The Mental Status Exam

The mental status exam, is an assessment tool that helps identify psychological symptoms that may assist the practitioner determine if there is a psychogenic problem. When assessing mental status, it is important to adjust questions and categories to avoid age and/or cultural bias.

Category	Description
Appearance	General appearance, grooming and gait. This is best observed as the client comes into the room. Grooming is one of the earliest areas to deteriorate when mental function has diminished.
Behavior	Speech, eye contact, body language, response to the environment. Observe for appropriate use of personal space. Does the person come right into your face, or stand an unusual distance away.
Insight	The ability of the client to be aware of one’s own abilities. The ability to analyze a problem objectively. Ask the client to explain a problem.
Intellectual Functioning	Simple calculations, ability to abstract or think symbolically and categories of association. This is done through direct questioning using math, proverbs or analogy.
Judgment	Assesses decision-making abilities. Ask client What he would do in a dilemma regarding an important decision.
Memory	Immediate recall, recent memory, remote memory. Ask the client about a recent current event that both you and the client should know. Ask about some event in the past that should be known by both. Be very careful in this area to avoid cultural bias.
Mood and Affect	Mood relates to the emotions of the moment while affects refers to the range of emotions displayed such as happy, sad, or unchanging. Compare in relation the client’s probable everyday behavior.
Orientation	Assess for awareness of person, time, place, and purpose.
Perceptual Processes	Awareness of self and one’s thoughts, reality and fantasy. Ask about delusions, illusions and hallucinations. Do not hesitate do ask direct questions.
Sensorium	Ability to concentrate, perception of stimuli.
Thought Contents	This assesses themes in conversation and is assessed by observing what the client discusses spontaneously in conversation.
Thought Processes	This measures a stream of conscious or mental activity as indicated in speech. Observe for rate, flow, and ability to pursue a topic logically.

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Neurological Assessment : Checks Pupils

Neurological Assessment : Checks Pupils

1. Observes Both Pupils Simultaneously For: Equality, Size and Shape.
   • Compares pupils for equality.
   • Determines size, dilated, constricted, pinpoint.
   • Determines irregularities in shape.
   
   
2. Observes Direct Pupillary Light Reflexes.
   • Checks one pupil at a time.
   • Shines flashlight into eye from side.
   • Repeat other eye.
   
   
3. Observes Consensual Pupillary Reflex
   • Shines flashlight into each eye alternately.
   • Observes opposite pupil. Opposite pupil should constrict when light shore.
   • Charts description of pupils: Equality, size, shape, reaction to light.
   
   
4. Observes pupillary response to accommodation
   • Have patient follow a closer moving object such as a pen.
   • Pupils will constrict (or accommodate) to the closer moving object. * cannot be tested on blind or confused persons.
   
   
5. Observes Extraocular Movements
   • Asks patient to focus on object.
   • Moves object; medical, lateral, superior, inferior and circular. In the pattern of an "H."
   • Observes movement of both eyes in each of above directions; notes abnormalities or weakness. A. Charts extraocular movements as "full" if no abnormalities or "unable to move eyes laterally, medially etc."

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