The Mental Status Exam (MSE) can serve as the basis for diagnosing mental illnesses and can provide a foundation for the dynamic understanding of the client's current level of psychological and emotional functioning.

By definition, the Mental Status Exam gleans information on the immediate and current level of an individual's functioning at the time of the interview. It should be conducted with sensitivity and respect for the individual. Much of the information can be gained though natural observation and sensitive inquiry into the individuals difficulties. Some of information must be directly requested and ideally, will naturally flow with the interview.

The MSE generally covers the following areas: Appearance, Behavior, Speech, Mood and Affect, Thought Content, Thought Process, Perception, Intellectual Ability, and Insight.

To illustrate the important areas of the MSE, we will look at a clinical vignette and apply the MSE to the example:

You see a woman in the intake department of a psych hospital. She wears wrinkled clothing and has one missing stocking. Her hair is unkempt. She has trouble sitting still, almost violently shakes her leg, and holds her hands up as if making a box in the air. She seems fearful and accuses you of having a gun when you open a desk drawer to get a pencil.

Important information can be gained from simple observation. The following are suggestions for areas to consider in conducting the MSE as it relates to Schizophrenia. However, the descriptions in this article are not exhaustive, and the areas described are more involved and detailed. Many publications and texts give very good descriptions of the MSE and different professionals need to decide what works best for them.

1. Appearance: Acutely psychotic individuals generally do not pay much attention to attire, grooming, or hygiene. They may be disheveled and odiferous (unless family has taken the responsibility). This woman is generally unkempt and oddly dressed. Unless there is a good reason for the missing stocking, this could indicate significant confusion.

2. Psychomotor Behavior: Excessive motor activity and odd mannerisms that are repeated over and over may indicate agitation or extreme disorganization. Alternatively, the individual may be rigid in posture (catatonic rigidity) or exhibit waxy flexibility (limbs can be moved into any position and will remain for extended periods of time). One should also look for unusual motor activity (Parkinsonian tremors, etc.).

3. Interpersonal Behavior: This woman exhibits fear and paranoia. Since it may not be so apparent in all cases, asking if the individual is ever "frightened or worried that someone will hurt her" or "concerned that people are sometimes watching her" is a good way to determine level of paranoid ideation. Observing her way of engaging you and your countertransference reaction can lead to better understanding of general interpersonal relationships as well as mood, level of dangerousness, motivation, etc.

5. General Behavior: Facial expression may give important clues as to what emotions the individual is experiencing (or lack thereof), his/or her level of fear, etc. In this case, the woman before you is quite agitated (violent shaking of her leg). This appears to be indicative of agitation. However, gait problems, ticks, or lethargy and somnolence should be noted.