The Mental Status Examination Chart (Page 2 of 4) in pdf

Glasgow Coma Scale

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Eyes open (E)

Major Components of the Mental Status Examination

Spontaneously

Appearance

Age, sex, race, body build, posture, eye

contact, dress, grooming, manner,

To speech

attentiveness to examiner, distinguishing

features, prominent physical abnormalities,

To pain

emotional facial expression, alertness

None

Retardation, agitation, abnormal

Motor

Best motor response (M)

movements, gait, catatonia

Obeys command

Rate, rhythm, volume, amount,

Speech

articulation, spontaneity

Localizes pain

Affect

Stability, range, appropriateness, intensity,

Flexion to pain

affect, mood

Extension to pain

Suicidal ideation, death wishes, homicidal

Thought

content

ideation, depressive cognitions, obsessions,

None

ruminations, phobias, ideas of reference,

Best verbal response (V)

paranoid ideation, magical ideation,

delusions, overvalued ideas

Oriented

Associations, coherence, logic, stream,

Thought

Confused

clang associations, perseveration,

process

neologism, blocking, attention

Inappropriate words

Perception

Hallucinations, illusions,

Incomprehensible sounds

depersonalization, derealization, déjà vu,

None

jamais vu

Summed coma scale = E + M + V

Intellect

Global impression: average, above

average, below average

Insight

Awareness of illness

6. Are there short forms of the MSE?

Adapted from Zimmerman M: Interviewing Guide for

Evaluating DSM-IV Psychiatric Disorders and the Mental

Several shortened forms of the MSE have been developed as

Status Examination. Philadelphia, Psychiatric Press

screening instruments. All are composed of a combination of

Products, 1994, pp 121–122.

measures to detect cognitive impairments more accurately.

Although helpful, such exams must be combined with

clinical history. The diagnosis of dementia and delirium also

requires the demonstration of a decline in cognitive

5. What is the first step in the MSE?

functioning from a higher baseline. All screening exams have

difficulty in identifying patients with mild cognitive

A determination of consciousness must be the first step in

impairment and patients with focal neurologic lesions, such

MSE. Basic brain function determines the patient’s ability to

as subdural hematomas or meningiomas. The key point is

relate to the surroundings and cooperate with the interviewer.

that MSEs should not be used as the sole criteria for

Disturbance of this basic function affects higher level mental

diagnosing delirium or dementia.

processes that make up the major portions of the exam. The

Glasgow Coma Scale was developed by Teasdale and Jennett

7. What are some of the more common screening exams?

in 1974 to assess impaired consciousness. It is based on eye

opening and motor and verbal responses to stimuli. The scale

ranges from 3 (deep coma) to 14 (full-alert wakefulness).

The Mini-Mental State Examination (MMSE) is probably the

best known. The MMSE tests orientation, immediate and

short-term memory, concentration, arithmetic ability,

language, and praxis. It takes about 10 minutes to administer.

The Cognitive Capacity Screening Examination (CCSE) tests

orientation, serial subtraction, memory, and similarities. It is

less sensitive to delirium or dementia in the elderly. The

Neurobehavioral Cognitive Status Examination (NCSE) is

especially good for medically ill patients; it focuses on

consciousness, orientation, attention, language, construction,

memory, calculations, and reasoning. It tends to be more

sensitive in detecting impairment because it is more detailed.

The Mental Status Examination Chart Page 2

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