Mental status refers to a clients level of cognitive and emotional functioning.

Mental health is an essential part of ones total health and is more than just the
absence of mental disabilities or disorders. It is defined as state of well-being on
which the individual realizes his or her own abilities, can cope with the normal
stresses of life, can work productively and is able to make a contribution to his or
her community. Is reflected to the following elements.
Outline of a Mental Status Assessment: The following elements may be
included in a mental status assessment:

Appearance

Motor

Speech

Affect

Thought Content

Thought Process

Perception

Intellect

Insight

FACTORS AFFECTING MENTAL HEALTH factors that may influence the clients
mental health or put him or her at risk for impaired mental health.

Economic and social factors

Unhealthy lifestyle choices
Exposure to violence
Spiritual factors
Cultural factors
Changes or impairments in the structure and function of the neurologic
system
Psychosocial developmental level and issues refer to chap 7 of your ref.
book

MENTAL DISORDER is a disorder that has the following features (APA, 2012):

A behavioral or psychological syndrome or patter that occurs in an individual

That reflects an underlying psychologic dysfunction
The consequences of which are clinical significant distress or disability
Must not be merely an expectable response to common stressors or losses or
a culturally sanctioned response to a particular event

That is not primarily the result of social deviance or conflicts with society

Appearance:

Age: (chronological age and whether person looks this age)

o

Point of reference for clients psychosocial developmental level and

appearance

Sex, Race
o

Male or female? Women tend to have a higher incidence of depression

and anxiety while men have a higher incidence of substance abuse and
psychosocial disorders

Body build (thin, obese, athletic, medium)

Position (lying, sitting, standing, kneeling)

Posture (rigid, slumped, slouched, comfortable, relaxed, threatening)

Slumped posture may reflect feelings of powerlessness or

hopelessness

Elevated shoulders towards ears and hold body stiffly client is tense or
anxious

Eye contact (eyes closed, good contact, avoids contact, stares)

o

Reduced eye contact is seen in depression or apathy

Extreme facial expression of happiness, anger or fright is seen in

anxious clients

Dress (what individual is wearing, cleanliness, condition of clothes, neatness,

appropriateness of garments)
o

Unusually meticulous grooming and finicky mannerisms is seen in

obsessive-compulsive disorder

Poor hygiene and inappropriate dress is seen with organic brain

syndrome

Bizzare dress is seen in schizophrenic or manic disorder

Grooming (malodorous, unkempt, dirty, unshaven, overly meticulous,

hairstyle, disheveled, makeup)

A dirty unshaven, unkempt appearance with foul odor may reflect

depression, drug abuse, low socio-economic level

Poor hygiene may be seen in dementia

Manner (cooperative, guarded, pleasant, suspicious, glib, angry, seductive,

ingratiating, evasive, friendly, hostile)
o

Uncooperative behavior may be seen in angry, mentally ill or violent

client

Attentiveness to examiner (disinterested, bored, internally preoccupied,

distractible, attentive)

Distinguishing features (scars, tattoos, bandages, bloodstains, missing teeth,

tobacco- stained fingers)

Prominent physical irregularity (missing limb, jaundice, profuse sweating,

goiter, wheezing, coughing)

Emotional facial expression (crying, calm, perplexed, stressed, tense,

screaming, tremulous, furrowed brow)
o

Apathy or crying may be seen with depression

Alertness (alert and oriented to what is happening , responds to questions

and interacts appropriately
o

Not alert to person, place day or time; does not respond appropriately

Motor:

Retardation (slowed movements)

Agitation (unable to sit still, wringing hands, rocking, picking at skin or

clothing, pacing, excessive movement, compulsive)

Unusual movements (tremor, lip smacking, tongue thrust, mannerisms,

grimaces, tics)

Gait (shuffling, broad-based, limping, stumbling, hesitation)

o

Gait is rhythmic and coordinated with arms swinging at sides

Catatonia (stupor, excitement)

Speech:

Rate (slowed, long pauses before answering questions, hesitant, rapid,

pressured)
o

Slow repetitive speech is characteristic of depression or PD

Loud rapid speech may occur in manic phases of bipolar disorder

Disorganized (nonstop) speech or long period of silence may indicate

mental illness or a neurologic disorder ( refer to page 97 of your voice
and speech problems

If client has difficulty with speech perform the following additional

tests:

Ask the client to name objects in the room

Ask the client to read from printed material appropriate for his
or her educational level

Ask the client to write a sentence

Deficits in this area needs further neurologic assessment

Rhythm (monotonous, stuttering)

Volume (loud, soft, whispered)

Amount (monosyllabic, hyper-talkative, mute)

Articulation (clear, mumbled, slurred)

Spontaneity

Affect:

Stability (stable, fixed, labile)

Range (constricted, full)

Appropriateness (to content of speech & circumstance)

Intensity (flat, blunted, exaggerated)

Affect (depressed, sad, happy, euphoric, irritable, anxious, neutral, fearful,

angry, pleasant)

Mood (reported by patient/client)

Thought Process:

Coherence (coherent, incoherent)

Logic (logical, illogical)

Stream (goal-directed, circumstantial, tangential {diverges suddenly from a

train of thought}, loose, flight of ideas, rambling, word salad)

Perseveration (pathological repetition of a sentence or word)

Neologism (use of new expressions, phrases, words)

Blocking (sudden cessation of flow of thinking & speech related to strong

emotions)

Attention (distractibility, concentration)

Thought Content:

Suicidal or homicidal ideations

Depressive cognition (guilt, worthlessness, hopelessness)

Obsessions (persistent, unwanted, recurring thought)

Ruminations

Phobias (strong, persistent, fear of object or situation)

Ideas of reference Paranoid ideation

Magical ideation

Delusions (false belief kept despite no supportive evidence)

Overvalued ideas

Other major themes discussed by patient/client

Perception:

Hallucinations (auditory, visual, olfactory [smelling], gustatory [taste], tactile)

Illusions (misinterpretation of actual external stimuli)

Depersonalization

Dj vu, Jamais vu

Intellect:

Global evaluation (average, above or below average)

Insight:

Awareness of illness

Adapted from: American Psychiatric Association (1994). Diagnostic & Statistical

Manual of Mental Disorders. 4th Edition. American Psychiatric
Association,Washington D.C.; Trzepacz, P.T. & Baker. R.W. (1993). The Psychiatric
Mental Status Examination. Oxford University Press; Robinson, D.J. (2000). The
Mental Status Exam Explained. Rapid Psychler Press.
HEALTH ASSESSMENT: COLLECTING SUBJECTIVE DATA: NURSING HEALTH HISTORY
Remember: be alert for all verbal and behavioral clues that reflect the clients
mental status from the very first interaction you have with the client.
Preparation:

Explain the purpose of assessing mental status explain that some questions
sound silly or irrelevant but it will help
Ensure confidentiality and respect for all that the clients share with you
Keep in mind that problems with other body systems may affect mental
status

BIOGRAPHICAL DATA
What is your name, address and telephone number? provide baseline data
How old are you? What is your date of birth? Note if the client is male or female.
to determine a reference point for clients psychosocial developmental level and
appearance
What is your marital status? relationships
What is your educational level and where are you employed? healthy lifestyles
influence ones ability to more effectively cope with mental disorders

ACTIVITY:
1. GO TO A COMMUNITY SHOPPING MALL DURING A BUSY TIME OF THE
DAY. SIT AND OBSERVE THOSE WHO PASS BY NOTING THEIR HYGIENE,
BEHAVIORS, FACIAL EXPRESSIONS, MANNERISMS AND SPEECH.
2. PAIR UP WITH A PEER AND TAKE TURNS ROLE-PLAYING THE VARIOUS
LOC: LETHARGY, OBTUNDED, STUPOR, AND COMA. WHILE ONE PERSON
PORTRAYS THESE VARIOUS LEVELS AS THE CLIENT, THE OTHER WILL
BE THE NURSE WHO WILL ASSESS AND RECORD THE CLIENTS LOC

3. PRACTIVE ASSESSING YOUR OWN DEVELOPMENTAL LEVEL. THEN

ASSESS YOUR PEERS DEVELOPMENTAL LEVEL. PRACTIVE RECORDING
YOUR FINDINGS.
4. EXPLAIN SOME NORMAL VARIATIONS THAT MAY VE OBSERVED IN THE
MENTAL STATUS EXAMINATION OF DIFFERENT CLIENTS.
5. EXPLAIN SOME NORMAL VARIATIONS THAT MAY BE OBSERVED IN THE
PSYCHOSOCIAL DEVELOPMENTAL LEVEL OF CLIENTS FROM DIFFERENT
CULTURES