Mental Status Examination (MSE) Teaching activities and resources

The Mental Status Examination (MSE)—a structured assessment of client’s behavioural and cognitive functioning—is a vital component of nursing care that assists with evaluation of mental health conditions. The MSE is analogous to the physical examination and is used to evaluate an individual’s current cogitative, affective and behavioural functioning (Varcarolis, 2014). Specifically, the MSE assesses a client’s current state including general appearance, mood and affect, speech, thought process and content, perceptual disturbances, impulse control, cognition, knowledge, judgment and insight (Lasiuk, 2015). The MSE can be used across clinical settings, not just in a psychiatric context, takes only a few minutes to administer and can generate information that is crucial for creating a plan of care (Robinson, 2008).

The acronym BEST PICK can assist with learning the main elements of an MSE (Carniaux-Moran, 2008). A brief description of the elements that are assessed includes:

• Behaviour and general appearance - age, sex, gender, cultural background, posture, dress/ grooming, manner, alertness, as well as agitation, hyperactivity, psychomotor retardation, unusual movements, catatonia, etc.
• Emotions: mood and state, emotional state and visible expression (state) including description and variability.
• Speech—rate, amount, style and tone of speech.
• Thought content and processes—abnormalities, obsessions, delusions and suicidal and homicidal thoughts and thought process as well as loose associations, tangential thinking, word salad, and neologisms, circumstantial thought, and concrete versus abstract thought.
• Perceptual disturbances—illusions and hallucinations.  
• Impulse control—ability to delay, modulate or inhibit expressions or behaviours.
• Cognition—consciousness, orientation, concentration and memory.
• Knowledge, insights and judgment—the capacity to identify possible courses of action, anticipate consequences, and choose appropriate behaviour, and extent of awareness of illness and maladaptive behaviours.

Source: Carniaux-Moran, C. (2008). The Psychiatric Nursing Assessement. In O’Brien, P.G., Kennedy, W.Z., Ballard, K.A. Psychiatric mental health nursing: an introduction to theory and practice.,Sudbury, MA: Jones & Bartlett.

Based primarily on observational data gathered by nurses and interview questions, the MSE can be used to establish a baseline, evaluate changes over time, facilitate diagnosis, plan effective care, and evaluate response to treatment in clients with mental health and addiction.

For more information, see Appendix I: Components of a Mental Status Assessment, pg. 96 in RNAO’s BPG Assessment and Care of Adults at Risk for Suicide Ideation and Behaviour.