The Mental Status Exam (MSE)

The Mental Status Exam (MSE)

Mental Status Exam

Heidi Combs, MD

What it is it?

• The Mental Status Exam (MSE) is the psychological equivalent of a physical exam that describes the mental state and behaviors of the person being seen. It includes both objective observations of the clinician and subjective descriptions given by the patient.

Why do we do them?

• The MSE provides information for diagnosis and assessment of disorder and response to treatment.

• A Mental Status Exam provides a snap shot at a point in time

• If another provider sees your patient it allows them to determine if the patients status has changed without previously seeing the patient

• To properly assess the MSE information about the patients history is needed including education, cultural and social factors

• It is important to ascertain what is normal for the patient. For example some people always speak fast!

Components of the Mental Status Exam • Appearance • Behavior • Speech • Mood • Affect • Thought process • Thought content • Cognition • Insight/Judgment

Appearance: What do you see? • Build, posture, dress, grooming,

prominent physical abnormalities

• Level of alertness: Somnolent, alert

• Emotional facial expression • Attitude toward the examiner:

Cooperative, uncooperative





• Eye contact: ex. poor, good, piercing

• Psychomotor activity: ex. retardation or agitation i.e.. hand wringing

• Movements: tremor, abnormal movements i.e.. sterotypies, gait


• Rate: increased/pressured, decreased/monosyllabic, latency

• Rhythm: articulation, prosody, dysarthria, monotone, slurred

• Volume: loud, soft, mute • Content: fluent, loquacious, paucity,



• The prevalent emotional state the patient tells you they feel

• Often placed in quotes since it is what the patient tells you

• Examples “Fantastic, elated, depressed, anxious, sad, angry, irritable, good”


• The emotional state we observe • Type: euthymic (normal mood),

dysphoric (depressed, irritable, angry), euphoric (elevated, elated) anxious

• Range: full (normal) vs. restricted, blunted or flat, labile

• Congruency: does it match the mood- (mood congruent vs. mood incongruent)

• Stability: stable vs. labile

Thought Process

• Describes the rate of thoughts, how they flow and are connected.

• Normal: tight, logical and linear, coherent and goal directed

• Abnormal: associations are not clear, organized, coherent. Examples include circumstantial, tangential, loose, flight of ideas, word salad, clanging, thought blocking.

Thought Process: examples • Circumstantial: provide

unnecessary detail but eventually get to the point

• Tangential: Move from thought to thought that relate in some way but never get to the point

• Loose: Illogical shifting between unrelated topics

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