[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Psychiatric assessment and psychopathology](https://durgical.com/en/behavioral-science/areas/assessment/) › The mental status examination

# The mental status examination

- Technique

A structured description of how a person looks, behaves, speaks, feels, thinks and perceives during the interview.

Updated Nov 13, 2026

## Key points

- Mood is what the patient reports (ideally in their own words); affect is what the examiner observes.
- Thought process is how thoughts are linked (form); thought content is what the person thinks about (delusions, obsessions, suicidal or homicidal ideas).
- Abnormal thought content includes delusions, ideas of reference and obsessions; suicidal thoughts and intent to harm others are always asked about.
- Perception covers hallucinations and other unusual perceptions; note which sense is involved.
- Attention is assessed first: an inattentive patient, as in delirium, cannot cooperate fully, so the rest of the cognitive exam is unreliable.
- Insight is the person’s awareness of being ill; judgement can be tested with a hypothetical situation that needs good judgement.

## What it is

The mental status examination (MSE) is the psychiatric equivalent of the physical exam: a snapshot of the person's mental functioning at the moment of the interview. It describes what is seen and heard, component by component, without jumping to a diagnosis. It is recorded in every psychiatric assessment and repeated over time to follow change, for example in delirium, psychosis or depression.

## Components of the mental status examination

| Component | What to note | Examples |
| --- | --- | --- |
| Appearance | Grooming, clothing for the weather, weight, scars, signs of substance use, apparent age | Unkempt and underweight; fresh cuts on the forearms |
| [Behaviour and attitude](https://durgical.com/en/conditions/catatonia/) | Eye contact, cooperation, psychomotor activity, abnormal movements | Restless and pacing; slowed movements; guarded and evasive |
| [Speech](https://durgical.com/en/conditions/bipolar-disorder/) | Rate, volume, amount, fluency, articulation | Fast and hard to interrupt; soft and slow with long pauses |
| [Mood](https://durgical.com/en/conditions/major-depressive-disorder/) | The emotion the person describes | «I feel empty»; «I have never felt better» |
| [Affect](https://durgical.com/en/conditions/schizophrenia/) | Observed emotion: range, intensity, stability and fit with the content | Flat; labile; smiling while describing a death |
| [Thought process](https://durgical.com/en/conditions/schizophrenia/) | Organisation and speed of thinking | Goal-directed; tangential; flight of ideas; loose associations |
| [Thought content](https://durgical.com/en/conditions/schizoaffective-schizophreniform-brief-psychotic-and-delusional-disorders/) | Main themes, delusions, obsessions, phobias, suicidal or homicidal ideas | Believes neighbours are poisoning the water; daily thoughts of dying |
| [Perception](https://durgical.com/en/conditions/schizophrenia/) | Hallucinations, illusions, depersonalisation | Hears a voice commenting on actions; sees insects on the wall |
| [Cognition](https://durgical.com/en/conditions/delirium/) | Consciousness, attention, orientation, memory, language, abstraction | Drowsy and inattentive; cannot recall three words after a few minutes |
| Insight | Awareness of illness and need for treatment | Denies any problem; accepts being ill but blames others |
| Judgement | Quality of decisions in real life and in hypothetical situations | Gave away savings to strangers; plans to drive while intoxicated |

## Clinical notes

- The MSE describes and does not diagnose: write what was observed (for example «answers after long pauses») rather than labels alone.
- A patient with depression may speak slowly and softly, and one with mania rapidly and loudly; dysarthria or aphasia suggests a medical or neurological cause.
- Confusion and inattention that are sudden or fluctuating point to a medical cause such as delirium; command hallucinations or voices commenting on behaviour probably represent a psychiatric disorder.
- The cognitive part can be completed with a brief screening test such as the MMSE or MoCA, but screening questionnaires cannot take the place of the full MSE.

## Memory aid

A Busy Student Makes A Tidy Table, Pens Carefully, Inks Judiciously: Appearance, Behaviour, Speech, Mood, Affect, Thought process, Thought content, Perception, Cognition, Insight, Judgement.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the difference between mood and affect in the mental status exam?

Mood is the emotion the patient reports; affect is the emotion the examiner observes, described by range, intensity, stability and congruence.

## What does abnormal thought content include?

Delusions (false, fixed beliefs), ideas of reference and obsessions; suicidal and homicidal ideas are always asked about.

## Why is attention assessed before memory?

An inattentive patient, as in delirium, fails the other tests, so the results cannot be interpreted.

## A patient accepts being ill but refuses all treatment because doctors are ‘part of the plot’. What does this say about insight?

Insight is partial: some awareness of illness, but no understanding of the need for treatment.

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## Elsewhere in DurgiPedia

- [Mental status: orientation, attention and screening tests](https://durgical.com/en/clinical-exam/mental-status-orientation-attention-and-screening-tests/)
- [The neurological examination: order and screening exam](https://durgical.com/en/clinical-exam/the-neurological-examination-order-and-screening-exam/)
- [Decision-making capacity (competence) and how to assess it](https://durgical.com/en/medical-ethics/decision-making-capacity-and-how-to-assess-it/)

## Connections

## Related 4

- [The psychiatric interview](https://durgical.com/en/behavioral-science/the-psychiatric-interview/)
- [Psychopathology: perception and thought (hallucinations, delusions, thought disorder)](https://durgical.com/en/behavioral-science/psychopathology-perception-and-thought/)
- [Psychopathology: affect, mood, consciousness and memory](https://durgical.com/en/behavioral-science/psychopathology-affect-mood-consciousness-and-memory/)
- [Screening questionnaires in primary care](https://durgical.com/en/behavioral-science/screening-questionnaires-in-primary-care/)

## Related conditions 6

- [Delirium](https://durgical.com/en/conditions/delirium/)
- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Bipolar disorder](https://durgical.com/en/conditions/bipolar-disorder/)
- [Dementia (major neurocognitive disorder)](https://durgical.com/en/conditions/dementia/)
- [Catatonia](https://durgical.com/en/conditions/catatonia/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Initial Psychiatric Assessment](https://www.msdmanuals.com/professional/psychiatric-disorders/approach-to-the-patient-with-psychiatric-symptoms/initial-psychiatric-assessment) (MSD Manual Professional Edition, 2024); [How To Assess Mental Status](https://www.msdmanuals.com/professional/neurologic-disorders/neurologic-examination/how-to-assess-mental-status) (MSD Manual Professional Edition, 2025); [Medical Assessment of the Patient With Psychiatric Symptoms](https://www.msdmanuals.com/professional/psychiatric-disorders/approach-to-the-patient-with-psychiatric-symptoms/medical-assessment-of-the-patient-with-psychiatric-symptoms) (MSD Manual Professional Edition, 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/behavioral-science/the-mental-status-examination/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/the-mental-status-examination/