The Mental Status
Examination
The Foundation of the Mental
Health Assessment
Purpose
 Provides an estimate on the quality of
client’s 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:
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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 isn’t
 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 client’s 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 client’s functioning in
outpatient mental health settings
MMSE
 Original MMSE was the Mini - Mental
State Examination (Folstein, Folstein,
& McHugh, 1975)
MMSE
 MMSE assesses:
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Orientation
Short, recent, remote, remote memory
Sustained concentration
Executive functions
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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 cognitiveintellectual 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 one’s 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
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Assessing Thought Form
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Blocking
Confusion/delirium
Confabulation
Poverty of speech
Flat speech
Content of Thought
 What are pervasive themes or ideas in
client’s 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 don’t observe
them
 See “Assessment Report” handout for
representative symptoms
 If needed, survey adaptive behaviors
The End
www.iupui.edu/~flip/msenotes.htm
 “Ye got all that??”