Mental Status Exam: Selected Glossary

Affect

Observed expression of emotion which is described in terms of its range and intensity, quality and
appropriateness.

Range and Intensity: Observed fluctuations according to person’s emotional state.

Full range: A variety of emotions are appropriately expressed.

Responsive: Normal shifts in affect appropriate to the context of the interview.

Constricted: Reduced range and intensity of emotional expression.

Blunted: More reduced than constricted.

Flat: Absence or near absence of any emotional expression.

Labile: Rapid and abrupt changes in emotional feeling tone, unrelated to external stimuli.

Exaggerated: Implies there may be some intentionality.

Quality: Refers to the type of emotion being expressed.

Expansive: Expression of feelings without restraint.

Elevated: More cheerful than usual.

Euphoric: Intense elation with feelings of grandeur.

Euthymic: Normal range of mood; absence of depressed or elevated mood.

Hyperthymic: A temperament in which a person is predisposed to display a cheerful affect.

Aphasic

Primary language disorders that produce errors in grammar and word choice due to a brain injury. Can
be fluent or non fluent.

Catatonia

A severe disturbance of motor function, usually manifested by markedly decreased activity, but may
involve hyperactivity, with alternation between these states. In the hypoactive state, the person is
immobile and may maintain peculiar postures for lengthy periods.

Circumstantial

Talking at length around a point before finally getting to it, usually in an overly detailed fashion.

Clanging

Speech in which words are chosen because of their sounds rather than their meanings. Puns and
rhymes are characteristic.

Concentration
 The ability to focus and sustain attention over a period of time. Can test concentration by asking the
person to do serial 7’s (instruct client to start at 100 and subtract 7, then from this number, subtract 7
again and keep going), or if this is too difficult, serial 3’s starting from 20, or recite the months of the
year backwards.

Compulsion

An uncontrollable impulse to perform an act repetitively.

Delusion

A false, fixed belief which is not consistent with the person’s social, cultural or religious background.

Examples of Types of Delusions:

Delusion of reference: A false belief that the behavior of others refers to him/her; that events,
objects or other people have a particular and unusual significance, usually of a negative nature.
Derived from an idea of reference in which a person falsely feels that others are talking about
him (for example, people on the radio or television are talking about him/her).

Erotomanic delusion: A false belief that one is loved, perhaps secretly, by another person who
is usually a person of higher status.

Grandiose delusion: A false belief that one possesses special wealth, powers, skills, talents,
influence or destiny.

Jealous delusion: A false belief that one’s sexual partner is unfaithful and goes to great effort to
prove the existence of the affair.

Paranoid delusion: A false belief that one is being harassed is in danger, being followed or
monitored, ridiculed, conspired against, cheated or persecuted.

Religious delusion: A false belief that one has special powers or identity due to a religious
cause.

Somatic delusion: A false belief that one’s body is diseased or has changed.

Thought broadcasting: A false belief that one’s thoughts can be heard by others as though
being broadcast out loud.

Thought insertion: A false belief that thoughts are being implanted in a person’s mind by other
people or forces.

Thought withdrawal: False belief that thoughts are being removed form a person’s mind by
other people or forces.

Depersonalization

Subjective sense of being unreal, strange, unfamiliar. An altered sense of one’s physical being.
Includes feeling outside of one’s body, observing oneself from a distance.

Derealization

Subjective sense that the environment is strange or unreal; a feeling of changed reality.

Dysarthria

Difficulty in speech articulation.

Dyskinesias
 Involuntary motor movements e.g. lip smacking; jaw movements; tongue movements.

Tardive dyskinesia is an involuntary movement disorder associated with prolonged anti-psychotic use
(tardive refers to the delayed onset).

Echolalia

The immediate repetition of vocalizations made by another person.

Flashbacks

Recurrent, involuntary, intrusive and distressing memories of a traumatic event(s).

Flight of ideas

Rapid speech with abrupt changes from topic to topic usually based on understandable links between
the topics, distracting external stimuli, or play on words.

Hallucinations

A sensory perception in the absence of an actual external stimulus. May involve any sensory modality:

Auditory: False perception of sound usually voices but may include other noises such as music;
the most common type of hallucination in psychiatric disorders.

Command hallucination: An auditory hallucination in which a voice instructs the person’s

Gustatory: False perception of taste, usually unpleasant, without external stimulus.

Olfactory: False perception of smell, without an external stimulus.

Tactile: False perception of touch or surface sensation (e.g. crawling sensation under the skin).

Visual: false perception involving sight, consisting of both formed images (e.g. a person) and
unformed images (e.g. flashes of light).

Ideas of Reference

False personalized interpretations of actual events; person believes that the behavior or events refer
specifically to them when in fact they don’t (e.g. person believes people on the street are talking about
him/her; people are staring at him/her etc).

Illusions

A misperception of a real external stimulus.

Impulse control

The ability to control acting on an impulse, drive or temptation to perform an action.

Incoherent speech

Thoughts, words or phrases joined together without a logical or meaningful connection and are not
understandable despite repeated attempts to explain.

Insight

Refers to the person’s awareness of having an illness; that various signs/symptoms are part of the
illness; acknowledgement of the need for treatment. Insight can range along a continuum from
 complete denial of illness to an acknowledgement of symptoms and need for treatment. Rated as
good (full insight), fair (partial insight) or poor (denial of illness).

Intellect

Intellect or intelligence is the assimilation and recall of factual information; logical reasoning and
problem solving skills; abstraction, generalization and symbolization.

Can be gauged in interviews by assessing general fund of knowledge i.e. name of Prime Minster;
Premier; current events; vocabulary; level of education; vocation; interests and hobbies.

Abstract thinking is the capacity to conceptualize meaning of words beyond literal (concrete)
interpretation. Can be tested with similarities by asking person to compare two objects and list
common qualities e.g. similarities between a chair and a desk (abstract response: both furniture;
concrete response: four legs, made of wood). Can also be tested by providing a proverb and asking
the person to interpret it e.g. “the grass is always greener on the other side” (abstract: things that
seem better elsewhere, aren’t necessarily; concrete: his lawn is greener than mine). Note proverbs
may be culture specific.

Judgment

The ability to assess a situation correctly and to act appropriately in the situation; ability to assess,
discern and choose among various options in a situation. To assess can give the person a hypothetical
situation and ask what they would do i.e. what would you do if you were in a theatre and smelled
smoke.

Loose associations

A disturbance in thinking shown by speech in which ideas shift from one subject to another that is
unrelated or minimally related to the first. Person is unaware of the disconnectedness.

Mannerism

Ingrained, habitual, involuntary movement.

Magical thinking

The belief that thinking something will cause it to occur.

Mumbling

Saying something indistinctly or quietly making it difficult for others to hear.

Neologisms

A new word, distortion of words, or condensed combination of words created by the person; which has
meaning for the person.

Non-suicidal self-injurious behavior

Often referred to as “self-harming” behavior or deliberate self-harm, non-suicidal self-injurious

Obsessional thoughts
 Thoughts which are unwelcome, repetitive and intrusive.

Orientation

Orientation is tested according to the following:

Person: Identifies self

Place: Hospital/office/floor level, city, province, country

Situation: Context and purpose of meeting with the clinician

Time: Time of day; date: day, month, year, season

Overvalued ideas

A relatively firm belief(s) not shared with members of the person’s culture or religion; not maintained
with delusional intensity.

Perseveration

A tendency to focus on a specific idea or subject without the ability to move on to other topics;
repeatedly comes back to the same topic despite your attempts to change the subject; repetition of
words, phrases.

Level of consciousness

Hyperalert: Extremely or excessively alert

Lethargic: State of fatigue or sluggishness

Drowsy: State of impaired awareness associated with a desire or inclination to sleep

Sleepy: Needing or ready for sleep

Stuporous: Lack of reaction to and unawareness of surroundings

Comatose: Profound degree of unconsciousness

Memory

Immediate memory: Tested with digit recall. Let the person know you are going to state 6 digits and
then ask them to recall the digits. Interviewer states the 6 digits without inflection, with one second
between each digit; ask person to repeat forwards then backwards (normal is 5-6 digits forward and 4-
6 backwards without error and within 30 seconds).

Short term memory: State 3 items that are not in the person’s view, and are unrelated to each other.
Have the person repeat them to you, and then 5 minutes later, ask the person to recall the items.
Interviewer can prompt if unable to recall.

Long term memory: Can be tested by asking about previous hospitalizations; significant life events;
date of birth (all of which you can verify).

Phobia

A marked and persistent fear of an object or situation (e.g. spiders, public speaking, flying).

Poverty of speech

Reduction in the amount of speech.

Rapid speech that is increased in amount and difficult to interrupt

Ruminations

A willful return to thinking about something; excessively mulling over something.

Tangential

A disturbance in association characterized by the person becoming side-tracked through a chain of

Tics

Short, sudden movements (e.g. eyes blinking; head jerking); can be suppressed for a time but results in
discomfort and is relieved if performed

Thought blocking

An abrupt interruption in train of thinking before a thought is finished; after a brief pause, the person
indicates no recall of what was being said or was going to be said.

Thought derailment

Occurs when speech begins again after an episode of thought blocking. Person usually begins talking
again but on a different topic and does not recall what they were speaking about before, and is
unaware of the change in topic.

Tremors

Involuntary movements consisting of regular, rhythmic oscillations of some part of the body. Usually
seen in the hands, arms, head, neck, lips, mouth or tongue.

Unintelligible speech

Unable to be understood; not comprehensible.

Word Salad

Incoherent mixture of words and phrases.

References

Robinson, D.J. (2008). The Mental Status Exam Explained. Rapid Psychler Press, Michigan.

Kaplan, H.I. & Sadock, B.J. (2009). Synopsis of Psychiatry. Lippincott Williams & Wilkins, Baltimore.