Come back on Friday for a question related to MSE. This can be an important part of an assessment in helping to distinguish between mood disorders, cognitive impairment, and thought disorders. It can help guide us as therapists in determining next steps such as appropriate referrals to other providers, and any further necessary diagnostic testing.
A mental status exam (MSE) uses observation, questions, and simple tasks to obtain information on several aspects of a client’s current mental state and is useful for determining if the client’s symptoms warrant referral to a physician or psychiatrist.
Area of Functioning
Examples
Appearance: dress and hygiene, physical traits, posture, facial expression, and eye contact
Is the client clean and well-groomed or dirty and unbathed; does he/she seem worried, excited, or suspicious?
Behavior and psychomotor activity: purposefulness, rate, and coordination of movement
Is the client's gait normal, slow, or uncoordinated; does he/she exhibit handwringing, ritualistic behaviors, compulsions, tics, or grimaces; is he/she lethargic, agitated, or hyperactive?
Affect and mood: type, intensity, range, and appropriateness of affect (how the client expresses emotions) and predominant mood (how the client feels)
Is the client sad, irritable, fearful, or friendly; is his/her mood inappropriate to the situation?
Attitude toward the therapist: how the client interacts and responds to the therapist
Is the client cooperative, defensive, manipulative, indifferent, overly familiar, or shy?
Speech and language: rate, volume, fluency, prosody, vocabulary, and pronunciation
Is the client's speech rapid or slow, clear, slurred, pressured, or incoherent; is his/her voice soft or loud; does he/she offer information or respond only to questions?
Thought content: statements, themes, and beliefs
Is the client's thought content consistent with reality or does he/she exhibit delusions, obsessions, ideas of reference, paranoid or homicidal ideation, phobias, or suicidal ideation?
Thought process: flow and organization of thought
Are the client's thought patterns coherent and logical or does he/she exhibit flight of ideas, loosening of associations, circumstantiality, tangentiality, or perseveration?
Cognition: attention and concentration, memory, insight, judgment, abstract thinking, and intelligence
Does the client have impaired attention (e.g., as measured by the digit span task that requires the client to repeat a series of digits of increasing length) or impaired concentration (as measured by the ability to name the days of the week backward); does he/she have deficits in short-term memory (e.g., as measured by the ability to recall the names of three items after several minutes); is there evidence of deficits in abstract thinking (e.g., as measured by the ability to interpret a familiar proverb); does the client have a history of impulsive behavior and unrealistic decisions?
Consciousness: alertness and orientation
Is the client alert or nonresponsive; does he/she respond only to certain types of stimuli (pain, touch, speech); is he/she oriented to time, place, and person?
