The Mental Status

Examination
The Foundation of the Mental
Health Assessment
 Purpose

Provides an estimate on the quality of

clients functioning
 Uses
Estimate functioning to determine
need for further testing
Estimate functioning to determine
treatment needs
Assess progress when functioning has
declined in an emergency situation
Periodically assess insidious decline in
functioning (e.g., dementias)
 Components
Assesses general quality of:

amnestic functions
cognitive processing and intellectual functions
form and content of thought
nature, expression, and appropriateness of affect
adaptive and maladaptive behaviors
Symptoms of psychopathology
 What an MSE isnt
An intelligence test
A detailed memory test
A fully precise measure of cognition,
affect, and behavior
 Prior to testing . . .
Rapport - building is important in order
to obtain the clients cooperation and
best effort in responding to the
examination
 Ways to Conduct a MSE
These components are assessed while
interviewing the client about her
concerns, circumstances, and history:
Thought form and content
Nature, expression, and appropriateness
of affect
Behavior strengths and weaknesses (or
adaptive behaviors)
 Ways to Conduct a MSE
These functions may be assessed
informally during the interview, or
formally through specific questions and
tasks:

Amnestic functions
Cognitive processing and intellectual functions
 The Mini-Mental Status
Examination
A brief measure of amnestic and cognitive
processing functions, used to
assess short-term changes in mental functioning
in hospitals
assess changes in cognitive functioning in
emergencies (e.g., injuries on the ball field)
Assess progressive changes in cognitive
functioning in long term care settings
Obtain a snapshot of clients functioning in
outpatient mental health settings
 MMSE

Original MMSE was the Mini - Mental

State Examination (Folstein, Folstein,
& McHugh, 1975)
 MMSE
MMSE assesses:

Orientation
Short, recent, remote, remote memory
Sustained concentration
Executive functions
Recognition
Registration
Sequencing and organization
Comprehension
Perceptual - motor skills
 Mental Status Scores
Simple scoring system (point per item)
Scores range from 0 - 30
Scores below 24 indicative of dementia
or cognitive deficit
Lower scores indicate greater deficits
Scores obtained from small sample of
Caucasian males and females from
middle US
 Variations of MMSE

Extended MMSE (John Ashford, M.D.,& Associates,

1992)
St. Louis MMSE (1991)
Solomon 7 Minute Screen (2000)
All these yield standardized scores
Standardization samples are small and not broadly
representative of national population
Samples are not fully culture - fair
Comprehensive Mental Status
Examination

These more fully assess cognitive-

intellectual functions
Include assessment of thought form
and content, affect, and
behaviors/symptoms
 Variations of MSEs
Practitioners tend to develop their own
versions of comprehensive mental status
examinations
As long as the protocol measures the areas
typically assessed by these examinations, a
wide range of specific items will serve the
purposes
Clinicians should avoid using IQ and memory
test items in their MSEs
 Assessing Thought Form
Thought form includes qualities of the way a person
thinks and speaks
Sample of problems in thought form, reflected in ones
speech:
Circumstantial/tangential thought
Pressured speech
Flight of ideas
Unusual vocal qualities (too loud, soft, trembling)
Agnosia, aphasia, apraxia, echolalia, echopraxia
Organizational/executive deficits
Perseverative speech
 Assessing Thought Form
Blocking
Confusion/delirium
Confabulation
Poverty of speech
Flat speech
 Content of Thought
What are pervasive themes or ideas in
clients thoughts, such as:
Hopeless thinking
Helpless thinking
Blaming/abdication of responsibility
Negativistic thinking
(Cleopatra Syndrome (queen of denial)
Positive thoughts
 Content of Thought

Content of thought assessment also

includes:
Hallucinations (visual, auditory [including
command], various others)
Delusions (reference, grandeur, persecution,
jealousy, guilt, nihilistic, various others)
Poverty of thought content
Low thought complexity
 Assessment of Affect
Range of affect:
Restricted
Dull
Blunted versus flat
labile
 Predominant Affect
Describes the types of affect exhibited
during interview, verbal and nonverbal

Can exhibit more than one emotion

during examination
 Appropriateness and
Responsiveness
Assess appropriateness of affect to
topics discussed

Is client responsive to encouragement?

Levity?
 Behaviors and Symptoms
Describe behaviors exhibited during
the interview
Assess dominant symptoms described
by client, even if you dont observe
them
See Assessment Report handout for
representative symptoms
If needed, survey adaptive behaviors
 The End
www.iupui.edu/~flip/msenotes.htm
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