Our Lady of Fatima University

Antipolo Campus

COLLEGE OF NURSING

Mental Status Examination

Name: __________________________________________________

Elated

Sad

Depressed

Age: _________ Educational Level: ___________________________

Irritable

Anxious

Fearful

Sex: _________ Occupation: ________________________________

Guilty

Worried

Angry

Hopeless

Labile

Flat Affect

Blunted/Diminished

Appropriate

Inappropriate (sad & smiling)

Presenting Problem: _______________________________________

________________________________________________________

Grooming ___________________________________________
Hygiene _____________________________________________

Concrete Thinking

Circumstantial Thinking

Eye Contact __________________________________________

Tangential Thinking

Loose Association

Posture _____________________________________________

Echolalia

Flight of Ideas

Over-all Appearance ___________________________________

Perseveration

Clang of Ideas

Blocking

Word Salad

Derailment
Hyperactive

Agitation

Psychomotor Retardation

Calm

Delusions __________________________________________________

Tremors

Tics

Suicidal Thoughts ___________________________________________

Catatonia

Akathisia

Obsessions

Paranoia

Facial Movement

Eye Contact

Phobias

Magical Thinking

Poverty of Speech

Normal

Talkative

Slow

Rapid

Illusion _________________________________________

Pressured

Loud

Visual Hallucination _______________________________

Soft

Monotonous

Auditory Hallucination _____________________________

Spontaneous

coherent

Other Hallucination _______________________________

Relevant

Depersonalization

Derealisation

Confabulation

Cooperative

Uncooperative

Oriented

Warm/Friendly

Distant

Remembered remote memory

Suspicious

Combative

Remembered recent

Guarded

Aggressive

Hostile

Aloof

Apathetic

Others