NURS 2872 - Mental Status Exam Slides

What is a “mental status exam”? Why is it important?

Mental status exam is the equivalent of a head-to-toe assessment in medical nursing. It is the nurse’s daily assessment performed each shift of the psychiatric patient and gives an overview of the patient’s psychiatric status.

What should you NEVER do when completing a mental status exam?

NEVER leave any sections blank. Comment on both normal and abnormal findings.

Why is proper documentation of a mental status exam critical?

If it isn’t charted, it didn’t happen. Accurate documentation ensures legal and clinical accountability.

What is assessed under 'General Appearance'?

Overall look of the patient. Example: 69-year-old Asian male who appears older than stated age. Dress is inappropriate for weather, disheveled, and strong smell of urine.

What question should you ask yourself when assessing General Appearance?

What does the patient look like overall?

What is assessed under 'Behavior - General'?

How the patient is acting overall. Example: The patient is not cooperative and avoids interview.

What is assessed under 'Behavior - Psychomotor'?

A description of the patient's movements and musculoskeletal system, including gait. Example: Pacing hallways, tremor noted in bilateral upper extremities.

What is included in the 'Speech and Communication' section of the MSE?

Description of the patient's speech including pace, volume, clarity, and amount. Also notes any communication abnormalities.

What is an example of abnormal speech in an MSE?

Hyper-verbal speech with loud volume and pressured pace. Noted lisp and difficulty communicating ideas.

What is 'Affect' in the mental status exam?

An objective observation by the interviewer of the patient’s overall mood state. Example: Labile affect, tearful when discussing son's death.

What is 'Mood' in the mental status exam?

A subjective statement by the patient about their current mood. Place in quotes. Example: “I feel amazing, much better than yesterday.”

What is assessed under 'Thought Content and Processes - Flow and Clarity'?

Whether thoughts are coherent, logical, and flow linearly. Example: Loose associations, difficult to follow.

What is assessed under 'Orientation and Level of Consciousness'?

Whether patient is alert and oriented to person, place, date, and situation. Example: Alert, but believes year is 3017 and he is on Mars.

What is assessed under 'Cognitive Function and Calculations'?

Concentration level (poor, fair, good) and ability to do simple math (rare). Example: Decreased ability to concentrate, frequent prompting required.

What is assessed under 'Thought Perception'?

Presence of delusions, hallucinations, or obsessions. Example: Bizarre delusion of heart removal by Satan; auditory hallucinations commanding violence.

What is assessed under 'Memory'?

Objective assessment of recent and remote memory. Example: Remote memory intact; recent memory impaired — can’t recall meals from past 3 days.

What is 'Insight' in the MSE?

Patient’s understanding of their illness. Example: Limited insight — denies psychosis while experiencing command hallucinations.

What is 'Judgement' in the MSE?

Ability to make decisions in the patient’s best interest. Example: Poor judgement — using heroin daily despite recent overdoses.

Why is the Risk Assessment section the MOST IMPORTANT part of the MSE?

It assesses suicidal, homicidal, and self-injurious risk, which directly affects safety and required interventions.

What is assessed under 'Suicide Risk'?

Presence of passive/active suicidal ideation, plan, intent, and protective factors. Example: Passive SI, no plan, protective factor = grandkids.

What is assessed under 'Homicidal Risk'?

Presence of homicidal thoughts, plans, intended victim, means, and understanding of consequences.
Example: Plans to “cut [daughter-in-law] like a fish,” owns knife, understands illegality.

What is assessed under 'Non-Suicidal Self-Injury'?

Any self-harm behaviors without intent to die, frequency, method, and location. Example: Head banging weekly for 10 years, sometimes needing stitches.

What is assessed under 'Access to Firearms'?

Whether the patient owns or has access to guns and their willingness to remove them. Example: Owns a rifle, refuses to remove it from home.

How would you summarize an example of a full mental status exam?

69-year-old Asian male, appears older than age. Inappropriate dress, disheveled, smells of urine. Uncooperative. Pacing with tremor. Hyper-verbal, pressured speech, lisp, trouble communicating. Labile affect, tearful about son's death. Mood: “I feel amazing.” Loose associations. Oriented to person/place only; believes year is 3017 and he’s on Mars. Poor concentration. Delusions and auditory hallucinations. Poor recent memory. Limited insight. Poor judgement (daily heroin use, overdoses). Passive SI, no plan; protective factor = grandkids. Active homicidal thoughts toward daughter-in-law; plan, means, intent; refuses to provide contact info. Head banging for 10+ years. Owns a rifle, refuses to give it up.