Mental Status Exam

What is a mental status exam?

A mental status exam is a way for healthcare providers to assess how you learn and understand your environment (mental capacity). The exam involves observations and questions to check your:

• General appearance.
• Behavior and movements.
• Perceptions.
• Mood and affect.
• Cognition, including attention, orientation, memory, reasoning and judgment.

You can think of it like a psychiatrist’s version of the physical examination, but any healthcare provider can perform it. Mental status exams can help detect and track a variety of conditions. These include mental health conditions (like schizophrenia and anxiety) and neurological conditions (like Alzheimer’s disease and Parkinson’s disease).

When do healthcare providers perform a mental status exam?

Healthcare providers may do parts of a mental status exam at regular checkups or follow-up appointments. The results can help them determine what further testing you need and identify treatment options.

It’s important to note that the mental status exam is a subjective assessment. This means that healthcare providers may reach different conclusions for the same person. Their healthcare specialty can play a role in this, too.

Providers do their best to consider several things when performing the exam. For example, the following factors can affect your performance during the exam:

• Your culture.
• Your native language.
• Your level of education and literacy.
• Sleep deprivation, hunger, pain or other stressors.

Providers don’t base a diagnosis purely on a mental status exam. They use it in combination with your:

• History of current illness.
• Past mental health history.
• Past medical history.
• Substance use history.
• Social history.
• Physical exam.
• Neurological exam.
• Test results, like blood tests.

What is included in a mental status exam?

Healthcare providers use a combination of observations and questions during a mental status exam. Through this process, they check multiple aspects of your mental capacity, which they divide into several broad categories.

Observations

Providers can quickly make assessments based on observations. Specific insight may include:

• Appearance: The provider notes your hygiene, if you look your stated age and if you have any noticeable injuries or scars.
• Behavior: The provider notes your levels of distress, cooperation and discomfort. They also consider the context of why you’re in the hospital to see if you behave as expected in this situation.
• Motor activity (movements): Certain mental health, neurodivergent and neurological conditions can cause abnormal movements, like hyperactivity, tremors, tics, rigidity and parkinsonism (to name a few).
• Speech: Throughout the exam, the provider notes the amount you talk and your fluency. They also note the speed and rhythm of how you talk and the volume and tone of your voice. They can assess if you have speech issues, like slurred speech (dysarthria).
• Affect: The provider observes your nonverbal cues. Terms they may use include happy, sad, agitated, blunted, anxious, bright and euphoric. They also note if your affect matches the mood that you say you’re in.
• Thought process: The provider observes how you organize your thoughts. Providers describe a regular thought process as straightforward and goal-directed. If you have an irregular thought process, your thinking may depend on a particular circumstance. You might not see the whole picture. Or you might have what some call “a flight of ideas.”

Questions

Providers ask directed questions to check certain parts of your mental capacity. With these questions, they can assess the following:

• Mood: The provider asks you to describe how you feel, and they record your response.
• What you’re thinking: The provider assesses what you’re thinking (like if you’re focusing on a certain topic) by listening and asking direct questions. In particular, they check for thoughts of suicide, homicide and delusions (firmly held false beliefs).
• How you perceive the world around you: The provider asks about the things you sense (hear, feel, see, smell and touch) in the world around you. They mainly ask this to check if you’re experiencing hallucinations.
• Insight: This refers to how you understand yourself and how you function in the world around you. The provider assesses this by listening and asking questions. They describe your insight as good, fair, limited or poor. If there’s a previous comparison, they describe it as worsening or improving.
• Judgment: This refers to your ability to make good decisions. Providers assess this by asking you what you would do in specific scenarios. They also base it on your history — for example, if you choose to take your medications regularly or not.

Assessing cognition is an important part of mental status exams. Cognition categories further divide into the following:

• Alertness: This is the level of your consciousness. For example, you may be awake and responsive, in a stupor or in a coma.
• Orientation: This refers to your awareness of your situation and surroundings. The provider asks if you know your name, current location (including city and state) and the date.
• Attention and concentration: Providers observe how well you stay focused on the questions they ask. They can also ask you to do certain tasks to directly evaluate concentration. For example, they may ask you to tap their hand every time you hear a certain letter in a list of random letters they say.
• Memory: The provider may test various forms of memory, including immediate recall, recent memory and long-term memory. For example, they may ask you to repeat back something they said. They may also ask which high school you went to or where you were born.
• Abstract reasoning: This assesses your ability to infer meaning and concepts. For example, the provider may ask you what two objects have in common or to explain a common saying.

What do the results of a mental status exam mean?

After the exam, the provider reviews their notes about things they observed and how you answered their questions. They can then assess if the observations and responses, taken all together, point to a certain issue.

For example, if you had issues with completing at least two cognitive or behavioral functions, it may point to a diagnosis of mild cognitive impairment or dementia. If you expressed experiencing hallucinations, it may point to a mental health condition like a manic episode of bipolar disorder or schizophrenia, or a neurological condition like Parkinson’s disease.

These exams also help providers monitor the progression of neurological conditions.

Providers typically add these notes to your medical record.

If the results are abnormal, what are the next steps?

If the mental status exam is abnormal, your healthcare provider may ask other questions to gain more insight into your medical and mental health history. For example, if you haven’t slept well for three days, it may explain why you had difficulty concentrating or putting together coherent thoughts.

Your provider may also order laboratory tests to see if a physical condition is causing your symptoms. These tests may include:

• Blood glucose test: Hyperglycemia or hypoglycemia can affect your mental capacity.
• Blood urea nitrogen (BUN) test: Uremia can cause fatigue and mental confusion.
• Urinalysis: A urinary tract infection (UTI) can cause mental and behavioral changes.
• Thyroid hormone test: Hyperthyroidism can cause anxiety and hypothyroidism can cause depression.

In some cases, they may also order other tests, like:

• Imaging tests, like a PET scan or brain MRI.
• Electroencephalogram (EEG).
• Cerebrospinal fluid analysis.

Your provider will explain the results of the exam, and together you’ll decide on the next steps.