How is the mental status exam performed

How is the mental status exam performed and what are its main components? 

The Mental status exam (MSE) is continuously performed throughout the encounter via observation of the patient.

It is not appropriate to document “unable to perform” a MSE as this means the patient was not observed.

If the patient does not participate in the encounter (due to disordered consciousness, refusal, or other reason), then that is an important observation to note as part of the MSE 

The Main Components of the Mental Status Exam (MSE)

Appearance and	Apparent age, body habitus, appropriateness of dress, grooming, hygiene, and distinguishing features
Behavior	Demeanor, posture/position, level of distress, degree of eye contact, attitude, psychomotor activity, gait, abnormal movements
Speech and	Coherence, rate, rhythm, volume, tone, and prosody
Language	Fluency, repetition, comprehension, naming
Mood and affect	Subjective and objective components of each, quality and range
Thought process and	Logicality, linearity, goal-directedness (inferred from speech)
Thought content	Suicidality, homicidality, delusions, obsessions, and usually also including perceptions: illusions and hallucinations)
Sensorium and	Level of consciousness and its stability
Cognition	Orientation, attention, concentration, intelligence, abstraction, executive function, construction (visuospatial)
Memory and	Registration and immediate, delayed, and autobiographical recall
Fund of knowledge	In relation to sociocultural and educational background
Insight and	Awareness of problems/behaviors including causes and ramifications; motivation to change
Judgment	Rationality of decisions made based on careful thought

Note: A variety of component headings and subcomponents are used in clinical practice, and this list is a suggestion of components and is not intended to be exhaustive.

Sources

From American Psychiatric Association: Psychiatric evaluation of adults. 2nd ed. Am J Psychiatry 163: (6 Suppl):3–36, 2006.