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mental status exam example, Summaries of Psychiatry

West Los Angeles CollegePsychiatry

mental status exam pdf to assess a patient

Typology: Summaries

2017/2018

Uploaded on 06/19/2023

melissa-nursing
melissa-nursing 🇺🇸

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Mental Status Exam
© 2013 Therapist Aid LLC Provided by TherapistAid.com
Client Name
Date
OBSERVATIONS
Appearance
□ Neat
□ Disheveled
□ Inappropriate
□ Bizarre
□ Other
Speech □ Normal □ Tangential □ Pressured □ Impoverished □ Other
Eye Contact □ Normal □ Intense □ Avoidant □ Other
Motor Activity □ Normal □ Restless □ Tics □ Slowed □ Other
Affect □ Full □ Constricted □ Flat □ Labile □ Other
Comments:
MOOD
□ Euthymic □ Anxious □ Ang ry □ Depressed □ Euphoric □ Irritable □ Other
Comments:
COGNITION
Orientation Impairment □ None □ Place □ Object □ Person □ Time
Memory Impairment □ None □ Short-Ter m □ Long-Te r m □ Other
Attention □ Normal □ Distracted □ Other
Comments:
PERCEPTION
Hallucinations □ None □ Auditory □ Visual □ Other
Other □ None □ Derealization □ Depersonalization
Comments:
THOUGHTS
Suicidality
□ None
□ Ideation
□ Plan
□ Intent
□ Self-Harm
Homicidality □ None □ Aggressive □ Intent □ Plan
Delusions □ None □ Grandiose □ Paranoid □ Religious □ Other
Comments:
BEHAVIOR
□ Cooperative □ Guarded □ Hyperactive □ Agitated □ Paranoid
□ Stereotyped □ Aggressive □ Bizarre □ Withdrawn □ Other
Comments:
INSIGHT □ Good □ Fair □ Poor Comments:
JUDGMENT □ Good □ Fair □ Poor Comments:

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Mental Status Exam

© 2013 Therapist Aid LLC Provided by TherapistAid.com Client Name Date

OBSERVATIONS

Appearance □ Neat □ Disheveled □ Inappropriate □ Bizarre □ Other Speech □ Normal □ Tangential □ Pressured □ Impoverished □ Other Eye Contact □ Normal □ Intense □ Avoidant □ Other Motor Activity □ Normal □ Restless □ Tics □ Slowed □ Other Affect □ Full □ Constricted □ Flat □ Labile □ Other Comments:

MOOD

□ Euthymic □ Anxious □ Angry □ Depressed □ Euphoric □ Irritable □ Other Comments:

COGNITION

Orientation Impairment □ None □ Place □ Object □ Person □ Time Memory Impairment □ None □ Short-Term □ Long-Term □ Other Attention □ Normal □ Distracted □ Other Comments:

PERCEPTION

Hallucinations □ None □ Auditory □ Visual □ Other Other □ None □ Derealization □ Depersonalization Comments:

THOUGHTS

Suicidality □ None □ Ideation □ Plan □ Intent □ Self-Harm Homicidality □ None □ Aggressive □ Intent □ Plan Delusions □ None □ Grandiose □ Paranoid □ Religious □ Other Comments:

BEHAVIOR

□ Cooperative □ Guarded □ Hyperactive □ Agitated □ Paranoid □ Stereotyped □ Aggressive □ Bizarre □ Withdrawn □ Other Comments:

INSIGHT □ Good^ □ Fair^ □ Poor^ Comments:

JUDGMENT □ Good^ □ Fair^ □ Poor^ Comments: