Jun Ostrea, M.D.

University of Santo Tomas

Hospital
Department of Neurology &
Psychiatry
Mental Status
Examination
Describes the sum total of
the examiner’s
observations and
impressions of the
psychiatric patient at the
time of the interview
Sections of Mental Status
Examination
General Description
Mood and Affect
Speech Characteristics
Perception
Thought Content and Mental Trends
Sensorium and Cognition
Impulsivity
Judgment and Insight
Reliability
General Description
 Appearance- overall physical
impression
 Gait, dress, grooming, posture, gestures,
facial expression, etc.
 Overt Behavior and Psychomotor
Activity
 Agitation, retardation, tremors, posture,
eye contact, scanning attitude, etc.
 Attitude Toward Examiner- level of
rapport established
 Irritable, aggressive, seductive, guarded,
defensive, apathetic, cooperative, etc
Mood and Affect
 Mood
 Pervasive and sustained emotion that
colors the person’s perception of the
world.
 Steady or sustained emotional state.
 Gloomy, tense, hopeless, elated,
depressed, fearful, suicidal, grandiose,
etc.
 Affect
 Present emotional responsiveness,
inferred from facial expression.
 Labile, blunt, flat, inappropriate,
Speech Characteristics
 Quantity
 Rate of production
 Quality.
 Slow, fast, pressured, spontaneous,
stammering, staccato, aphasia, coprolalia,
echolalia, incoherent, mute,
Perception
 Disturbances:
 Hallucinations
 Illusions
 Depersonalization
 Derealization
 Formication

• Sensory system involved and

content must be described
Thought Content and
Mental Trends
 Process/Form: way in which a person
puts ideas and associations, the form
in which a person thinks.

 Content: what the person is actually

thinking about (ideas, beliefs,
preoccupations, obsessions,
delusions)
Thought Content and
Mental Trends
 Thought Process
 Loosening of associations or derailment
 Flight of ideas
 Racing thoughts
 Tangentiality
 Circumstantiality
 Word salad or incoherence
 Neologisms
 Clang associations
 Thought blocking
 Vague thought
Thought Content and
Mental Trends
 Content of Thought
 Delusions
 Paranoia
 Preoccupations
 Obsessions and compulsions
 Phobias
 Suicidal or homicidal ideas
 Ideas of reference and influence
 Poverty of content
Sensorium and Cognition

Assesses brain function

including intelligence,
capacity for abstract
thought, and level of insight
and judgment
Sensorium and Cognition

 Mini-Mental State Examination

 Brief instrument to grossly
assess orientaion, memory,
calculations, reading and writing
capacity, visuospatial ability, and
language
 Quantitative
 Perfect score is 30
Sensorium and Cognition

 Consciousness
 Orientation and Memory
 Concentration and Attention
 Reading and Writing
 Visuospatial Ability
 Abstract Thought
 Information and Intelligence
Sensorium and Cognition

 Consciousness
 Disturbance usually indicate
organic brain impairment
 Clouding Of Consciousness:
overall reduced awareness of the
environment
 Altered state of consciousness
Sensorium and Cognition

 Orientation
 According to time, place, and
person
 What is your name?
 Who am I?
 What place is this?
Sensorium and Cognition

 Memory
 Immediate: digit span
 Recent: past few days
 Recent Past: past few months
 Remote: childhood, personal
matters
Sensorium and Cognition

 Concentration
 Subtracting serial 7s or 3s from 100
 Attention
- Calculations
- Spell backward
- Naming five things that start
with a particular letter
Sensorium and Cognition

 Reading and Writing

 Ask to read a sentence and
do what the sentence says
 Ask to write simple but
complete sentence
Sensorium and Cognition

 Visuospatial Ability
 Ask to copy a figure
Sensorium and Cognition

 Abstract Thought
 Ability to deal with concepts
 Are meanings of simple proverbs
understood?
 Ask to explain similarities between an
apple and a pear.
Sensorium and Cognition

 Information and Intelligence

 Vocabulary
 Fund of knowledge
 Educational level and socioeconomic
status must be taken into account
 Handling difficult concepts can reflect
intelligence , even in the absence of
formal education or extensive fund of
information
Impulsivity

 Is the patient capable of controlling

sexual, aggressive, and other
impulses
 Critical in ascertaining the patient’s
awareness of socially appropriate
behavior
 Measure of the patient’s potential
danger to self and others
Judgment and Insight

 Judgment
 Does the patient understand the likely
outcome of his or her behavior?

 Is he or she influenced by this

understanding?

 Can the patient predict what he or she

would do in imaginary situations?
Judgment and Insight

 Insight
 Degree of awareness and
understanding about being ill
Judgment and Insight

 Six Levels of Insight

1. Complete denial of illness
2. Slight awareness of being sick
and needing help but denying it
at the same time
3. Awareness of being sick but
blaming it on others, external
factors, or organic factors
Judgment and Insight
4. Awareness that illness is due to
something unknown in the
patient

5. Intellectual Insight: admission

that the patient is ill and that
symptoms or failures in social
adjustment are due to patient’s
own irrational feelings without
applying this knowledge to
future experiences
Judgment and Insight

6. True Emotional Insight:

emotional awareness of
motives and feelings within the
patient and the important
persons in his or her life, which
can lead to basic changes in
behavior
Reliability

 Includes an estimate of the

psychiatrist’s impression of the
patient’s truthfulness or veracity