Mental status exams

Mental status exams were one of the first mental health assessment measures. Although the origin of it is not entirely clear, Adolf Meyer is often credited with the ideas behind its creation. In 1918, he developed a rough method to evaluate a patient’s mental state for his psychiatric practice. Since that time, the mental status exam has been refined for a variety of uses, most frequently to measure a person’s cognitive functioning.

What is a mental status exam?

The mental status exam (MSE) is administered verbally by a clinician. It involves a series of specific questions - along with therapist observations - that are used to determine the client’s mental state. It intends to measure aspects of cognition, mood, and behavior to form an overall picture of the client at a particular moment. The mental status exam is not standardized. Instead, the clinician can choose what types of questions to ask that will meet their specific objectives. For example, a neuropsychologist working with potential dementia clients might focus more on cognitive processes than their effect.

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Components of the mental status exam

The following are common components of a mental status exam:

Appearance

This category provides an overall physical impression of the client. Are they well-groomed and neatly dressed? How is their posture? Do they have a foul odor? You don’t want to judge a book by its cover but you can often tell a lot about a person by their appearance. If a client shows up for an appointment looking disheveled, it tells you something about their functioning.

Behavior

Similarly, a client’s behavior during a mental status exam can give you clues as to their behavior outside the office. Are they cooperative? Do they have good eye contact? Do they exhibit agitation or irregular movements?

Mood

Mood is how the client perceives their current internal emotional status. Therefore, a simple question from the clinician, such as “How do you feel today?” can give you a glimpse into a client’s mood.

Affect

Affect, in contrast, is how a client’s emotional state is perceived by the therapist. A clinician observes body movements, facial expressions, and speech, among other factors, to determine a client’s affect.

Speech

Much can be ascertained about a person from their speech, including symptoms of anxiety and problems with cognition. For example, is it clear or slurred? Is it pressured or relaxed? Asking open-ended questions can give the therapist a good idea of the client’s natural speech fluency.

Thought content

This category helps determine what a client is thinking about. Thought content can give indications about serious problems, including suicidal ideation, hallucinations, delusions, and obsessive thinking. For instance, a therapist might ask, “Do you ever see things that other people don’t see?

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Thought Process

Thought process, on the other hand, has to do with the rate of thoughts and how they are connected. For example, when asked a question, does the client provide a coherent answer in an appropriate time frame? Or are they rambling and going off on tangents? Do they have racing or fragmented thoughts?

Cognition

Cognition includes orientation to time, place, person, and situation (i.e., What is today’s date? Where are you? Who are you? What are you doing here?). It also includes memory and the ability to concentrate. For example, the clinician might ask the client to remember a series of seven numbers and then repeat the numbers back to them. Or the therapist may go back later in the interview to see if the client still remembers, to test long-term memory.

Judgment

Questions of judgment assess whether a person acts appropriately in a given situation. For example, a client may be asked, “What would you do if you saw the person ahead of you drop a $20 bill?” Besides hypothetical situations, it is also beneficial to explore situations that have already occurred and may have had negative consequences: “How would you handle your situation now if you had another chance?”

Insight

Insight involves the level of understanding the individual has about themselves and their problems. In other words, do they understand the reality of their situation and what is necessary to help them improve? Insight is an integral part of the success of treatment. In general, poor insight leads to an unfavorable prognosis.

For a more detailed exploration of the components of the mental status exam, you can check out this informative worksheet.

When should I use the mental status exam?

Whether or not a clinician administers a mental status exam often depends on their profession. For example, an MSE is a common part of a psychiatric evaluation but not as popular with outpatient psychotherapists. That may be because it tends to feel more medical. This is not to say that a therapist would never give an MSE, but they generally have their own intake forms and are more concerned with past behavior, presenting problems, and individual goals as compared to how a client is functioning at a particular point in time. Therefore, if someone presented at an emergency room for a mental health issue, the clinician would probably perform an MSE, but a client would not as likely receive one as part of a psychotherapy intake session.

Additionally, the MSE is often used as a screening measure for neuropsychological impairment and is performed more with elderly populations or those with suspected brain deficits. You will find it administered less to clients with traditional therapy concerns, such as depression or anxiety. Having said that, a clinician may perform a mental status exam with any client in any setting. It provides a fount of useful information. The MSE often gives you the first glimpse of the symptoms that make up psychiatric disorders.

Is a mental status exam a valid and reliable measure?

A mental status exam can provide valuable information about a person’s mental state at a particular moment in time. However, it is not a highly valid or reliable measure. This is mainly because it is not standardized. The MSE given in a hospital, for instance, may be very different from the one given in a psychiatrist’s office. It should be noted that this is also a strength of the MSE. It can be tailored for a particular client or population. Just don’t look at a mental status exam as an example of strong psychometric assessment properties.

What is the mini-mental state exam?

The Mini-Mental State Exam (MMSE) is a standardized assessment tool that measures the severity of cognitive impairment over time. It is only 11 questions and is used as a screening item for cognitive difficulties. Despite sharing a similar name, it is not to be confused with a mental status exam. Although both measures can assess cognitive deficits, the MMSE has an isolated focus and exhibits stronger psychometric properties.