In discussions of mental status, checklist items are often grouped together under certain headings. The groupings, and the corresponding headings, vary from reference to reference. One approach is shown below. This was adapted from a programmed instruction written by Stephen Cohen and published in the American Journal of Nursing in 1981 (Volume 81, pages 1493-1518).

Physical Appearance
appearance in relation to age
attractiveness
clothing, appropriateness to age
clothing, neatness and cleanliness
clothing, style
cosmetics
hygiene and grooming
odor
overall physical health

Psychomotor Behavior
gait
handshake
individually abnormal movements
movements, coordination
movements, pace and energy
posture

Mood and Affect
attitude toward nurse
affect, appropriateness
affect, range
affect, stability
specific feelings and moods

Intellectual Performance
attention and concentration
capacity for abstraction
fund of knowledge
insight
orientation to person
orientation to place
orientation to time
performance in relation to level of education
short term memory
social judgment

Speech
amount of speech
clarity of speech
liveliness of speech
pressure of speech
rate of speech
rhythm of speech
volume of speech

Thought
clarity of thought
content of thought
flow of thought

Level of Consciousness
level of consciousness

Useful Terms to Describe Patient

Table of Variations

A complete list of variations is provided below. The list is not comprehensive, it is meant only to suggest the range of findings that can be made in practice. As a general rule, a nurse need note only those mental status findings that are abnormal; normal findings may be omitted. But, in some respects, normalcy may be an important finding; for example, it is often worthwhile noting that a patient is alert and responsive and physically in no acute distress and that his gait is normal and his memory intact. Whether such observations are reported will vary with the nurse and the circumstances. Normal findings are included below where they are often important.

appearance in relation to age: old for age, young for age, childish for age

attractiveness: attractive, appealing, beautiful, drab, handsome, homely, seedy, unattractive

clothing, appropriateness to age: appropriate for age, young for age, old for age

clothing, neatness and cleanliness: neat, clean, unkempt, dirty, elaborate, conservative, dressy, stylish, old-fashioned, brightly colored, darkly colored, lacking in consistent style

cosmetics: no makeup, florid makeup, bizarre makeup, appropriate makeup, careless application of makeup, heavy makeup, bright colors, pale colors

hygiene and grooming: clean, dirty, unbathed, uncut hair, messy hair, alcoholic odor, odor of stool, ketotic odor; smell of cologne, perfume, or shaving lotion

overall physical health: acute distress, no acute distress, robust, frail, cachectic

gait: brisk, slow, propulsive, skipping, dancing, swaggering, shuffling, normal

handshake: firm, warm, cool, moist, resistant, fierce, limp, refused, prolonged

individually abnormal movements (other than gait): grimaces, twitches, tics, tremors, mannerisms, ambitendence, stereotypies, rituals, echopraxia

movements, coordination: coordinated, uncoordinated, awkward, clumsy, agile, graceful

movements, pace and energy: hyperactivity, agitation, restlessness, retardation, excessive movement

posture: erect, slumped, rigid, posturing

affect, appropriateness: appropriate, inappropriate

affect, range: lively, neutral, normal blunted, flat

affect, stability: stable, labile

attitude toward nurse during present encounter: cooperative, frank, open, defensive, fearful, hostile, evasive, suspicious, reticent, guarded, friendly, pleasant, playful, ingratiating, seductive, provocative, negativistic, irritable, distant, shy, overly familiar

specific feelings and moods: irritability, anger, expansiveness, anxiety, calmness, sadness, depression, apathy, euphoria, hostility, happiness, fear, grief, pride, guilt, helplessness, hopelessness

When reporting abnormalities in a patient’s intellectual performance, a nurse should cite specific examples of his behavior that support her conclusions.

attention and concentration: sufficient, deficient, easily distractible, short span of attention, poor concentration

capacity for abstraction: able to abstract, concrete thinking

fund of knowledge: adequate, inadequate

insight into illness: present, absent

judgment: good, poor, fair

orientation to person: oriented, disoriented

orientation to place: oriented, disoriented

orientation to time: oriented, disoriented

performance in relation to educational level: performing at educational level, performing below educational level

short-term memory: intact, impaired

amount: talkative, verbose, taciturn, silent

clarity: clear, slurred, mumbling, running together of words, lisping

liveliness: lively, monotonous, dull

pressure: pressured, low key, intense, explosive

rate: slow, fast, hesitant

rhythm: even, jerky, stuttering, lilting, explosive

volume: loud, soft, inaudible, whispering

When reporting abnormalities in a patient’s thought, especially in respect to content and flow, a nurse should cite specific examples of the patient’s behavior that support her conclusions.

clarity: coherent, incoherent, cloudy, confused, vague, unclear in meaning or associations

content: rhymes, puns, homicidal ideation, feelings of unreality, delusions, hallucinations, neologisms, ideas of reference, compulsions, phobias, grandiosity, suicidal ideation (passive or active), obsessions, illusions, paranoia, preoccupations, depersonalization, ideas of influence, confabulation Link to Corresponding sections

flow: lack of spontaneity, slow reaction to questions, doubting and indecision, loose associations, flight of ideas, thought blocking, thought insertion, thought withdrawal, circumstantiality, tangentiality, perseveration, poverty of thought, echolalia, word salad, clang associations

level of consciousness: alert and responsive, drowsy, stuporous, comatose, periods of unresponsiveness

Ask the patient to do the following:

Stage 1: Add any two small whole numbers.

Stage 2: Multiply any two small whole numbers or spell the word "world" backward or state the number of nickels in $1.35.

Stage 3: Name the days of the week backward or perform a "serial threes" test -- that is, subtract three from 100, then an additional three form the result, and so on until he reaches zero. (Normal standard: Fewer than 2 errors in 120 seconds or less.)

Stage 4: Name the months of the year backward or perform a "serial sevens" test -- that is, subtract seven from 100, then an additional seven from the result, and so on until he reaches zero (Normal standard: Fewer than four errors in 90 seconds or less.)

Stage 5: Repeat a random series of numbers forward, beginning with a series of three numbers, then increasing the series by one number at a time. (Normal standard: A forward series of from five to eight numbers).

Stage 6: Repeat a random series of numbers backward, beginning with a series of three numbers, then increasing the series by one number at a time. (Normal standard: A backward series of from four to six numbers.)

Ask the patient to state the meaning of each of two proverbs, describing its application to his own present circumstances. Some useful proverbs are listed below:

Don’t cry over split milk.

The tongue is the enemy of the neck.

People who live in glass houses shouldn’t throw stones.

Don’t count your chickens before they hatch.

Birds of a feather flock together.

The proof of the pudding is in the eating.

A stitch in time saves nine.

A rolling stone gathers no moss.

The squeaky wheel gets the grease.

Also ask the patient to describe the similarity between the objects in each of two pairs below:

an apple and an orange

a fly and a tree

a chair and a table

a child and a dwarf

Ask the patient to do two of the following:

Name five large cities in the United States.

Name the capitals of several states selected for local familiarity.

Name any of the following persons: mayor, governor, president, vice-president.

Name the capitals of several foreign countries.

Describe a current event.

Ask the patient two or more questions such as the following: "What do you feel is wrong with you?" "Why do you think you are here (clinic, hospital, nursing home, and so forth)?" "What do you think is the reason for this therapy (medication, surgery, physiotherapy, and so forth)?"

LEVEL OF CONSCIOUSNESS (in the patient who initially appears drowsy, stuporous, or comatose)

Do the following:

Stage 1: Call the patient by name.

Stage 2: Touch the patient.

Stage 3: Shake the patient.

Stage 4: Pinch a fold of skin over the patient’s sternum, increasing the intensity of the pinch as necessary.

Ask the patient all of the following questions, in any order:

in respect to person --"What is your name?" If me the address of the building we’re in, including the street, the other people here?

in respect to place --"Where are we now? Tell me the address of the building we’re in, including the street, city, and state." If the patient is in a hospital, add: "What is the number of the room we’re in?"

in respect to time --"What time of day is it? What day of the week is it? What is the date? Give me the day, month, and year. What is the season of the year?" If the patient is in a hospital, add: "How long have you been in the hospital?"

Ask the patient to do one of the following:

Describe a recent event that both you and he had the opportunity to remember. Example: Ask patient to describe the contents of his breakfast

Repeat the names of three items, immediately after you have stated them and again five minutes later.

Ask the patient to do two of the following:

Describe what he would do if her were the first person to discover a fire in a movie theater.

Describe what he would do if he found a stamped, addressed envelope on the street.

Describe what he would do if here were stopped for speeding.

Explain why criminals are put into prisons.

Do the following:

Stage 1: Ask the patient how he feels and about the current status of any mood (for example, depression) identified during a previous encounter.

Stage 2: Ask patient to relate a very happy or sad incident in his life and observe his affect while he does.

Ask the patient all the questions below. Each questions (or set of questions) is designed to reveal a particular type of disturbance in the content of the patient’s thought. The types of disturbance are listed on the right. The questions may be asked in any order.

Nurse’s Questions (Type of Disturbance Suggested By Positive Answer)

"Do you feel you must carry out certain rituals or practices that you know are unnecessary?" (compulsion)

"Sometimes a person’s mind plays tricks on him when he is under stress. Is that happening to you? Have you had any trouble with your thinking? Has anything happened to you recently that you can’t explain?" (delusion, hallucination, or illusion)

"Do you reel unreal or unlike yourself? (depersonalization)

"Do you feel that things are not the same as they used to be, that they are not real?"(feelings of unreality)

"Do you feel you are an exceptionally gifted or talented person?" If patient says yes, add: "in what way do you feel you are exceptionally gifted or talented?" (grandiosity)

"Do you sense (hear, seek, smell, touch, or taste) things that other people can’t?" (hallucination)

If patient says yes, add: How real are these experiences to you? How do you explain them?"

If the experiences are auditory, add: "What do you hear?"

If the patient hears voices, add: "How many voices are there? Are they male or female? Do you recognize the people? Who are they?

"Is there anyone you’re so angry with that you would like to like to kill him?" (homicidal ideation)

If patient says yes, add: "Who angers you so much? What plans do you have to kill this person? Do you have the means available?"

"Do you feel that other people are controlling you?" (idea of influence)

"Do you feel that people are talking about you? Do you feel that the radio or TV is talking about you, or even talking directly to you?" (idea of reference)

"What do you mean by (filling a neologism used by the patient)? (neologism) Where does the word come from?"

"Do you have worries that you can’t get out of your head?" (obsession)

"Do you feel someone is trying to harm you or making your life especially difficult?" (paranoid ideation)

"Do you have any strong fears of certain places or things? Are there certain situations you avoid at all costs?" (phobia)

"Do you feel preoccupied with one or two thoughts?" (preoccupation)

"Sometimes when a person is upset or depressed, he thinks about suicidal ideation (active or passive) dying or killing himself. Do you feel that way?"

If patient says, yes, add: "Have you thought of a way of taking your life? What steps have you already taken?"