Psychiatric Mse
Cebu Normal University
College of Nursing
MENTAL STATUS EXAM
I. GENERAL DESCRIPTION General Appearance Apparent Age: _______________________________________________________________________________ Manner of dress: _____________________________________________________________________________ Cleanliness: _________________________________________________________________________________ Posture: ____________________________________________________________________________________ Gait: _______________________________________________________________________________________ Facial Expression: _____________________________________________________________________________ Eye Contact: _________________________________________________________________________________ Pupil Dilation and Constriction: __________________________________________________________________ Speech Rate: _______________ Rapid _______________ Slow Volume: _______________ Loud _______________ Soft Amount: ________Paucity ________Muteness ________ Pressured Speech Characteristics: ________ Stuttering ________ Slurring of Words ________ Unusual Accent Motor Activity Level of Activity: _____ Lethargic _____ Tense _____ Restless _____ Agitated Type of Activity: _____ Tic _____ Grimaces _____ Tremors Unusual Gestures or Mannerisms: _______________________________________________________________ Interaction during the interview: ________ Hostile ________ Uncooperative ________ Irritable ________ Guarded ________ Apathetic ________ Defensive ________ Suspicious ________ Seductive
II. EMOTIONAL STATE Mood How are you feeling today? _____________________________________________________________________ Rate: _______________________________________________________________________________________ Have you ever thought of harming yourself or others?
College of Nursing
MENTAL STATUS EXAM
I. GENERAL DESCRIPTION General Appearance Apparent Age: _______________________________________________________________________________ Manner of dress: _____________________________________________________________________________ Cleanliness: _________________________________________________________________________________ Posture: ____________________________________________________________________________________ Gait: _______________________________________________________________________________________ Facial Expression: _____________________________________________________________________________ Eye Contact: _________________________________________________________________________________ Pupil Dilation and Constriction: __________________________________________________________________ Speech Rate: _______________ Rapid _______________ Slow Volume: _______________ Loud _______________ Soft Amount: ________Paucity ________Muteness ________ Pressured Speech Characteristics: ________ Stuttering ________ Slurring of Words ________ Unusual Accent Motor Activity Level of Activity: _____ Lethargic _____ Tense _____ Restless _____ Agitated Type of Activity: _____ Tic _____ Grimaces _____ Tremors Unusual Gestures or Mannerisms: _______________________________________________________________ Interaction during the interview: ________ Hostile ________ Uncooperative ________ Irritable ________ Guarded ________ Apathetic ________ Defensive ________ Suspicious ________ Seductive
II. EMOTIONAL STATE Mood How are you feeling today? _____________________________________________________________________ Rate: _______________________________________________________________________________________ Have you ever thought of harming yourself or others?