<p> Overview of a Mental Status Examination (MSE) Rie Rogers Mitchell, Ph.D. Behavior Disorders, EPC 695B</p><p>The Mental Status Examination is a structured interview, which is designed to assess the psychological functioning of an individual. Completion requires meeting with the client long enough to collect observational, interview, exploration, and testing data (approximately 30 to 60 minutes). Results offer a verbal picture of a person's mental functioning at a given point in time in a number of different areas. </p><p>Four methods can be used to assess mental status: 1. Observation – For example, through observation an interviewer can assess appearance and behavior, alertness, and psychomotor activity. 2. Conversation – For example, through conversation an interviewer can assess attention and concentration, speech and thought, orientation, memory, and affect.</p><p>3. Exploration – For example, through exploration an interviewer can assess mood, energy, perception, insight, judgment, and thought content. 4. Testing – For example, through testing an interviewer can assess abstract thinking and intelligence, memory and orientation, level of alertness, attention and concentration, aphasia, agnosia, and apraxia. </p><p>The methods sometimes overlap and give similar information. For example, intelligence can often be assessed through testing, while general intelligence can also be assessed through conversation and exploration. </p><p>Below are the general areas of assessment. You should focus on these areas while the client is with you (and document after the interview) to produce a complete Mental Status Examination. </p><p>APPEARANCE AND BEHAVIOR</p><p>1. Does the client look healthy? 2. What is the client's gender? 3. Does the client appear to be of a certain race or ethnic group? 4. Does s/he look his age? If not, does he appear older to younger? 5. Does s/he have any obvious physical deformities? Describe. 6. Is s/he appropriately dressed? 7. Is his/her clothing clean? 8. Does s/he walk or move in an unusual way? 9. Does s/he sit in a comfortable posture? 10. Does s/he have any visible scars? 11. Do his/her height and weight appear to be appropriate? 12. Does he have any visible tics or unusual movements of the body, face, or eyes? 13. Does he make eye contact? If so, consistently or intermittently? 14. What is the client's facial expression? Does it change over the course of the interview?</p><p>3 ATTITUDE TOWARD THE INTERVIEWER</p><p>1. What is the client's attitude toward you? Describe the comments and behavior on which you base this observation. 2. Does it change over the course of the interview? 3. Does s/he respond to empathy? 4. Does s/he appear to be capable of empathy?</p><p>PSYCHOMOTOR ACTIVITY</p><p>1. Does the client show psychomotor restlessness or agitation by moving around constantly, appearing to have difficulty sitting still. 2. Does s/he show psychomotor retardation, characterized by a general slowing of movement, speech, and thought?</p><p>EMOTIONS (MOOD/AFFECT: (Affect is observed; Mood is self-reported)</p><p>1. What is the client's predominant mood? Describe the comments and behavior on which you base this observation. 2. What is his/her predominant affect? Describe the comments and behavior on which you base this observation. 3. Does his/her affect vary over the course of the interview? 4. Does his/her affect seem excessive at any time? Describe. 5. Does s/he exhibit labile affect (e.g., rapid shifts from happiness to sadness, often accompanied by giggling and laughing or sobbing and weeping)? 6. Does s/he affect include hostility (a predominantly argumentative and antagonistic stance toward the interviewer and others)? 7. Is his/her affect appropriate to the content of the interview? 8. Does s/he display a minimum of emotion with little variation in facial expression (i.e., blunted affect)?</p><p>FLOW OF SPEECH</p><p>1. Does the client speak? Does s/he speak unusually loud or soft? 2. Does s/he speak unusually rapidly or slowly? 3. Does s/he have a speech impediment? 4. Does s/he speak with complexity or simply? 5. Does s/he have the ability to "come to the point."</p><p>CONTENT OF THOUGHT (Not listed in Rosenthal & Akiskal chapter)</p><p>1. Is the client's thought process circumstantial (i.e., thoughts are unessential, secondary, or incidental)? 2. Is it perseverative (i.e., repetitive)? 3. Is his thinking tangential (i.e., divergent or digressive)? 4. Does s/he demonstrate loose associations or flight of ideas (see DSM-IV, p. 767)? 4 How are his/her ideas (a) put together and (b) in what sequence and (c) with what speed? 5. Does s/he exhibit somatic delusions, or delusions of grandeur, persecution, or control? On what comments do you base this observation? 6. Does s/he appear to exhibit thought broadcasting or ideas of reference? 7. Does s/he suffer obsessive thoughts or experience compulsive behavior? 8. Is s/he phobic? If so, what is the nature of the phobia? 9. Are there indications of homicidal or suicidal ideation? If so, on what comments do you base this observation? 10. Is there a particular subject that seems to preoccupy the client's thoughts? If so, describe.</p><p>PERCEPTUAL DISTURBANCES (Morrison includes this section under Content of Thought) </p><p>1. Does the client appear to have hallucinations? 2. Does s/he appear to have delusions? 3. Does s/he appear to have illusions?</p><p>ORIENTATION (Morrison includes this section under Cognition and Intellectual Resources) </p><p>1. Can s/he tall you the day of the week? Month? Year? 2. Can s/he tell you the name of his/her city? State? 3. Can s/he tell you his/her name and/or who you are? 4. Can s/he tell what the interview is all about, i.e., the purpose of his/her visit with the counselor? 5. Does the client have clear sensorium? 6. Is s/he oriented to time, place, person and situation?</p><p>ATTENTION, CONCENTRATION AND MEMORY (Morrison includes this section under Cognition and Intellectual Resources)</p><p>1. Does the client appear to be attending during the interview? 2. Does s/he exhibit a capacity for concentration within the normal range? 3. Does s/he exhibit appropriate immediate, short term, long term, and remote memory? If not, on what do you base this observation?</p><p>INTELLIGENCE (Morrison includes this section under Cognition and Intellectual Resources)</p><p>1. What type of vocabulary and abstract ability does s/he appear to have? 2. Does the client appear to be of average intelligence or above?</p><p>RELIABILITY, JUDGMENT AND INSIGHT</p><p>1. Does his/her judgment appear impaired in any way? If so, on what comments or behavior do you base this observation? 2. Does s\he have an appropriate sense of self-worth? If not, on what comments or behavior do you base this observation? 5 3. Does s/he appear to understand the consequences of his/her behavior? 4. Does s/he exhibit a capacity for insight? Does client know s/he has problem and can s/he discuss possible causes and reasonable solutions?</p><p>Sample of a Mental Status Exam</p><p>Below is an example of a mental status exam written following the first interview with Angel G. Mr. G. came with concerns about caring for his family after being laid off recently from his job.</p><p>Angel G. is a thin, neatly dressed Hispanic male who appeared younger than his stated age of 39. He sat stiffly throughout the interview and made only intermittent eye-contact. His right hand continually tapped the chair. Mr. G.'s speech was rapid and loud. His predominant mood was anxious. He stated, "I don't sleep. All night I'm thinking and thinking. What if I don't find anything?" Mr. G.'s predominant affect was fearfulness but did vary with the content of the interview and was not notably labile or inappropriate. He described his thoughts as "racing all the time lately," but evidenced no thought disorder. His thoughts are preoccupied with fears he may lose his wife and children. Mr. G. denies nay suicidal or homicidal ideation and shows no evidence of illusions or hallucinations. He is oriented x 3 and is of average intelligence or above. He states, "I forget all the time. Like I'm going crazy or something. I never forgot anything before." Mr. G.'s judgment appears somewhat impaired regarding his fears that his family might leave him. "Last week I could not let my children go to school. I thought if they went I would never see them again." He has a capacity for insight and stated, "My father lost his job and my mother took us away. I think this has something to do with that." Mr. G. related to the interviewer in an alternately guarded and self-deprecating way, stating several times, "I don't like talking about his. Probably you can't do much for somebody like me."</p><p>References</p><p>Austin, J.Sue, Partridge, E., & Bitner, J. (1992-93). Using the mental status exam in counseling. CACD Journal, 13, 53-56.</p><p>Folstein, M.F., Folstein,S.E., & McHugh, P.R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198. </p><p>Lukas, S. (1993). Where to start and what to ask: An assessment handbook. New York: W.W. Norton & Company.</p><p>Morrison, J. (1995). The first interview. New York: The Guilford Press</p><p>Othmer, E. & Othmer, S.C. (1989). The clinical interview. Washington, D.C.: American Psychiatric Press, Inc.</p><p>Rosenthal, R.H., & Akiskal, H.S. (1991). Mental status examination. In M. Hersen & S.M. Turner (eds.), Diagnostic interviewing. New York: Plenum Press.</p><p>6</p>