This Mental Status Exam Cheat Sheet (MSE) provides a structured assessment guide for evaluating a patient's behavioral and cognitive functioning. It covers key components such as general appearance, speech, thought processes, emotions, and cognitive testing. Designed for healthcare professionals, this concise guide ensures a comprehensive and consistent approach to mental health evaluations. Practical tips and helpful links are included to enhance the effectiveness of the exam.
Basics
What is a Mental Status Exam?
A Mental Status Exam (MSE) is a structured assessment of a patient's behavioral and cognitive functioning. It includes descriptions of the patient's appearance, behavior, motor activity, speech, thought process, thought content, perception, cognition, insight, and judgment.
Purpose of Mental Status Exam
The MSE is used to diagnose mental illnesses, assess the severity and impact of symptoms, and evaluate the patient's ability to function in daily life. It helps in forming a treatment plan and monitoring the progress of the patient.
Components of Mental Status Exam
- General Appearance
- Face
- Body
- Engagement with Interviewer
- Motor
- Speech
- Formal Thought Disturbances
- Emotions
- Thought Content
- Perceptions
- Cognitive Testing
- Insight and Other
- Psychological Defenses
- Cognitive Distortions
General Appearance
Alertness
- Normal
- Decreased
- Increased
Arousal
- Normal
- Decreased
- Increased
Distractibility
- Normal
- Increased
Apparent Age
- As stated
- Younger
- Older
Habitus
- Normal
- Overweight / Obese
- Underweight
Stature
- Normal
- Short
- Tall
Grooming/Hygiene
- Good
- Disheveled / Unkempt
Dress
- Appropriate
- Inappropriate
Make-Up
- None
- Appropriate
- Garish
- Bizarre
Tattoos / Piercings
- Present
- Absent
Face
Hair
- Normal appearance
- Uncombed
- Alopecia
- Evidence of trichotillomania
Dentition
- Good
- Poor hygiene
- Missing teeth
- Evidence of dentures
Eyes
- Normal
- Eye glasses
- Exophthalmus
- Strabismus
- Nystagmus
- Ptosis
Facial Asymmetries
- None
- On left
- On right
- On forehead
- On lower face
Facial Dyskinesias
- Blepharospasm
- Grimacing
- Jaw thrusts
- Lip smacking/puckering
- Chewing/sucking
- Tongue protrusion/writing
Facial Tics
- Absent
- Present
Dystonia
- Absent
- Present
Parkinsonian Features
- Flat affect
- Drooling
- Decreased blink
Dysmorphisms
- Microcephaly
- Macrocephaly
- Ears
- Webbed neck
- Prominent epicanthal folds
- Short palpebral fissures
- Hypertelorism
- Short nose/low bridge
- Indistinct philtrum
- Large tongue
- Micrognathia
- Macrognathia
Facial Expression
- Appropriate
- Sad
- Anxious
- Angry
- Contemptuous
- Disgusted
- Perplexed
THE BODY
Skin
- Normal
- Puffy
- Spider angiomas
- Hemangiomas
- Café au lait spots
- Neurofibromata
- Bruises
- Cancer-like growths (Kaposi, basal cell, squamous cell)
Scars
- None
- Needle tracks
- Skin popping
- Self-cutting
- Burns
- Surgical
- From fights / accidents
Trunk / Extremities
- Scoliosis
- Lordosis
- Limb abnormalities
- Arthritis
- Amputation
Other Medical Conditions
- Smoker’s cough
- Shortness of breath (SOB)
- Goiter
- Clubbing
- Tobacco-stained fingers
- Pregnant
Aids
- Cane
- Walker
- Wheelchair
- Hearing aid
- Prosthesis
Engagement with Interviewer
Eye Contact
- Appropriate
- Heightened (vigilant)
- Avoidant
- Decreased
Cooperation
- Appropriate
- Guarded
- Evasive
- Suspicious
- Challenging
Reliability
- Good
- Contradictory
- Unreliable
- Unknowledgeable
Transference
- Intimidating
- Dismissive
- Critical
- Entitled
- Suspicious
- Seductive / Flirtatious
- Adoring
- Helpless / Waif-like
Interviewer’s Countertransference
- Intimidated
- Angry
- With-holding
- Over-identifying
- Solicitous
- Overwhelmed
- Grandiose
Motor
Motor Activity Level
- Normal
- Hyperactive (goal-directed)
- Agitated (non-goal-directed)
- Hypoactive
Dyskinesias
- Ballismus (large, violent movements)
- Hemiballismus (confined to one side)
- Athetoid (slow writhing-like, sinusoidal movements)
- Choreiform (rapid, jerky movements)
Other Movements
- Tics (sudden spasmodic movement)
- Stereotypies (ritualistic, repetitive movement or utterance, like rocking, finger-flicking, hand waving)
- Mannerisms (distinctive manner of moving or speaking, like gesticulating while speaking)
- Tremors (resting, intention)
- Dystonias
Catatonia
- Waxy flexibility / catalepsy (immobility with unresponsiveness)
- Echopraxia (mimicking gestures)
- Echolalia (repeating words)
- Automatic obedience
- Negativism (doing the opposite of command)
Gait
- Cerebellar ataxic gait (appears drunk, wide-based)
- Magnetic gait (feet appear magnetically stuck to floor, lifted as against magnetic attachment)
- Parkinsonian (festinating gait: small accelerating steps, often on tiptoe, with forward center of gravity)
- Paralytic (weakness evident on one side)
- Antalgic (gait used to avoid pain in weight bearing structures)
- Spastic (scissor-like with stiff legs close together)
Speech
Expression
- Spontaneous
- Fluent
- Nonfluent
- Ungrammatical
Comprehension
- Normal
- Reduced
Speech Form
- Normal
- Dysarthric
- Delayed onset
- Loud
- Soft
- Fast
- Slow
- Decreased prosody
- Monotone
Paraphasias
- None
- Auditory (sounds similar)
- Syntactical (means similar)
Formal Thought Disturbances
Definition
Pattern of interruption or disorganization of thought
Disturbance in Thought Form
- Poverty of thought (reduced thought)
- Incoherence
- Word salad (severe incoherence)
- Thought blocking
- Clanging
- Punning
- Neologisms
Disturbance in Connection Between Thoughts
- None
- Overinclusive
- Perseverative (remaining or returning to limited set of topics)
- Circumstantial (adding irrelevant detail but reaching goal)
- Tangential (moving from related thought to related thought but not reaching goal)
- Loose associations (illogical shifting to unrelated topics)
- Flight of ideas (severe looseness of association)
- Derailing (loss of train of thought following thought blocking)
Emotions
Mood (Self-report)
- Example: Happy, Sad, etc.
Affect Quality
- Happy
- Sad
- Desperate
- Worried
- Anxious
- Angry
- Irritable
- Euphoric
- Expansive
- Detached
- Dysphoric (sad, angry, or anxious)
Affect Range / Intensity
- Normal
- Expansive
- Restricted
- Blunted
- Flat
Affect Fixity
- Normal
- Volatile / Labile
Affect Congruency
- Congruent or incongruent to topic
Thought Content
Content
- Worries
- Ruminations
- Phobias
- Obsessions
- Compulsions
Risk
- Suicide
- Homicide
- Neglecting dependent
- Victim of abuse / neglect
Delusions
- Referential
- Persecution
- Insertion
- Broadcasting
- Control
- Alienation
- Nihilism
- Grandiose
- Erotomanic
- Somatic
- Fregoli’s (disguised persecutor)
- Capgras (loved one replaced by imposter)
Perceptions
Auditory Hallucinations
- Running commentary
- Arguing
- Derogatory
- Commanding: of suicide / self-injury or of homicide or violence
Other Perceptions
- Visual hallucinations
- Visual illusions
- Tactile hallucination
- Derealization (world not real)
- Depersonalization (self not real)
Cognitive Testing
Orientation
- ☐ Place ☐ Time ☐ Person ☐ Situation
3-Word Repeat
- ☐ 3 ☐ 2 ☐ 1
5-Minute Recall
- ☐ 3 ☐ 2 ☐ 1 ☐ 0
3-Step Command
- ☐ 3 ☐ 2 ☐ 1 ☐ 0
Serial
- ☐ 5 ☐ 4 ☐ 3 ☐ 2 ☐ 1 ☐ 0
DLROW
- ☐ 5 ☐ 4 ☐ 3 ☐ 2 ☐ 1 ☐ 0
Intersecting Pentagons
- ☐ 2 ☐ 1 ☐ 0
Proverb Interpretation
- Abstract
- Concrete
- Idiosyncratic
Similarities / Differences
- Abstract
- Concrete
- Idiosyncratic
Insight & Other
Insight
- Good
- Fair
- Poor
Judgment
- Good
- Fair
- Poor
Impulse Control
- Normal
- Impaired
Motivation
- Good
- Fair
- Poor
Psychological Defenses
Mature Defenses
- Humor: appropriate use of humor to reframe viewpoint and decrease catastrophizing
- Sublimation: impulses directed to socially useful projects
- Altruism: vicarious gratification
- Suppression: conscious deferment
Neurotic Defenses
- Isolation: splitting off of unacceptable affects from the idea that accompanies it, e.g., speaking of traumatic events with a neutral affect.
- Displacement: an affect shifted from one object (person) to another, e.g., kicking the dog when you’re mad at the boss.
- Reaction formation: transforming an unacceptable impulse into its opposite, e.g., showering a person you hate with kindness.
- Denial: an unconscious repression of unacceptable impulses, emotions, desires, instincts
Immature Defenses
- Regression: a return to earlier modes of acting or feeling, e.g., becoming very needy and helpless when under stress
- Somatization: transforming unacknowledged needs (e.g., dependence) into physical symptoms as a way to have needs met without acknowledging them.
- Acting Out: avoiding unacceptable affects or impulses by engaging in a flurry of diversionary activity.
- Blocking: a temporary stopping of thoughts or feelings as a protection against them.
Cognitive Distortions
All-Or-Nothing Thinking
Seeing things in categories of all-good or all-bad. Performance that is less than perfect is interpreted as a complete failure.
Overgeneralizing
Generalizing a single negative event into a larger never-ending pattern of defeat.
Negative Mental Filter
Dwelling on negative details to the exclusion of positive aspects, even when the positive aspects are more prominent.
Disqualifying The Positive
Rejecting positive experiences by insisting they "don't count." For instance, handling an interpersonal challenge effectively and maturely but concluding that it was “just luck.”
Jumping To Conclusions
Interpreting events negatively even though there is little evidence to support the negative assessment.
Mind Reading
Believing that others hold a negative view of you without confirming this belief or entertaining alternate explanations. For example, thinking your boss is angry with you because he didn’t say “Hi.” His behavior in fact may have been unrelated to you, perhaps related to preoccupation with financial problems.
The Fortuneteller Error
Predicting the future in a negative way as if it were preordained to turn out badly.
Catastrophizing
Exaggerating the importance of negative events until they are seen as overwhelming. This increases a person’s sense of helplessness and hopelessness.
Emotional Reasoning
Believing that your negative emotions reflect the state of the world. For instance, when depressed, believing that the world is “going to hell in a hand basket.”
Essentializing
Seeing setbacks as a reflection of your core self. Rather than thinking, “I made a mistake,” you think, "I'm a loser." This distortion also occurs when assessing others. For instance, if someone forgets your name, concluding, “He’s such a self-centered and shallow guy.”
Personalizing
Believing yourself to be the cause of external negative events, even though it is unlikely you are responsible for them. For instance, when your parents argue, concluding that it’s your fault. This distortion is particularly common among people raised or living with an abusive parent or spouse or with a substance abuser.
Tips and Links
Practical Tips
- Conduct the MSE in a quiet, private environment to minimize distractions.
- Build rapport with the patient before starting the exam to make them feel comfortable.
- Observe the patient's nonverbal cues as they can provide additional information about their mental state.
- Be patient and allow the patient to express themselves fully without rushing them.
- Take detailed notes during the exam for accurate documentation and follow-up.