See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/364604785

Know about Mental status Examination

Article · October 2022

CITATIONS READS

0 3,969

3 authors:

Pooja Godiyal K. Chitra

State College of Nursing, Dehradun Tamil Nadu Agricultural University
14 PUBLICATIONS 3 CITATIONS 166 PUBLICATIONS 1,648 CITATIONS

SEE PROFILE SEE PROFILE

Gyanendri Tomar

16 PUBLICATIONS 2 CITATIONS

SEE PROFILE

All content following this page was uploaded by Pooja Godiyal on 21 October 2022.

The user has requested enhancement of the downloaded file.

 Indian Journal of Nursing Sciences
International Peer Reviewed Journal

Review Article
Know about Mental Status Examination
K. Chitra, Pooja Godiyal, Gyanendri Tomar

Department of Nursing, State College of Nursing, Dehradun, Uttarakhand, India

Abstract

The mental status examination (MSE) is an ordered summary of observations, patient’s mental experiences, and behavior
at the time of interview. The major purpose of MSE is to make a thorough study about the patient’s behavior and to
make clinical diagnosis as per the impression. MSE helps to record the current and severity of symptoms to evidence
the diagnosis made. MSE needs to be documented in the desired format with detailed description added to that patient’s
verbatim, which shows the significant symptoms.

Key words: Cognitive functions, Mental status examination, Neurological disorders

Address for correspondence: Mrs. K. Chitra, Department of Nursing, State College of Nursing, Dehradun, Uttarakhand, India.
E-mail: [email protected]

Introduction What is the MSE?

The mental status examination is analogous to the physical The MSE is a psychological examination in which the
exam: it contains a series of observations, examinations components examined, observed, and documented is
and documentations in set point of time. The questions something equivalent of the physical examination. The
that are focused and ordered which reveal the findings components are especially important in neurologic and
that determine whether it is normal or pathological.[1] psychiatric evaluations. The aim is to perform, observe,
The findings of observation are made in the context of an document and evaluate both quantitatively and qualitatively,
interview. Interview patterns may vary from one patient to a wide range of mental functions and behaviors at a specific
other patient. The documented findings “paints a picture” of point of time. The MSE provides important information
a patient’s appearance, thinking, emotion and cognition.[2] through assessment is current behavior, patients verbatim
on examination, severity of symptoms, possible diagnosis,
The data from the mental status examination (MSE), course of illness, and response to treatment. Recorded
combined with Psychiatric History collection comprises of information, documented details throughout the interview
illness history, personal, family, childhood, marital, sexual, will become a part of the MSE. This MSE is not performed
pre-morbid personality histories. Along with the details only once at the time of admission, it is done on the daily
of MSE, History and Psychiatric Review of Systems, the basis throughout the course of treatment. Then the MSE of
documented information forms the database from which the first day will be compared with the subsequent days to
psychiatric diagnoses are formed. This may be provisional, monitor the level of improvement or deterioration of illness
clinical, and final diagnosis also.[2] that is patient’s prognosis.[3]

Access this article online Why do We do Them?

Website:http://www.innovationalpublishers.com/Journal/ijns e-ISSN: 2581-463X
DOI: 10.31690/ijns.2021.v06i04.001 1. The MSE is a diagnostic tool that provides information
for assessing the patient’s present situation
This is an open access journal, and articles are distributed under the 2. The MSE gathers set of information to form clinical
terms of the Creative Commons Attribution Noncommercial Share diagnosis of illness
Alike 4.0 License, which allows others to remix, tweak, and build
upon the work non-commercially, as long as appropriate credit is given
3. MSE helps to compare and differentiate the patient
and the new creations are licensed under the identical terms. condition at the time of admission, during hospital stay
and also, at the time of discharge
How to cite this article: Chitra K, Godiyal P, Tomar G. Know about
Mental Status Examination. Indian Journal of Nursing Sciences 4. MSE paves way for right treatment on the basis of
2021;6(4):74-76. impression left back on patient interview

74 © 2021 IJNS | Published by Innovational Publishers

 Chitra, et al., IJNS Vol 6 (4), 74-76, 2021

5. MSE is a collection of information on all major Table 1: Major components of MSE

components of mind collectively in a set point of Major components of MSE
time Appearance Appropriate to age, body build, clothing,
6. MSE findings give a base identity about the patient to hygiene and grooming, eye contact
all and any health care providers in the team Motor Activities Body posture and gait, rate of movements,
7. Details of MSE will be sufficient to deal with the coordination of movements abnormal
patient but there are significant details in Psychiatric movements
History collection also. So, MSE must be always Speech Rate, flow of speech, pitch, speed and
accompanied by the History of the patient including intensity, quantity, and reaction time
education, cultural and social factors Mood and Affect Congruent/incongruent, types of
affect – labile, blunt
Key Factors in MSE Thought Content Theme occupied, delusions,
pre‑occupations of ideas,
Assessment of Patient’s mental status needs to be properly de‑personalizations, and de‑realizations
done. It is important to understand that social, cultural, Thought Process Rate, flow, and level of connectivity.
and educational background matters high during the abnormalities – circumstantiality,
assessment. Performing MSE needs to be in their own tangentiality, flight of ideas, thought
regional language for the better understanding of the block, perseveration, verbigeration, and
essence of examination. The reliability of the MSE needs word salad
to be found in their particular geographical area for its Perception Hallucination – auditory, visual, olfactory,
sustainability. Patients who do not know English it may gustatory, tactile, or haptic
be difficulty in understanding various components of the Illusion – affect, completion, pareidolic
MSE. Age may be another devastating factor. In general, Cognition Attention, concentration, orientation,
elderly population patients over the age of 60 years tend to memory‑ short term and longterm,
perform less well on the cognitive elements of the MSE. intelligence – general knowledge,
digit test and abstract thinking and
This may be related to less education also rather than to
judgment – personal, social and test
aging alone.[3,4]
Insight Awareness of illness – 6 point scale and 5
point scale
First Step in MSE MSE: Mental status examination

A determination of consciousness must be the first step

in MSE. Basic brain function determines the patient’s Executive Function of MSE
ability to relate to the surroundings and cooperate with
the interviewer. Disturbance of consciousness affects the The frontal lobes, dorsolateral prefrontal cortex, head of
entire MSE and especially higher-level mental processes the caudate nucleus, and medial thalamus are referred to as
that make up the major portions of the examination. executive functions of the brain. The major and complex
cognitive abilities are primarily mediated by them. Disorders
in these areas can be assessed by evaluating the patient’s
Major Components of MSE ability to self-regulate. Frontal lobe disorder may result
when patient unable to inhibit the impulsive responses to a
Components may not vary but the pattern of format may
stimuli. Perseveration of motor activity is another example
vary from author to author and examination may vary
of frontal lobe dysfunction. Performing an alternating task
from examiner to examiner. However, most detailed
such as palm up– palm down, and later insert a third task
MSE’s include information about appearance, motor
such as (Palm up-Palm down-Close fist). The impaired
activity, speech, affect, thought content, thought process,
patient may be able to repeat only two components of the
perception, higher mental functioning, and insight
assigned task. Focal lesions, any degenerative disorders,
[Table 1].[1,3,4]
Huntington’s chorea, may affect these structures and may
lead to disorders of executive function.[3]
MSE – Is Separate Part in Patient
Evaluation? MSE, in Cognitive Intact Patients?
No. MSE is not separate part of patient evaluation. It is a Yes. Testing of cognitive functions provides a useful
part of patient evaluation supplemented with other data’s baseline. The initial examination provides a point for
collected through history, physical exam, and laboratory comparison with the further subsequent examinations. May
and radiologic studies. Separate interpretation of MSE be the conditions can improve or deteriorate. Furthermore,
makes an erroneous conclusions. Collateral information mental status observations are a major pillar for clinical
from families and friends is also invaluable to confirm or diagnosis. MSE aids in identifying the classical symptoms
supply missing data.[3] paving way to diagnose the disorder. It observes in the aspects

© 2021 IJNS | Published by Innovational Publishers 75

 Chitra, et al., IJNS Vol 6 (4), 74-76, 2021

of affect, speech, and behavior, especially as they change questionnaires have a fairly significant false-negative
during the course of meetings. Frequent fluctuations may rate, especially in patients with cognitive dysfunctions.
be considered as crucial information throughout treatment. Especially in elderly population, with the education grade
MSE observations in other components are necessary even less than standard Nine, different cultural experience, may
in the patient with intact cognitive functions.[3,5] limit the usefulness of MSE screening questionnaires.
Unlike a detailed mental status examination, screening
Other Screening Exams questionnaires are less sensitive to subtle cognitive
impairment.[3,5,6]
The Mini-Mental State Examination (MMSE) is probably
the best known. The MMSE tests orientation, immediate Conclusion
and short-term memory, concentration, arithmetic ability,
language, and praxis. It takes about 10 minutes to administer. MSE is a widely used tool for diagnosing the mental health
The cognitive capacity screening examination tests status of the patient as well as to compare the patient’s
orientation, serial subtraction, memory, and similarities. The condition from the time of admission to throughout the
neurobehavioral cognitive status examination is especially hospital stay and to the time of discharge.
good for medically ill patients; it focuses on consciousness,
orientation, attention, language, construction, memory, Acknowledgment
calculations, and reasoning. Montreal cognitive assessment
is scale similar to MMSE to assess orientation, attention, We would like to acknowledge our family members and
concentration, and memory.[3,5] friends for their immense support and understanding while
writing this research article.
Psychiatric Review of Systems
Source of Financial Support
Signs and symptoms of psychiatric illness are often
described in the history of present illness and the detailed Nil.
examination of Mental Status. The Review of System in
psychiatry includes all the details and notes for important
signs and symptoms. The Review of system in psychiatry Conflict of Interest
is a systematic inquiry, searching for pertinent positives
and negatives over a period of time preceding the time of None.
interviews.[6]
References
1. Cognitive: Memory or Concentration changes
2. Psychosis 1. Semple D, Smyth R. Oxford Handbook of Psychiatry. 13th ed.
3. Substance Abuse Oxford, United Kingdom: Oxford University Press;2015.
4. Mood and Affect: Depression, Mania, Suicidal 2. Newman G. How to assess Mental Status. MSD Manual
ideation, Guilt Professional Version; 2020. Available from: https://www.
msdmanuals.com/en-in/professional/neurologic-disorders/
5. Neurovegetative: Sleep, Appetite, Libido, Interests,
neurologic-examination/how-to-assess-mental-status [Last
Energy accessed on 2021 Feb 02].
6. Anxiety: Anxiety symptoms, Panic/Agoraphobia, 3. House RM. The Mental Status Examination; 2021.
Obsessions/Compulsions, Flashbacks Available from: https://www.brown.edu.courses/bi_278/
7. Eating Disorder: Anorexia, Bulimia other clerkship [Last access on 2021 Jan 21].
8. Violence: Rages, Assaults, Homicidal ideation 4. Detre TP, Kupfer DJ. Psychiatric history and mental status
9. Impulse Control: Pathological gambling, examinations. In: Freedman A, Kaplan H, Sadock B, editors.
Trichotillomania, Kleptomania. Comprehensive Textbook of Psychiatry. Vol. 1. Baltimore:
Williams and Wilkins; 1975. p. 724-35.
5. Norris DR, Molly’s C, Sonya S. The mental status
Limitations of MSE examination. Am Fam Physician 2016;94:635-41.
6. Martin DC. The Mental Status Examination. NCBI.
Although MSE is well structured, screening questionnaires Clinical Methods: The History, Physical, and Laboratory
are still subject to interpretive bias and depend on the Examinations. 3rd ed., Ch. 207. Boston: Butterworths;
skill and experience of the interviewer. All screening 1990.

76 © 2021 IJNS | Published by Innovational Publishers

View publication stats