A mental status examination is an assessment of the patient’s behavioral and cognitive functioning, which may include the following elements.

A mental status examination includes:

1. General observations made during the clinical encounter:
   • Appearance:
     • Body habitus
     • Dressing/grooming
     • Hygiene
     • Grooming
     • Posture
   • General behavior:
     • Eye contact
     • Cooperativeness 
     • Defensiveness
     • Irritability
     • Shyness
     • Relaxed
     • Resistant 
     • Withdrawn
   • Level of consciousness (state of wakefulness):
     • Checks for the ability to relate to the surroundings and cooperate with the interviewer
     • Eye-opening, motor and verbal responses to stimuli
     • Glasgow Coma Scale to assess impaired consciousness that ranges from 3 (deep coma) to 14 (full-alert wakefulness)
   • Attentiveness:
     • Ability to focus
     • Concentration
   • Mood:
     • Facial expressions such as tearfulness, smiles, and frowns
     • Euthymic (normal mood)
     • Dysphoric (depression, anxiety, and guilt)
     • Euphoric (a pathologically elevated sense of well-being)
   • Motor and speech activity:
     • Hypophonia (an abnormally weak voice usually seen after brainstem or peripheral damage)
     • Stammering
     • Rapid and pressured speech
     • Akathisia (excessive motor activity) shown by wringing of hands, inability to sit still
     • Bradykinesia (psychomotor retardation) is shown by the slowing of physical and emotional reactions
     • Catatonia (immobility with muscular rigidity or inflexibility)
     • Slowness and loss of spontaneity in movement
   • Language, memory, and orientation:
     • Verbal or written communication skills
     • Recall past events
     • Aphasia (an inability or impaired ability to understand or produce speech, as a result of brain damage)
     • Phonemic errors (mistakes in pronunciation)
     • Semantic errors (errors in the meaning of words)
     • Neologisms (meaningless words that have a specific meaning for the patient)
   • Thought and perception:
   • Attitude and insights:
     • A sense of hostility
     • Anger
     • Helplessness
     • Pessimism
     • Overdramatization
     • Self-centeredness
     • Passivity
   • Reaction evoked in the examiner:
     • Feelings aroused in the examiner by the patient
2. A detailed cognitive ability testing:
   • Gnosia (the ability to name objects and their function)
   • Praxis (motor planning to perform a task)
   • Prosody (a striking feature of the speech that is interpreted as stress or intonation)
   • Visuospatial proficiency (ability to perceive and manipulate objects and shapes in space)
3. Specific testing: Based on the physician’s judgment, clinical examination or screening tools can be used that have varying sensitivity and specificity for neurologic and psychiatric disorders, but none are diagnostic for any mental status disorder.
   • Addenbrooke’s Cognitive Examination-Revised: A 20-minute test to assess attention, executive functioning, language, memory, orientation, and visuospatial proficiency.
   • Mini-Mental Status Examination: To assess a wide range of domains, including attention, language, memory, orientation, and visuospatial proficiency.
   • Mini-Cog: A brief screening tool of five minutes or less to measure executive functioning, memory, and visuospatial proficiency. 
   • Montreal Cognitive Assessment: A brief screening tool of 10 minutes or less to assess attention, executive functioning, language, memory, and orientation.

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