The mental status examination is crucial portion of every consultation. It should not be confused with the Mini Mental State Examination developed by Marshall Folstein in 1975 to assess the presence of "organic brain disease". Although the MiniMental State Examination has a place in the interview, certainly with respect to dementia, it need not be performed on every patient.
The elements of the mental status examination are outlined in the Initial Consultation Worksheet and more detailed explanations are covered on this page.
Level of consciousness
Assessment of consciousness should include determining whether the patient is oriented to surroundings and time. Usually, this is done at the beginning of the examination.
Appearance
The appearance of a patient is important to help draw clinical conclusions. Thus, the mental status exam should document whether the patient was well groomed, disheveled, malodorous, etc. In addition, the level of eye contact and cooperation should be noted.
Attention
Attention can be disrupted in many disorders (e.g., mania, substance-induced changes, delirium, etc.) Although detailed assessments of attention may be interesting, they usually aren't feasible. Reasonably brief tests that in some ways provide a measure of sustained attention are asking a patient to spell WORLD backwards, or name the months of the year backwards.
Memory
It is important to assess both recent and remote memory as differential impairment can assist in diagnosis. Classically, patients are given three words and then asked to recall them after three minutes as a test of recent memory. Asking whether the patient can name the president and the president before provides some test of more remote memory.
Executive function
Executive function largely reflects frontal lobe function, although other regions are involved as well. This can be assessed generally by noting impulsivity. One can do a quick Go/No-go task by having the patient tap a desk when the examiner taps once, but not tapping if the examiner taps twice. A more concrete test is the Clock Drawing test, which is remarkably sensitive. A variant of a three position hand test can also work: instruct the patient to make the same hand positions you are making: fist, palm open, palm flat down.
Language disorders
Without covering the variety of aphasias that can result from specific lesions, it is important to note whether the patient speaks at a normal rate and volume and with normal prosody. Assessment of speech is important because it can do reveal different brain lesions that may have occurred.
Mood and affect
Include affect or different aspects of emotional states of the patient. The mood is typically a longer-lasting state, such as depression, euphoria, or euthymia. Affects tends to capture more of the expression of emotional content. Thus, a patient's affect can be within normal range or appropriate, constricted, flat, or blunted.
Thought content
Thought content includes the presence of different aberrant thoughts or their absence. It's important to note the positive and negative findings here. Areas included under the assessment of the contents are: suicidality, homicidality, paranoid ideation, auditory and visual hallucinations, delusions, etc.
Thought process
The assessment of thought process involves checking for the presence of any formal thought disorder. A patient's thoughts can be described as linear and goal-directed, tangential, circumstantial, or disorganized. One should also document any loose associations.
Judgment and insight
Judgment insight can often be assessed through the interview of the patient and the patient's recent actions. More formal assessment can be obtained by asking the patient what he or she would do in certain circumstances where the answer would appear to be rather commonsensical. For example, one can ask the patient will would you do if you found a letter on the sidewalk with his stamp on it?
Psychomotor
It is important to report whether the patient's psychomotor activity appears normal, excited, or retarded. It can also be helpful to comment on general muscle tone.