1. MENTAL STATUS
EXAMINATION (MSE)
Ms. Meril Manuel
Lecturer
VINE

2. MENTAL STATUS
Mental status is the total
expression of a person’s emotional
responses, mood, cognitive
function, and personality

3. COMPONENTS
1. General appearance and behaviour
2. Speech
3. Mood and affect
4. Thought
5. Perception
6. Cognition (higher mental functions)
7. Judgement
8. Insight

4. 1. GENERAL APPEARANCE AND BEHAVIOUR
a) General appearance:
Body build and physical appearance
(approxi-mate height, weight, and appearance)
Looks comfortable/uncomfortable
Physical health
Grooming
Hygiene
Self-care
Dressing (adequate, appropriate)
Facies (non-verbal expression of mood).

5. FACIAL
EXPRESSIONS

6. b. Attitude towards the examiner
Cooperation/guardedness/evasiveness/
hostility
Attentiveness
Shows interest/appears disinterested

7. c. Comprehension
Intact/impaired (partially/fully).
d. Gait and posture
Normal or abnormal (way of sitting,
standing, walking, lying),

8. e. Motor activity
Increased/decreased
Excitement/stupor
Abnormal involuntary movements (AIMs) tics, tremors
Restlessness/akathisia
Catatonic signs (mannerisms, stereotypes, posturing,
waxy flexibility, negativism, ambitendency, automatic
obedience, echo- praxia, psychological-pillow)
Conversion and dissociative signs (pseudo seizures,
possession states).
Social withdrawal, autism.

9. Psychological pillow
 A sign of catatonia in which the patient holds her head a
few centimeters above the bed or pillow.
 It is a symptom of catatonia and can last for many hours.

10. f. Social manner
Increased, decreased, or inappropriate.
g. Rapport
Whether a working empathic relationship can
be established with the patient, should
mentioned.
h. Hallucinatory behaviour:
o Smiling or crying without reason
o Muttering/ talking to self (non-social speech)
o Odd gesturing in response to auditory or visual
hallucinations.

11. 2. SPEECH
a. Rate and quantity of speech
Whether speech is present or absent
(mutism).
If present, whether it is spontaneous.
Productivity is increased or decreased.
 Rate is rapid or slow.
Pressure of speech or poverty of speech.
b. Volume and tone of speech
Increased/decreased.

12. c. Flow and rhythm of speech
Smooth/hesitant.
Dysprosody.
Blocking (sudden).
Circumstantiality.
Tangentiality, loosening of associations.
Verbigeration, Perseveration
 stereotypies (verbal).
Flight of ideas, clang associations.
Loosening of association

13. 3. MOOD AND AFFECT
 Affect is outward expression of person’s current
feeling State
 Mood is sustained Emotional State; Overall General
mood
In addition to non-verbal mood observed , the patient
is asked about present ‘mood.’ This is recorded as
subjective affect while the observed emotional
change is described as objective affect.

14. Mood is described as
Relaxed, Happy, Anxious, Angry,
– Depressed, Hopeless, Hopeful,
– Apathetic, Euphoric, Euthymic
(Normal/EvenMood),
– Elated, Irritable, Fearful, Silly

15. AFFECT AND MOOD
Affect: How do they appear to you?
Mood: asks the patient directly how
he/she feels

16. Examples
 Mood is described as general warmth, euphoria,
elation, exaltation and ecstasy in mania
 Anxious and restless in anxiety and depression;
 Sad, irritable, angry and despaired in depression;
 Shallow, blunted, indifferent, restricted, inappropriate
and labile in schizophrenia.
 Anhedonia may occur in both schizophrenia and
depression

17.  Questions to ask about mood
How do you generally feel most of the
time?
What's your mood like?
How would you say you feel generally -
happy, sad, frightened, angry?

18. DEPRESSED MOOD

19. IRRITABLE MOOD

20. BLUNT
AFFECT

21. FLAT
AFFECT

22. 4. THOUGHT
a. Stream and form of thought:
 Stream and form of thought’ overlaps with
examination of ‘speech.’
 Spontaneity, productivity, flight of ideas, poverty of
content of speech, thought block
 Continuity of thought is assessed.
 Whether the thought processes are relevant to the
questions asked.
 Any loosening of
associations, tangentiality, circumstantiality, illogical
thinking, perseveration, verbigeration is noted.

23. b. Content of thought:
Obsessions and contents of phobias; ideas
and delusions of persecution, reference,
grandeur, love, jealousy (infidelity), guilt,
nihilism, poverty

24. Hypochondriacal symptoms, hopelessness,
helplessness, worthlessness, and suicide
should be explored.
 Delusions of control, thought insertion,
thought withdrawal, thought broadcasting,
Neologisms

25. Questions about thought form
Do your thoughts seem faster than normal
Do you find you have lots and lots of
different thoughts?
Does your mind seem to be slowed down?
Do you ever have the experience when your
thoughts suddenly stop?
Do you ever feel that your mind is suddenly
wiped blank and you have no thoughts at
all?

26. Questions about delusions
 Do you ever feel that people are following you?
 Do you ever feel that people are seeking to harm
you in some way?
 Do people spy on you?
 Has anything strange or unusual been going on?
 Is there anything special about yourself which makes
you different from other people?
 Is there anything you can do which other people
can't?
 Do you think that somebody has put a spell on you?
Is a spirit/djinn/demon causing problems for you?

27.  Questions about thought insertion
 Do you ever have thoughts in your mind which are not
your own?
Does anything else use your mind to think with?
Does anything put thoughts into your mind from
outside?
Where do those thoughts come from?
Questions about thought withdrawal
 Does anything ever take your thoughts away?
Do you ever have your mind wiped blank?
Does anything take thoughts out of your mind so that
they're not there any more?

28. Questions about thought broadcast
 Can other people tell what you are thinking?
Do your thoughts ever go out of your own mind?
Do your thoughts go out of your mind to other
people?
Are your thoughts ever put on the television or
radio?
Do your thoughts go out of your mind to
somewhere else?

29. 5. PERCEPTION:
a. Hallucinations:
Auditory, visual, olfactory, gustatory or tactile
Auditory hallucinations should be further enquired
-what was heard
-how many voices were heard
-in which part of the day-
-male or female voices
-how interpreted and whether second person or third
person hallucinations (i.e., whether the voices are
addressing the patient or are discussing him in third
person).

30. b. Illusions and misinterpretations: Whether
visual, auditory, or in other sensory fields;
whether occur in clear consciousness or not.
c. Depersonalization and derealization.
d. Somatic passivity phenomenon:
Strange sensations imposed by ‘somebody.’
e. Others:
Autoscopy, abnormal vestibular sensations,
sense of presence should be noted here.

31. ILLUSION

32. 6. COGNITION OR NEUROPSYCHIATRIC
ASSESSMENT
a) Consciousness
b) Orientation
c) Attention
d) Concentration
e) Memory
f) Intelligence
g) Abstract thinking

33.  a. Consciousness
Conscious/confusion/clouding/delirium/stupor/coma.
 Any disturbance of consciousness should be rated on
Glasgow Coma Scale.
b. Orientation:
Whether the patient is well oriented to
 time
(time, date, day, month, year, season, time spent in
hospital)
 place
(where is he, location, where does he stay) and
 person
(his own name, can he identify people around him and
their role in setting).

34. c. Attention: Is the attention easily aroused and
sustained. Ask the patient to repeat digits forwards
backwards.

35. d. Concentration:
 Can the patient concentrate
 Ease of distractibility
 Ask to subtract serial sevens from hundred
(100-7 test), or serial threes from forty (40-3
test), or to count backwards from 20, or
 enumerate the names of the months (or days
of the week) in the reverse order.
 Note down the answers and the time take
perform the tests.

36. e. Memory
Immediate retention and recall (IR and R):
Recent
 How did the patient come to the room/hospital;
 what he ate for dinner the day before or for breakfast
the same morning.
Remote:
Ask for the date of marriage
 name and birthdays of children
 any other relevant questions from the person’s past.
Note any amnesia (anterograde/retrograde),
confabulation, if present.

37. QUESTIONS TO ASK FOR MEMORY
Long-term memory:
Where did you live when you were growing
up?
What was the name of the school you went
to?
Short-term memory:
What did you have for breakfast?
What did you do yesterday?

38. f. Intelligence:
Ask questions about general information,
keeping in mind the patient’s educational and
social background, his experiences and interests
e.g., ask about
o the current and the past prime ministers and
presidents of India
o the capital of India, and
o the name of the various states.
Test for reading and writing.
Give simple tests of calculation.

39. g. Abstract thinking:
Abstract thinking testing assesses patient’s
concept formation.
The methods used are:
Proverb testing: Asking the meaning of
simple proverbs.
Similarities (and also the differences)
between familiar objects, like: table and chair;
banana and orange; dog and lion; eye and ear.
differences

40.  Similarities:
What do the following have in common?
Chair and desk?
Apple and pear?
Poem and statue?
 Proverbs: What do people mean when they
say…..?
Don’t cry over spilled milk
A rolling stone gathers no moss
When the cat’s away the mice will play

41. 7. JUDGEMENT
Personal judgment
Social judgment
is observed during the hospital stay and during the
interview session.
Test judgment
is assessed by asking the patient what he would do
in certain test situations, like ‘a house on fire’, or ‘a
man lying on the road’, or ‘a
sealed, stamped, addressed envelope lying on a
street’.
 Judgment is rated as Good/Intact/Normal or

42. 8. INSIGHT:
patient’s degree of awareness and
understanding that they are ill

43. LEVELS OF INSIGHT
Insight is rated on a 6-point scale from one to six
1) Complete denial of illness
2) Slight awareness of being sick & needing
help but denying it at the same time
3) Awareness of being sick but blaming it on
others, on external factors, or on organic
factors.
4) Awareness that illness is due to something
unknown in the patient
5) Intellectual insight
6) True emotional insight

44. Thank you