Mental Status Examination
1. General Appearance
a. Weight - Obese/ Over-Weight/ Under-Weight/ Others
b. Hair - Bizarre Style/ Unnatural Colour/ Unkempt
c. Dress - Underdressed/ Overdressed/ Bizarre/ Normal Wear
d. Eye Contact - Present/ Partial/ Absent
e. Rapport - Easily Established/ Established with Difficulty
f. Touch with Surroundings - Present/ Partial/ Absent
g. Attitude towards examiner - Cooperative/ Defensive/
Guarded/Suspicious/Uncooperative/ Integrating/ Hostile/ Others
Comments - Eg: Client is overweight with Kempt and Tidy hair
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2. Motor Behaviour
a. Hyperactive/ Restless/ Awkward Gestures/ Self-Injurious/ Retarted/ Tics/
Mannerism/ Stereotypes/ Hallucinatory Behaviour/ Touching Examiner/
Utilization Behaviour/ Aggressive/ Preoccupied/ Silly/ Smiling/ Rigidity
Comments - Eg: Client was Restless, Preoccupied and constantly touching her hair
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3. Mood/ Affect :
a. Subjective: ……………………………………………………………..
Diurnal Variation : Yes/ No
b. Objective: Anxious/ Panicky/ Fearful/ Depressed/ Weeping/ Irritable/
Cheerful/ Europhic/ Blunted/ Flat/ Others
c. Depth: Normal/ shallow
d. Range: Adequate/ Restricted
e. Stability: Stable/ Labile/Inconsistent
f. Congruence to Thought:
g. Appropriate to the Situation:
h. Communicability:
i. Reactivity to the Situation:
4. Speech
a. Intensity/ Tone: Soft/ Audible/ Loud/ Whispering
b. Reaction to Stimulus: Immediate/ Shortened/ Delayed/ Normal
c. Speed: Normal/ Very Slow/ Rapid/ Pressure of Speech
d. Prosody/ Tempo: Normal/ Fluctuation/ Monotonous
e. Ease of Speech: Spontaneous/ hesitant/ Mute/ Slurring/ Shattering/
Whispering / Muttering/ Speaks only when questioned
f. Productivity: Normal/ Over abundant/ Poverty of speech/ Poverty of Content
g. Relevant/ Irrelevant to the Context:
h. Coherent/ Incoherent:
i. Goal Direction : Goal directed/ Non- Goal directed/ Directed/ Circumstantial/
Tangential
5. Thought Content and Thought Process
a. Stream:
1. Normal :
2. Retarded:
3. Accelerated:
Thought Blocking:
Circumstantiality:
Flight of Ideas:
Prolixity:
Pressure of Speech:
Form
ii. Normal/ derailment/ Loosing of Association/ Neologism/ Word Salad/
Incoherence/ Clang/ Illogicality/ Tangentiality/ Distractible/
Circumstantiality/ Loss of Goal/ Self Reference
b. Possession
i. Obsession/ Compulsion:
ii. Thought Alienation: Thought Insertion/ Thought Broadcasting/
Thought Withdrawn
c. Content:
i. Religious Preoccupation/ Philosophical Preoccupation/ sex
Preoccupation/ Somatic Preoccupation/ Preoccupation with
Precipitating Factors/ Excess Day Dreaming
ii. Phobia
iii. Ideas of Hopelessness/ Helplessness/ Worthlessness/ Ideas of Guilt/
Death Wishes/ Suicidal Thoughts/ Homicidal Ideas/
Hypochondriacal Ideas
iv. Ideas of Reference/ Persecution/ Grandiosity/ Infidelity
v. Delusion: Present/ Absent
Sample Talk - Eg: “I don't think I deserve to be loved“
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6. Perception
a. Illusion: Present/ Absent
b. Hallucination: Present/ Absent
c. Types of Hallucination: Auditory/ Visual/ Tactile/ olfactory
Comment- Eg Perception is Normal
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Sample Talk- Eg “I sometimes hear my mother calling me even though she is dead”
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7. Cognition :
a. Orientation :
Comment:…………………………………………………………………………………
Place
Question/ Test -
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Comment-
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Person
Question/ Test -
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Answer…………………………………………………………………………………………
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Comment-
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Time
Question/ Test -
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Comment-
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b. Attention and Concentration
Question/ Test -
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Answer…………………………………………………………………………………………
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Comment-
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c. Memory
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i. Recent Memory
Question -
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Answer:
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Comment - Eg Clients’s memory is Intact/ Adequate Or Impaired
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ii. Remote Memory
Question -
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Answer -
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iii. Immediate Memory
Question -
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Answer-
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d) Abstraction
Question -
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Answer -
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e) General Intelligence
i. Information
Question -
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Answer -
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ii. Calculation
Question -
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Answer -
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iii. Comprehension
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Answer -
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iv. Vocabulary
Question -
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Comment…………………………………………………………
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f) Judgement:
a. Test: Poor/ Satisfactory/ Intact
Question -
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b. Personal - Poor/ Satisfactory/ Intact
Question -
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c. Social - Poor/ Satisfactory/ Intact
Question -
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Answer:…………………………………………………………………………
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Comment:
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8. Insight:
a. Complete Denial Of Illness
b. Slight awareness of being sick but denying at the same time
c. Awareness of being sick but blaming it on external factors
d. Awareness that illness is due to something unknown in the patient
e. Intellectual Insight
f. Emotional Insight
9. Diagnostic Formulation:
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10. Provisional Diagnosis:
(Counsellor/ Therapist can recommend provisional diagnosis for other disease along
with the primary ailment if the symptoms of the other disease is confirmed) :
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11. Differential Diagnosis:
(Incase patient shows signs or symptoms of diseases that are not yet confirmed) :
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12. Management Plan:
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