{"id":5321,"date":"2025-02-04T00:33:00","date_gmt":"2025-02-04T08:33:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=5321"},"modified":"2026-02-19T18:03:21","modified_gmt":"2026-02-20T02:03:21","slug":"clerkship-tips-how-to-administer-a-mental-status-examination","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination","title":{"rendered":"Clerkship Tips: How to Administer a Mental Status Examination"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#What_is_the_Mental_Status_Exam\" >What is the Mental Status Exam?\u00a0<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Components_of_the_Mental_Status_Exam\" >Components of the Mental Status Exam&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Appearance\" >Appearance&nbsp;&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Affect\" >Affect&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Speech\" >Speech<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Language\" >Language&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Mood\" >Mood&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Attitude\" >Attitude&nbsp;&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Perceptions\" >Perceptions&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Thought_Processes\" >Thought Processes&nbsp;&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Thought_Content\" >Thought Content&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Insight_Judgement\" >Insight &amp; Judgement<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Cognition\" >Cognition&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Conducting_a_Mental_Status_Exam_MSE\" >Conducting a Mental Status Exam&nbsp;(MSE)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Limitations_and_Considerations\" >Limitations and Considerations&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#Practice_to_Prepare_and_Impress_Your_Peers\" >Practice to Prepare and Impress Your Peers<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#About_the_Author\" >About the Author<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.osmosis.org\/blog\/nclex-qotd-mental-status-assessment\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>mental status exam (MSE)<\/strong><\/a> is a <strong>crucial component<\/strong> of a comprehensive <strong>clinical evaluation<\/strong>. While it is particularly valuable in <strong>neurology<\/strong> and <strong>psychiatry<\/strong>, any practitioner should include an <strong>MSE<\/strong> in any thorough clinical evaluation, ranging from <strong>GPs<\/strong> to specialists. Though it may seem complex at first, with practice, performing a <strong>mental status exam<\/strong> can become second nature. Let&#8217;s take a few minutes to explore this <strong>health assessment tool<\/strong> and discuss some tips for seamlessly integrating it into your <strong>clinical practice<\/strong>.\u00a0\u00a0<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_is_the_Mental_Status_Exam\"><\/span>What is the Mental Status Exam?\u00a0<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>mental status exam<\/strong>, or <strong>MSE<\/strong>, is a structured examination that utilizes <strong>interviewing techniques<\/strong> and <strong>observational skills<\/strong> to identify the <strong>psychological functioning<\/strong> of a patient at a specific point in time. The modern <strong>MSE<\/strong> is a descendant of evaluation techniques developed by <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4421897\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Karl Jaspers<\/strong>&#8216; work<\/a> in <strong>descriptive psychopathy<\/strong> and <strong>descriptive phenomenology<\/strong>. <strong>Karl Jaspers<\/strong> argued that the only way to understand a patient&#8217;s lived experience is through the patient&#8217;s description. In other words, a clinician can only appreciate a patient&#8217;s experiences by listening to the patient&#8217;s account rather than relying solely on external observations or interpretations.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This perspective played a pivotal role in shaping the modern <strong>mental status exam<\/strong>, as Jaspers challenged the prevailing belief of the <strong>Freudian school<\/strong> of practice that clinicians could best understand <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780122678059500328\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>psychopathology<\/strong><\/a> through external observations or interpretations of unconscious forces driving mental health symptoms. Like many aspects of medicine, the modern <strong>MSE<\/strong> integrates the strengths of both approaches. It incorporates the patient&#8217;s account of their lived symptomatic experience while relying on the clinician&#8217;s external observations and interpretations to guide diagnosis.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/learn\/Mental_status_Physical_and_Cognitive_Examination_and_Findings\"><img loading=\"lazy\" decoding=\"async\" height=\"1024\" width=\"850\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2025\/02\/ASEPTIC_Mnemonic_for_Mental_Status_Exam_Appearance_Speech_Emotion_Perception_Thoughts_Insight_Judgment_Cognition_6067e7.png?w=850\" alt=\"Appearance\nSpeech\nEmotion\nPerception\nThoughts\nInsight &amp; Judgment\nCognition\" class=\"wp-image-5546\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/02\/ASEPTIC_Mnemonic_for_Mental_Status_Exam_Appearance_Speech_Emotion_Perception_Thoughts_Insight_Judgment_Cognition_6067e7.png 1200w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/02\/ASEPTIC_Mnemonic_for_Mental_Status_Exam_Appearance_Speech_Emotion_Perception_Thoughts_Insight_Judgment_Cognition_6067e7.png?resize=249,300 249w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/02\/ASEPTIC_Mnemonic_for_Mental_Status_Exam_Appearance_Speech_Emotion_Perception_Thoughts_Insight_Judgment_Cognition_6067e7.png?resize=768,925 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/02\/ASEPTIC_Mnemonic_for_Mental_Status_Exam_Appearance_Speech_Emotion_Perception_Thoughts_Insight_Judgment_Cognition_6067e7.png?resize=850,1024 850w\" sizes=\"auto, (max-width: 850px) 100vw, 850px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Components_of_the_Mental_Status_Exam\"><\/span>Components of the Mental Status Exam&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Like a traditional <strong>physical examination<\/strong>, the <strong><a href=\"https:\/\/www.sciencedirect.com\/topics\/neuroscience\/mental-status-examination\" target=\"_blank\" rel=\"noreferrer noopener\">mental status exam<\/a><\/strong> is divided into specific evaluation domains. The specific elements included in the exam tend to vary from institution to institution, but there tend to be more similarities than differences. A full <strong>mental status examination<\/strong> should consider <strong>appearance<\/strong>, <strong>attitude<\/strong>, <strong>behavior<\/strong>, described <strong>mood<\/strong>, <strong>facial language<\/strong>, <strong>body language<\/strong>, <strong>speech<\/strong>, <strong>thought content<\/strong>, <strong>thought processes<\/strong>, <strong>perceptions<\/strong>, <strong>cognition<\/strong>, <strong>insight<\/strong>, and <strong>judgment<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Let&#8217;s briefly describe each portion of the <strong>MSE<\/strong>, review an example of how it may be documented or presented, and <a href=\"https:\/\/www.osmosis.org\/blog\/category\/study-tips-and-techniques\" target=\"_blank\" rel=\"noreferrer noopener\">clinical pearls<\/a> that suggest clinical findings.\u00a0\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Appearance\"><\/span>Appearance&nbsp;&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Appearance<\/strong> is an observational component of the <strong>MSE<\/strong> and should include consideration of <strong>age<\/strong>, <strong>height<\/strong>, <strong>weight<\/strong>, <strong>hygiene<\/strong>, <strong>eye contact<\/strong>, and <strong>clothing<\/strong>.<\/li>\n\n\n\n<li>&#8220;An adult male that appears his stated age of average height and weight in weather and setting appropriate attire. He maintained good eye contact during the interview.&#8221;&nbsp;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: Disheveled hygiene or poorly maintained clothing may suggest a patient is not attending to their <strong>activities of daily living<\/strong>, which can occur with <strong>mood disorders<\/strong>, <strong>substance use disorders<\/strong>, and <strong>psychotic disorders<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Affect\"><\/span>Affect&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Affect<\/strong> is dependent on the clinician&#8217;s external observations. When describing affect, include information that explains the patient&#8217;s <strong>body language<\/strong> and whether it matches their stated mood and overall range of emotional expression. For extra credit, commenting on <strong>mood reactivity<\/strong> can be useful in identifying certain forms of <strong>depression<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&#8220;Their affect and body language appeared dysphoric and congruent with stated mood. Their overall range of emotional expression was narrow. They demonstrate mood reactivity at times.&#8221;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: <strong>Mood reactivity<\/strong> is a classic symptom of &#8220;<strong>Major depressive disorder with atypical features<\/strong>.&#8221; The other symptoms associated with this diagnosis are <strong>hypersomnia<\/strong>, severe <strong>psychomotor slowing<\/strong> (&#8220;leaden paralysis&#8221;), and <strong>increased appetite<\/strong>.<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: Patients that have &#8220;<strong>inappropriate affect<\/strong>,&#8221; such as laughing without clear, humorous context or crying without contextual cause, may be experiencing <strong>pseudobulbar affect<\/strong>, which can occur with both <strong>neurological conditions<\/strong> and <strong>psychotic disorders<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Speech\"><\/span>Speech<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Evaluation and description of a patient&#8217;s <strong>speech<\/strong> should assess <strong>tone of voice<\/strong>, <strong>rate of speech<\/strong>, <strong>prosody<\/strong> (rhythm) of speech, and any abnormal findings regarding speech.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Speech: Normal rate, rhythm, tone, and prosody.<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: Increased <strong>rate of speech<\/strong> may suggest <strong>pushed<\/strong> or <strong>pressured speech<\/strong>, which can occur in <strong>manic episodes<\/strong> or <strong>hypomanic episodes<\/strong> in addition to acute intoxication on <strong>stimulants<\/strong>. Abnormal <strong>prosody<\/strong> of speech may indicate an underlying <strong>neurological pathology<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Language\"><\/span>Language&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Language<\/strong> describes the patient&#8217;s use of <strong>syntax<\/strong> and <strong>grammar<\/strong> while speaking. It can include findings such as <strong>difficulty finding words<\/strong>, <strong>confabulation<\/strong>, <strong>stuttering<\/strong>, and <strong>aphasia<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Language: Patient exhibits intermittent stuttering at times but appears fluent and does not have word-finding difficulties&#8221;.&nbsp;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: <strong>Language<\/strong> is important when considering diagnoses such as <strong>childhood-onset fluency disorder (stuttering)<\/strong> and <strong>Tourette&#8217;s<\/strong>.<\/li>\n\n\n\n<li>When working with an interpreter, asking the interpreter for their impression of the patient&#8217;s use of their preferred language is essential.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Mood\"><\/span>Mood&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Mood <\/strong>is dependent on the patient&#8217;s described symptomatic experience. Ask them directly about their perceived mood (when possible) and specify it in quotation marks in your examination notes.\u00a0\u00a0<\/li>\n\n\n\n<li>&#8220;Patient describes their mood as &#8216;depressed.'&#8221;&nbsp;<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Attitude\"><\/span>Attitude&nbsp;&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Attitude <\/strong>may also be considered their level of cooperation. It considers the patient&#8217;s approach during the interview process. For instance, a patient who&#8217;s defensive when being interviewed can be regarded as defensive.\u00a0\u00a0<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&#8220;Patient was mostly cooperative during the interview but exhibited defensive tendencies when past violent behaviors are discussed.&#8221;&nbsp;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl:<\/strong> Patients who act as though they&#8217;re suspicious during clinical interviews may be experiencing <strong>paranoia<\/strong>.\u00a0\u00a0<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Perceptions\"><\/span>Perceptions&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Perceptions<\/strong> describe a patient&#8217;s reported experience of phenomena like visual and auditory <strong>hallucinations<\/strong>. It should also include the observations of the clinician concerning the patient experiencing <strong>perceptual disturbances<\/strong>, especially when there&#8217;s a concern about <strong>psychosis<\/strong> and the patient denies hallucinations.\u00a0<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&#8220;The patient denied auditory and visual hallucinations but did appear to respond to internal stimuli while observed arguing out loud while alone in their room.&#8221;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: Visual hallucinations in older patients may be a sign of <strong>acute delirium<\/strong>. <strong>Tactile hallucinations<\/strong> such as &#8220;pins-and-needles&#8221; and perceptions of &#8220;bugs on my skin&#8221; are common in <strong>substance withdrawal<\/strong>, especially <strong>alcohol<\/strong> and <strong>benzodiazepine withdrawal<\/strong>.\u00a0\u00a0<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Thought_Processes\"><\/span>Thought Processes&nbsp;&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Thought processes<\/strong> refer to the rate of thought procession, the continuity of thought processes, and the overall quantity of thoughts.\u00a0<\/li>\n\n\n\n<li>&#8220;Patient appeared linear and logical during discussion of recent events.&#8221;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl:<\/strong> Patients who appear to have rapid thought processes or appear to jump from topic to topic while speaking may be experiencing a &#8220;<strong>flight of ideas<\/strong>,&#8221; which is a classic symptom of <strong>manic episodes<\/strong>.\u00a0<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL3_2023.png?w=700\" alt=\"\" class=\"wp-image-5021\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Thought_Content\"><\/span>Thought Content&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Thought content<\/strong> is likely the portion of the <strong>MSE<\/strong> with the most variation amongst clinicians. <strong>Thought content<\/strong> seeks to describe if a patient is experiencing <strong>suicidal thoughts<\/strong>, <strong>homicidal thoughts<\/strong>, <strong>delusions<\/strong>, negative cognitive distortions, <strong>phobias<\/strong>, <strong>intrusive thoughts<\/strong>, preoccupations, or symptoms of <strong>psychosis<\/strong> such as <strong>thought blocking<\/strong>, <strong>thought insertion<\/strong>, and <strong>thought broadcasting<\/strong>. It tends to be the longest section of an <strong>MSE<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&#8220;The patient did not have suicidal thoughts or homicidal thoughts. They did have delusions of surveillance, as they believe they are being monitored through a chip inserted in their brain.&#8221;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: <strong>Thought broadcasting<\/strong>, <strong>thought insertion<\/strong>, and <strong>thought blocking<\/strong> are classic symptoms of <strong>psychosis<\/strong>.\u00a0<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Insight_Judgement\"><\/span>Insight &amp; Judgement<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Insight <\/strong>and <strong>judgment <\/strong>refer to the patient&#8217;s ability to make rational decisions and their perceptions of their mental functioning. It&#8217;s also important to describe your rationale for each section.\u00a0<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The patient&#8217;s insight appears to be fair, as they&#8217;re able to identify that they&#8217;re feeling depressed. They do not appear to appreciate the role of <strong>alcohol<\/strong> in their depression. Their judgment appears to be good, as they were able to recognize that <strong>medical treatment<\/strong> is prudent given their severe depression and sought out treatment of their own accord.&#8221;<\/li>\n\n\n\n<li><strong>Clinical Pearl:<\/strong> Poor insight and judgment may suggest a patient is not sufficiently educated about their condition. In cases like this, take the time to explain your diagnosis to the patient because poor insight and judgment are significant risk factors for poor outcomes.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Cognition\"><\/span>Cognition&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Cognition<\/strong> should comment on a patient&#8217;s overall ability to <strong>reason<\/strong> and <strong>process information<\/strong>. Describing <strong>orientation<\/strong>, <strong>attention span<\/strong>, and recent and remote <strong>memory recollection<\/strong> in this section of the exam notes is prudent. The cognition section should include formal cognitive testing such as a <strong>MOCA<\/strong> or <strong>SLUMS<\/strong> when concerned about a <strong>neurocognitive disorder<\/strong>.\u00a0<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&#8220;The patient was oriented to person, time, place, situation, and year. The patient&#8217;s recent memory regarding the trauma is impaired. Their remote memory appears intact based on their ability to furnish a complete medical history. Their attention span was poor, but this is likely due to their recent trauma prior to presentation&#8221;.&nbsp;&nbsp;<\/li>\n\n\n\n<li><strong>Clinical Pearl<\/strong>: Carefully completing the <strong>cognition evaluation<\/strong> of the <strong>mental status exam<\/strong> is an essential tool for diagnosing <strong>acute delirium<\/strong>. In delirium, patients will exhibit fluctuating attention span and &#8220;waxing and waxing&#8221; cognition.\u00a0\u00a0<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Conducting_a_Mental_Status_Exam_MSE\"><\/span>Conducting a Mental Status Exam&nbsp;(MSE)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The best way to learn the <strong>mental status exam<\/strong> is through practice. When seeing patients, we recommend completing a brief <strong>MSE<\/strong> without relying on external cues such as <strong>note templates<\/strong>. While this sounds daunting, it will allow you to develop your flow for assessing each component of the exam.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>MSE<\/strong> is also essential for students in <strong>graduate healthcare education programs<\/strong>, as standardized patient encounters often do not allow the use of templates. By developing a personalized flow, the conversation to discover the narrative information required for a thorough <strong>mental status exam<\/strong> will feel natural for you and the patient. While developing your technique of giving an <strong>MSE<\/strong>, a common mistake worth mentioning is feeling that you &#8220;must complete&#8221; each portion of the exam. This pressure can lead to <strong>safety concerns<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For example, asking a patient who is severely <strong>agitated<\/strong> if they&#8217;re having thoughts of wanting to harm staff may result in escalating the patient&#8217;s agitation further. In such situations, it can be better to infer the patient&#8217;s violent ideations by working backward from their displayed behavior. For instance, you may present or document, &#8220;Patient appears to have <strong>aggressive ideations<\/strong>. They were confrontational with hospital staff and threatened physical harm.&#8221; This ability to use subtle language can do wonders for maintaining <strong>clinical rapport<\/strong> with patients while completing an <strong>MSE<\/strong>.\u00a0\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Another helpful tip is to <strong>be honest with patients<\/strong> if they ask why certain questions are being asked. While it may feel better to avoid answering questions due to a concern that patients may adjust their answers to do well on the <strong>MSE<\/strong>, attempting to hide the intent of the evaluation can lead to <strong>distrust<\/strong> or <strong>anxiety<\/strong> in the patient. Finally, when documenting, we recommend using the domains described above just as most clinicians document a <strong>physical exam<\/strong>. When in doubt, explain your findings in the simplest terms.\u00a0\u00a0<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Limitations_and_Considerations\"><\/span>Limitations and Considerations&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A properly executed <strong>clinical assessment<\/strong> melds a patient&#8217;s symptomatic experience with external observations to allow for accurate clinical care. However, the <strong>mental status exam<\/strong> has <strong>limitations<\/strong>. For instance, patients with ulterior motives for presentation may know the right things to say to achieve their expected outcomes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>MSE<\/strong> is also limited to patients who can fully engage in interviews, which isn&#8217;t feasible for very young children, <strong>averbal patients<\/strong>, or patients experiencing a <strong>neurocognitive disorder<\/strong>. Due to these limitations, it&#8217;s essential to use the <strong>MSE<\/strong> as one piece of a comprehensive evaluation that includes other clinical tools such as a <strong>physical exam<\/strong>, <strong>laboratory results<\/strong>, <strong>chart review<\/strong>, and <strong>collateral information<\/strong> from friends and family.\u00a0\u00a0<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Practice_to_Prepare_and_Impress_Your_Peers\"><\/span>Practice to Prepare and Impress Your Peers<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">With enough practice, the <strong>MSE<\/strong> can be an invaluable tool for any <strong>healthcare provider<\/strong>. We hope this guide clarifies the importance of the <strong>mental status exam<\/strong> for you and your colleagues. It&#8217;s not every day that clinicians can learn and use an assessment tool with <strong>high accuracy<\/strong>, <strong>low cost<\/strong>, and <strong>low time commitment<\/strong> that can identify so many conditions!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please share your thoughts about the <strong>mental status exam<\/strong> in the comments. Do you have questions about it? Would you like to see more content, such as deep dives into each section? Let us know below!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"About_the_Author\"><\/span>About the Author<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.linkedin.com\/in\/michael-klug-550bb446\/\" target=\"_blank\" rel=\"noreferrer noopener\">Michael Klug, DO,<\/a><\/strong>&nbsp;is currently a third-year psychiatry resident working in Eastern North Carolina. He completed medical school in New Jersey after attending college in New Orleans. Outside of mentoring medical students, patient care, and nerding out about new psychiatry and neurology research, he spends his free time playing guitar, trying coffee from all over the world, and lifting weights.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.osmosis.org\/blog\/nclex-qotd-mental-status-assessment\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.osmosis.org\/blog\/nclex-qotd-mental-status-assessment<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4421897\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4421897\/<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780122678059500328\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780122678059500328<\/a><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2023\/08\/Blog_Display_Ads_MD2_2023.png?w=700\" alt=\"\" class=\"wp-image-5315\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2023\/08\/Blog_Display_Ads_MD2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2023\/08\/Blog_Display_Ads_MD2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Get your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a>\u00a0now to discover why millions of current and future <strong>clinicians and caregivers love learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Mental Status Exam (MSE) is essential for evaluating psychological functioning in clinical practice. This guide explores its components, significance, and tips for effective implementation in patient assessments, making it a valuable tool for healthcare providers across various specialties.<\/p>\n","protected":false},"author":180,"featured_media":5323,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,5,10,12,21,28,30,16,37,32,43],"tags":[224,218,215,222,148,217,223,226,225,219,220,221],"class_list":["post-5321","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-clerkships","category-clinical-skills","category-communication","category-guides","category-mental-health","category-np","category-do","category-pa","category-nursing","category-residency","tag-assessment-techniques","tag-clinical-skills","tag-healthcare-education","tag-healthcare-providers","tag-medical-training","tag-mental-health-assessment","tag-mental-health-tools","tag-mental-status-exam","tag-mse","tag-neurology","tag-patient-evaluation","tag-psychiatry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Clerkship Tips: How to Administer a Mental Status Examination - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/clerkship-tips-how-to-administer-a-mental-status-examination\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Clerkship Tips: How to Administer a Mental Status Examination - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"The Mental Status Exam (MSE) is essential for evaluating psychological functioning in clinical practice. 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