1. General Presentation:

A. Appearance - Apparent age, grooming, state of health, hygiene/cleanliness, physical characteristic (build/weight, physical abnormalities, deformities, etc.), state of health, distress, pain, appropriateness of attire, pride, dignity, etc. Note that "unilateral neglect of dress" as a description of appearance should be enough detail for identification. Take into consideration the individual's age, race, sex, educational background, cultural background, socioeconomic status, etc.

B. Motor Activity - Posture (slouched, erect), gait (staggering, shuffling, rigid), coordination, speed/activity level, gestures, tremors, tics/grimacing, relaxed, restless, pacing, threatening, hyperactive or under active, disorganized, purposeful, stereotyped movements, repetitive, etc.

C. Interpersonal Behavior - Rapport with the interviewer. Engaged, interested, cooperative, opposition/resistant, submissive, defensive, fearful, etc. Note how the individual greets the examiner.

D. Facial Expression - Relaxed, tense, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful, etc.

E. General Behavior - Distant, indifferent, evasive, negative, irritable, labile, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, somnolent, etc.

2. State of Consciousness - Alert, hyperalert, lethargic (reasons for lethargy are often organic)

3. Speech:

A. Form - Conversational, distractible, rambling, circumstantial, tangential

B. Quantity - Mute, overtalkative, can't be interrupted

C. Rate - Rapid, accelerated, pressured, slow, blocked

D. Quality - Dramatic, histrionic, sarcastic, humorous

F. Expressive Language - Normal, circumstantial, anomia, paraphasia, clanging, echolalia, incoherent, blocking, neologisms, perseveration, flight of ideas, mutism

G. Receptive Language - Normal, comprehends, abnormal

H. Dysprodia - Flat monotone speech- no emotional expression

4. Mood and Affect:

A. Mood - A symptom as reported by the individual describing how he/or she feels emotionally, such as: normal, euphoric, elevated, depressed, irritable, anxious, angry

B. Affect - Observed reaction or expressions; range of affect includes: broad, restricted, blunted, flat, inappropriate, labile, mood congruent, mood incongruent

5. Orientation and Intellectual Ability:

A. Orientation - Time, person, place, and self; the individual should be asked questions such as the day of the week, month, the date, where he/or she lives, where he/or she is now, if he/or she knows who he/or she is.

B. Intellectual Ability - Above average, average, below average

C. General Information - The last four presidents, governor, the capitol, what direction does the sun rise, etc.

D. Calculation - Serially subtracting 7 from 100 (at least six times); simple multiplication word problems such as, "If a pencil costs 5 cents, how many pencils can you buy with 45 cents?"

E. Abstract Reasoning - This is the ability to make valid generalizations. Responses may be literal, concrete, personalized, or bizarre. Use proverbs (i.e. "Still waters run deep" or "A rolling stone gather no moss") to gauge abstract reasoning .

F. Opposites - Slow/fast, big/small, hard/soft

6. Attention & Concentration:

A. Concentration - Days of the week backward; serial sevens, serial threes, serial fives

B. Attention - Non-numeric test (e.g. read series of random letters and have patient tap finger or say yes every time he/or she hears the chosen letter) and numeric test (e.g. string of digits forward and backward, starting with three digits. Stop when patient misses two of each. Average is 7 digits).

7. Memory - Immediate (10 to 30 sec), short-term (up to 1 hour), recent (2 hours to 4 days), recent past (past few months), and remote past (6 months to lifetime)

8. Thought Processes/Content - Deals with organization and composition of thought. Examples include: normal, blocking, loose associations, confabulation, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, delusions, depersonalization, suicidal ideation, and homicidal ideation.

9. Hallucination - None, auditory, visual,olfactory, gustatory

10. Insight - Good, fair, poor. Understanding, thought,feeling, behavior

11. Impulse-Control - The ability/tendency to resist or act on impulses; good, fair, poor

* Note that this is not exhaustive. Mental Status Exam questions could go on interminably.