told to patient.
• Echopraxia:-
• Def:-automatic imitation of
another persons movements
like clapping , snapping
fingers

• Negativism:-
Purposeless resistance
to all external
suggestions or
advice.

• Initiation
• Reaction time
• Rate
• Productivity
• Volume
• Tone
3. SPEECH
•Relevance
•Stream
•Coherence
•Others

• Initiation:
spontaneous / speaks when
spoken to/minimal/ mute
• Reaction time:
normal/ delayed/ shortened/
difficult to assess
3. SPEECH

• Rate: normal/ slow/ rapid
• Productivity:
monosyllabic/ elaborate
replies/pressured
• Volume: normal/
increased/ decreased
3. SPEECH

• Tone: normal variation/monotonous
• Relevance: fully relevant/ sometimes off
target/irrelevant
• Stream: normal/ circumstantial/
tangential
• Coherence: fully coherent/loosening of
associations
3. SPEECH

• Others: rhyming/punning/echolalia
perseveration/neologism/Verbigeration
• Punning:-the humorous use of a word or phrase
so as to emphasize or suggest its
different meanings or applications
• Neologism:-coining new words or use words in
inappropriate way
• Verbigeration- a manifestation of stereotype
consisting of morbid repetition of words , phrases
sentence.
3. SPEECH

1) Subjective
2) Objective
3) Range
4) Reactivity
5) Appropriateness
6) Congruity
7) liability
4.MOOD

• Objective-
depressed,euphoric,e
lated,blunted,
flat,Dysphoric,
Irritable mood,
Exaltation, Ecstasy,
Expansive mood
4.MOOD

• Elation:- mood
consisting of feeling of
joy, euphoria, triumph
and intense self
satisfaction or optimism
associated with
increased psychomotor
activity.
• Euphoric:-
excitement and
intense feelings
of well-being and
happiness.
4.MOOD

. Dysphoric:-
unpleasant,
uncomfortable and
dissatisfied mood with an
admixture of sadness,
anxiety and irritability.
• Irritable mood:-
• state in which one is
easily annoyed and
provoked to anger.
4.MOOD

• Ecstasy:-a state of extreme
happiness, especially when feeling
pleasure:
• Exaltation:-feeling of intense elation
and delusion of grandeur
• Expansive mood:-expression of
feelings without restraint, frequently
with an overestimation of their
significance and importance.
4.MOOD

• Range-wide , restricted(over a
course of time , horizontal-happy-
sad-angry-placid- fearful).
• Reactivity-present/absent(in
response to stimulus,
longitudinal)
4.MOOD

1. Athenic-joy,hate,anger
2. Asthenic- fear, sadness, anxiety, shame
3. Flat- near or absolute absence of any signs
of affective expression
4. Blunt-significant reduction in intensity of
emotional expression
5. Constricted- reduction in intensity of
emotion that is less severe than that of
blunted affect.
5.AFFECT

6. Restricted-mild reduction in range and
intensity of emotional expression.
7. Inappropriate
8. Incongruent- discordance between affective
expression and content of speech/ideation.
9. Labile affect:- abrupt,rapid,unstable changes in
emotions unrelated to external stimuli
10. Affective incontinence- inability to control the
affect
5.AFFECT

i. Disorder of form of
thought
ii. Disorders of stream of
thought
iii. Disorders of possession
of thought
iv. Content of thought
6.THOUGHT

Disorder of form of thought
• 1. Asyndesis orDerailment :lack of adequate connections between
successive thoughts Loosening of association simply means that the
patient's thoughts are unrelated. • Seen mostly in mania or schizophrenia.
• How did you bruise your arm? • I woke up in the morning, I washed my
face and I applied some make up on..then I tried to create some cute style
with my hair and then I opened the door and walked out to the parking and
opened the door of the car and sat in the car and I started driving while
listening to some jazz music and then when I got out of the car I entered
the building and hit my arm with the door.
6.THOUGHT

• 2. Metonyms-imprecise approximations in which a
substitute term is used instead of amore exact one or
It is a figure of speech in which a thing or concept is
referred to by the name of something closely
associated with that thing or concept "the White
House" or "The Pentagon" are used to refer to the
U.S. presidential staff or the military leadership,
respectively.
6.THOUGHT

• 3. Over inclusion- Overinclusive thinking is usually conceptualized (form a
concept or idea of something) as the inability to preserve conceptual boundaries
and identified as a cognitive characteristic of individuals with schizotypy who
show an over-responsiveness to associative or irrelevant aspects of words and
extraneous stimuli . People with OT tend to have a broader conceptual boundary.
For example, when answering the questions in categorization tasks, such as “Are
feet vehicles?”, people with OT tend to think of feet as vehicles based on the fact
that feet transport people and items from one place to another just like vehicles.
However, people without OT would not place feet in the vehicle category because
they believe that wheels are the necessary features of vehicles
6.THOUGHT

• 1. Disorders of tempo:-(the abnormality
in the speed of the production of one's thoughts.)
• a) Retarded thinking:-slowing down of
thought /flow of thought
Associated features:-lack of attention &
concentration, inability to make decisions, no
clarity in thinking, dull fuzziness in head. seen in
depression and in manic stupor.
6.THOUGHT
Disorder of Stream of thought

• b. Flight of ideas:-fragmented ideas; frequent
shifts in conversation topics Most commonly
seen in manic episodes, bipolar disorder and
manic phases of schizophrenia.
For example ✦I went to the market. I should read
that book. ✦ When did you buy this dress? It's a
lovely evening. ✦ I should go for a walk. I feel
like having a chocolate. ✦ I need to study for the
examination. That movie has received very good
reviews.
6.THOUGHT

• c. Circumstantiality- Using of excessive details
which distract from the central theme of a
conversation. (unnecessary details and irrelevant
remarks cause a delay in getting to the point.) • The
disorder is often associated with schizophrenia and
obsessive-compulsive disorder.
• Why do people comb their hair? • "Because it
makes a light in life, my box is broken help me blue
elephant. Isn't banana brave? I like electrons, hello
please!"
6.THOUGHT

• d. Tangentiality- final goal is not reached and patient
losses track of original question For example, in answer to the
question "Where are you from?", the person answers "My dog
is from England. They have good fish and chips there. Fish
breathe through gills."
• e. Incoherence- pattern of speech that is essentially
incomprehensibe Speech that is unintelligible because, though
the individual words are real words, the manner in which they
are strung together results in incoherent gibberish. • a listener
is unable to understand the meaning or purpose of the phrase.
• It mostly appears in people with dementia and schizophrenia.
6.THOUGHT

• 2. Disorder of continuity
a. Perseveration- Persistent repetition of words or
ideas even when another person attempts to
change the topic.e.g. "It's great to be here in
Nevada, Nevada, Nevada, Nevada, Nevada." This
may also involve repeatedly giving the same
answer to different questions. e.g. "Is your name
Mary?" "Yes." "Are you in the hospital?" "Yes."
"Are you a table?" "Yes."
6.THOUGHT

• b. Thought block- interruption of train of speech before a thought
or idea has been completed. schizophrenic patient’s speech is suddenly
interrupted/comes to a halt; he then goes on talking about something
else after so many seconds; patient may complain that his/her mind is
empty during discrete periods; unable to recover what has just been
said
c. Echolalia - Echoing of another's speech[41] that may only be
committed once, or may be continuous in repetition. This may involve
repeating only the last few words or last word of the examiner's
sentences. This can be a symptom of Tourette's Syndrome, e.g. "What
would you like for dinner?", "That's a good question. That's a good
question. That's a good question. That's a good question."
6.THOUGHT

Disorder of possession of thought
• Thought alienation:-
patient has experience
that his thoughts are
under control of an
outside agency or that
others are participating in
his thinking.
• Thought insertion:- Patients
belief that one's thoughts are not
one's own, but rather belong to
someone else and have been
inserted into one's mind.
• Thought broadcasting:-
Patient belief that others can hear
or are aware of one's thoughts
6.THOUGHT

• Obsession- a persistent thought, idea, or image that is intrusive
(unwelcome, involuntary thought, image, or unpleasant ) or
inappropriate, and is distressing or upsetting
• Compulsion:- def. – a disorder in which a person feels compelled to
perform certain stereotyped actions repeatedly to alleviate persistent
fears or intrusive thoughts, typically resulting in severe disruption of
daily life.
• Rumination:- involves negative thought patterns that are immersive
or repetitive. Or The process of continuously thinking about the same
thoughts,
6.THOUGHT
Disorder of possession of thought

Disorder of Content of thought
6.THOUGHT
1. Obsession
2. Compulsion
3. Ideas of hopelessness- an attitude characterized by an
untoward and unfavourable expectations from self &
environment.
4. Ideas of worthlessness:- Feeling that one is good for
nothing and cannot tackle problems of life with due skill it
is frequent underestimation of one’s talent, knowledge and
capabilities.

• 5. Suicidal ideas
• 6. Homicidal ideas
• 7. Depersonalization:- experience a persistent or
recurring feeling of being outside of your body
• 9. Derealization :- a feeling that one's
surroundings are not real, especially as a symptom
of mental disturbance.
6.THOUGHT

• 10. Idea of reference the incorrect idea that the words
and actions of others refer to one's self, belief that
innocuous or coincident events experienced have strong
personal significance) or influence (belief that other
people or external agents are covertly exerting powers
over oneself), persecutory ideas
• 11. Delusion (something that is falsely or delusively
believed ) Erotomanic/Grandiose/ Jealous/
Persecutory/ Somatic /Paranoia/Negation Or
Nihilistic
6.THOUGHT

• Erotomanic: patient belief that someone is in
love with oneself
• Grandiose: belief that one is the greatest,
strongest, fastest, richest, and/or most intelligent
person ever
• Persecutory: belief that the person, or
someone to whom the person is close, is being
malevolently treated in some way),
6.THOUGHT

• Somatic: A somatic delusion is a false belief that a person's
internal or external bodily functions are abnormal. This belief
may also extend to viewing one's physical appearance as very
irregular. Also known as monosymptomatic hypochondriacal
psychosis, this condition is a very rare form of a delusion.
• Jealous : delusional jealousy, is a psychological disorder in
which a person is preoccupied with the thought that
their spouse or sexual partner is being unfaithful without
having any real proof,[1] along with socially unacceptable or
abnormal behaviour related to these thoughts
6.THOUGHT

• Paranoia :Paranoid delusions, also known as
persecutory delusions, are fears, anxieties, and
suspicions centered on perceived victimization or
unwarranted feelings of being threatened by external
forces such as individuals or government authorities.
• Paranoia/Negation Or Nihilistic :
a depressive delusion that the self, part of the self, part
of the body, other persons, or the whole world has
ceased to exist.
6.THOUGHT

• 1. Illusion- misinterpretation of
perception
• 2. Hallucinations:- perception
occurring without external
stimulation
7.PERCEPTION

1. Illusion- is a distortion of the senses, which can reveal
how the human brain normally organizes and interprets
sensory stimulation. • Optical illusions,
• Auditory illusions and
• Tactile illusions.
7.PERCEPTION
2. Hallucination- A hallucination is a perception in the
absence of external stimulus that has qualities of real
perceptions
 Auditory
Visual
Olfactory
Gustatory
Tactile

Attention
Sustained Attention Or
Concentration
Memory
Intelligence
Abstraction
7. COGNITIVE FUNCTION

Attention
• Def:- It is patients ability to attend to
specific stimulus without being
distracted by extraneous internal or
external stimuli
• Attention :-normally aroused/
aroused with difficulty / digit forward
/digit backward

Def:-It is ability to maintain attention to a
specific stimulus over an extended period
• Concentration :- normally sustained/
sustained with difficulty /
• distractible100-7/40-3/
• 20-1/Name of months(backwards)/Name
of weekdays (backwards)
Sustained Attention

• Def:- It is a general term for mental
process that allows the individual to
store memory for later recall.
• Memory :-
• 1,Immediate:- (Digit repetition test)
Memory

• 2) Recent: (recent happenings - last
meal, visitors etc)/verbal recall - 3
unrelated objects /5 unrelated objects,
or imaginary/address of 5 items
• 3) Remote: personal
events/impersonal events/illness-
related events
Memory

• General fund of
information: Questions
presented in increasing
difficulty.
• Arithmetic ability: mental
arithmetic /written sums
Intelligence

Abstraction
• Abstraction :- (the cognitive process of
isolating, or “abstracting,” a common feature
or relationship observed in a number of
things, or the product of such a process.)
• Normal/ concrete/interpretation of
proverbs/Similarities between paired
objects

• Awareness of abnormal behaviour
/experience:- yes / maybe / no
• Attribution to physical causes:- yes /
maybe / no
• Recognition of personal
responsibility:- yes /maybe / no
• Willingness to take treatment: yes
/maybe /no
9. INSIGHT

Social Judgement:- It is a more complex
function that includes basic knowledge of
social situations, knowledge of socially
appropriate responses in such situations and
ability to apply the correct response personally
when faced with a actual social situation It can
assess by history from informants who have
witnessed the patients actual performance in
dealing with day to day events.
10. JUDGEMENT

Personal Judgement The
individuals personal
expectations/plans/attitudes are
assessed.
• Personal: intact / impaired
• Social: intact / impaired
• Test: intact / impaired
10. JUDGEMENT

Mental status examination

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