What is a mental status exam?

A mental status examination (MSE) is a method used by health professionals to determine the patient’s mental capacity or how well they can learn and comprehend their environment. The examination consists of information-gathering techniques known as the following:

• Physical characteristics.
• Conduct and Motor activity.
• Sensory experience.
• Emotional state and the expression of feeling.
• Thought process, which includes attention, alertness, orientation, memory, and the aspects of judgment and reasoning.

It is similar to how a physical examination is conducted by a psychiatrist, although any medical worker can actually do it. Mental status examinations can serve to evaluate and follow the course of many different disorders. These may be psychiatric disorders (e.g. schizophrenia, anxiety) or disorders affecting the nervous system (e.g. Alzheimer’s disease, Parkinson’s disease).

When is a mental status examination conducted by doctors?

Doctors can complete certain segments of a mental status examination during regular check-ups or at follow-up appointments. This allows them to recommend what other tests you need and also what treatments could be utilized.

It needs to be added that the mental status examination is an evaluative procedure that is influenced by personal judgment. It implies that different health care providers can arrive at varying conclusions about the same patient. Even the medical specialty of the physicians can play a role in this.

The providers do their best to consider a number of factors when and if they are performing the exam. For instance, the following issues may cause interference with your performance in the course of the exam:

• The behavioral norms of your ethnic group.
• The primary way of communication of individuals from various cultures.
• Education level and the ability to read and write.
• Sleep deprivation, lack of food, aching, or any other pressure.

A mental status exam alone can never be used to arrive at a decision. Rather, it is combined with your:

• The current state of the patient and its implications.
• History of mental illnesses.
• Earliest told of medical ailments.
• Substance abuse.
• Evaluation of the body.
• Inspecting the nervous system.
• Laboratory findings including those of specimen analysis.

What is included in a mental status exam?

Healthcare providers use observations and questioning during a mental status exam. As a result, they assess many parts of your mental ability, which they break down into several general categories.

Providers can often quickly make assessments by using observations. Some specific insight may involve the following:

• Appearance: The provider notes your hygiene, if you look your stated age, and if you have any noticeable injuries or scars.
• Behavior: The provider notes your levels of distress, cooperation and discomfort. They will also consider the context of why you're in the hospital to see if you behave as expected in this situation.
• Motor activity (movements): Some mental health, neurodevelopmental and neurological disorders cause movement to be abnormal, including movements such as over activity, tremors, tics, rigidity and parkinsonism (the list is not exhaustive).
• Speech: The provider assesses how much you talk throughout the exam and your fluency. They note the rate and cadence of your speech, and the volume and quality of your voice. They can determine if there are problems with your speech such as slurred speech.
• Affect: The provider observes your nonverbal cues. Terms they might use include happy, sad, agitated, blunted, anxious, bright and euphoric. They also note if your affect is congruent or matches the mood you say you're in.
• Thought process: The provider observes how you organize your thoughts. Providers describe a regular thought process as straightforward and goal-directed. If you have an irregular thought process, your thinking may depend on a particular circumstance. You might not see the whole picture. Or you might have what some call "a flight of ideas."

Providers ask you series of targeted questions to test particular aspects of your mental ability. Through these questions, they can measure the following:

• Mood: The provider asks you to tell them how you feel, and they record your reply.
• What you’re thinking: The provider assesses what you’re thinking (like if you’re focusing on a certain topic) by listening and asking direct questions. In particular, they check for thoughts of suicide, homicide and delusions (firmly held false beliefs).
• How you perceive the world around you: The service provider asks you to tell him about things you sense (hear, feel, see, smell and touch) surrounding you. They ask this mainly to check whether you are hallucinating.
• Insight: This refers to how well you understand yourself and how you function in the world around you. The provider assesses this by listening and asking questions. They describe your insight as good, fair, limited or poor. If there's a previous comparison, they describe it as worsening or improving.
• Judgment: This is the ability to make good decisions. Providers test this by asking you what you would do in given situations. They also determine it based on your history — for instance, if you decide to take your medications regularly or not.

Assessment of cognition is an important part of the mental status examination. Cognition areas break down into the following:

• Alertness: This is the level of your consciousness. For example, you are awake responsive in a stupor or in a coma.
• Orientation: This refers to your awareness of your situation and surroundings. The provider asks you if you know your name, current location (including city and state) and the date.
• Concentration and attention: The providers check your ability to maintain focus on what they are inquiring about. They can even ask you to do some specific task to assess concentration firsthand. For instance, they could be asking you to tap their hand every time you hear a certain letter that appears in a list of random letters that they will randomly say.
• Memory: The provider may check many types of memory. Immediate recall, recent memory, and long-term memory can all be tested, for instance. Your healthcare provider may ask you to repeat back something they said. They also could ask which high school you went to or where you were born.
• Abstract reasoning: It is about inferring meanings and concepts. For example, the service provider would request you to identify what is common between two objects or to explain a common saying.

What do the results of a mental status exam mean?

A provider assesses their observations and your responses to questions, comparing them to decide if they may together indicate a specific problem. After you have been given the exam, your provider will review their notes about things observed and how you responded to the questions.

For example, having problems with accomplishing at least two cognitive or behavioural functions may indicate mild cognitive impairment or dementia. If you reported having hallucinations, it may indicate a mental health condition such as a manic episode of bipolar disorder or schizophrenia or a neurological condition such as Parkinson's disease.

These tests also allow providers to monitor how a neurological condition is progressing.

These notes are usually included by healthcare providers in your medical record.

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