Mental Status Exam Checklist: Fill & Download for Free

You can look up a MSE Mental Status Exam. It is a rather involved checklist of things that can be readily observed, some by asking for verbal responses, others by simply observing. Typically, I do a fairly good mental status exam in one session, possibly sometimes in moments.

Thanks for the A2A,I wish that psychiatric diagnosis was as easy as basing it on the subjective report of patients, on what they are currently feeling, thinking or experiencing, or on what events happened over the course of their lives.These pieces of information undoubtedly play an important role in starting the diagnostic assessment, but the better part of a psychiatric evaluation is rather methodical, objective and medical. It is almost mechanistic and definitely algorithmic, like any other medical exam. In fact, it needs to be so for the sake of the patient and her safety. The more strictly defined and mechanical mental status testing is, the less chance there is that the patient would be harmed by a poorly prescribed regimen.Psychiatric diagnosis is almost the opposite of what people fantasize it to be. It is certainly not a psychotherapeutic exploration of the patients memories and traumas. It is much more about carefully watching out for the appearance of a certain tic when those same traumas are discussed, or testing for emotional intensity, blushing, lability, psychomotor states, under the effect of discussing an uneasy topic.Psychiatrists, unlike therapists and most psychologists, evaluate patients who are mute, delirious, confused or even half-comatose. They are trained to study nonverbal cues and behaviors and to examine the process (the shape) of thoughts rather than their content or what is actually being said.If you go to the cardiologist and complain of chest pain, the doctor would make you do the exact opposite of what you think she would. They would make you get on a treadmill and run to reproduce the threshold of the pain. That is how medicine works and why it is successful in saving so many lives and suffering in society. The same applies for psychiatry, the doctor is not there simply to empathize and appeal to a person’s psychic pain, as important and vital those things are, the doctor needs to also test that psychic pain safely and objectively for the sake of the patient and to come up with a diagnostic assessment that can help a patient tremendously if done right.Diagnosis in psychiatry is actually not something that the patient knows or feels or likely to agree with. It often needs the best expertise of the psychiatrist to get right. The DSM is widely misunderstood and deliberately made into a checklist by insurance companies and non-medical providers.In recent years, psychiatry has been diluted into a quasi-medical quasi-social practice, that caters mostly to “problems in life” rathe than medical symptoms and diagnoses. A refashioned definition of mental illness is now popularized, which emphasizes more social identity and pseudo-psychological reactions than on the meaning of illness and pathology. That is arguably when things began to go terribly wrong.In psychiatry, diagnosis is much more central to treatment than in, say, psychotherapy or clinical psychology which often have the luxury that it can start from any non-medical point and build therapy from there to help a client.In psychiatry, however, your medical treatment is as good as your diagnosis. Only by getting the medical diagnosis right, can the choice of starting a certain medication over another be considered reasonably safe. The more objective, medical and mechanistic the diagnosis is, the better the treatment outcome tends to be.In academic settings, we used to redirect any psychiatric resident who based his or her diagnosis on what the patient said or on their life story. We called this “hiding behind the patient’s words” and the resident was invariably asked to go back and examine the patient’s mental status more objectively and thoroughly. We also taught them to “not just listen…but also test and check…sometimes even interrupt”. A psychiatric diagnosis is a tough endeavor and any treatment in psychiatry is not likely to be safe if it was outsourced to a patient’s life story or their opinion on what diagnosis means. The same holds in the rest of medicine, but in psychiatric this is even more acute, since the most reliable diagnostic tool is the expertise of the psychiatrists.So to cut the long answer short, my best advice is do not try to come up with your own diagnosis, or think that you even may know it, leave it to the psychiatrist. If you feel he or she did not spend enough time to test you correctly then ask for an additional session or seek a second medical opinion.In my experience, the least reliable psychiatrists are the ones that let the patient do all the talking and then tell them in quick fashion that they have diagnosis X and send them out the door with a pill. You need a physician who makes you jump on a psychiatric “treadmill”.Hope this helps,

First of all, David, I'm glad you're at least considering a career in medicine. It's a wonderful career field that allows you to help people every day, but to make it to become a physician it really helps to have a head start.Let me share a little of my story, to help you understand where I am coming from…Personally, I didn't decide I wanted to enter medicine until I was 21, after 14 months of working in a research lab that I found deeply unsatisfying (it also didn't help that I was cheated out of receiving any credit on one project I made substantial contributions to because “we don't give co-authorships to undergrads around here…”) and socially isolating, and actually shadowing a physician- who was the first person to ever encourage me to pursue becoming a doctor if I wanted to…I *deeply* regret that I didn't make the decision earlier (and I should have known Medicine was the right field for me after I literally hung around campus an extra week at RPI without telling my parents I was already done with finals, just so I could ride that last week of finals with the transporting student ambulance agency I was a part of. RPI is a college campus most sane people can't WAIT to get the heck away from at the end of the semester, by the way…)To be fair, I had some things working against that, like certain important people in my life telling me I would never amount to anything when I was growing up- but I now fear I may never have the chance to become a doctor, due to age-discrimination against older medical school applicants (I'll be 29 shortly after I next apply, and 30 when I'd start medical school), and medical schools taking issue with my college GPA (I graduated slightly above the median at some excellent schools- but if simply doing well on exams and quizzes had been my primary academic goals instead of gaining research experience, learning as much as possible, and trying to earn co-authorships, I would have undoubtedly earned better grades… Not dealing with deeply troubling family situations all through college would also have helped as well- I was easily smart enough to graduate with grades top of my class in college or grad school, and occasionally did set the curve on some exams on the rare occasions when family issues weren't too stressful…)The last time I applied to medical schools I got exactly 0 interviews, despite excellent MCAT scores, no permanent record of any kind (there was one incident where I was falsely accused of things I didn't do in the campus judicial system- but those charges were ultimately all dropped without a record… I still reported all this to medical schools though, as the AMCAS Primary demands even accusations which were dropped be reported- which in my opinion is highly unfair and unjust…), and a fierce passion to help others. So, this is my disclaimer- I'm not an unbiased source…Anyways, if you are willing to face off against a system of medical admissions that is, in my opinion, hugely flawed and unjustly favors the rich (especially, children of MD's), you will find an extremely rewarding career at the end of the tunnel as an MD if you have the temperament and talent to become physician.If not, you might find a similarly rewarding career in nursing or as a clinical psychologist…Medicine requires the OPPOSITE of a robotic mindset. Medicine is all about thinking on your feet, adapting to situations that are nothing like what you read in the textbook, and at its core, acting with compassion and empathy towards another human being.Sure, some doctors become hyper-specialized, and hole themselves up in laboratories, surrounded by specialized medical equipment. But the experiences of such doctors are grossly in the minority when it comes to the practice of medicine. Most doctors spend a great deal of time thinking very flexibly and juggling a dozen different differential diagnoses in their head…I know much of this because, particularly during the past 7 years, I've spent a great deal of time around healthcare practitioners, most of it in clinical settings…I've shadowed doctors and PA's (in slightly more than half the cases, actually staying with their families due to commute times from where I call home). I've taken or led regular volunteer trips to nursing homes (through APO), and volunteered in hospitals. I've taken EMT courses (twice), and rode on ambulances for work (as a paid EMT), experience and continuing education (as an unpaid 3rd-seating EMT), personal fulfilment (as a CPR-level member at RPI Ambulance- where I did it simply because I loved medicine and helping people, even when I had nothing to gain for my time), and just once as a patient (a trip in high school that was unnecessary and led to no actual medical treatment- there's a long story there…)I've picked up countless (I lost mental count after about 72– I work at one of the busiest EMS agencies in Massachusetts, serving some of the largest hospitals in the Boston area) patients from hospital floors, ER's, nursing homes, mental health facilities, dialysis clinics, and even doctor’s offices (when a patient turns up for a routine appointment with an urgent and life-threatening condition they should have gone to an ER for, PCP's call an ambulance) and transported them to various other facilities on that same list- or back home. And through all this, I have almost never seen a healthcare practitioner act “like a robot”.Sure, sometimes you see a textbook presentation of a particular illness or ailment (although, in my own case, an EMT's textbook is actually very limited- so more often than you think you find yourself dealing with rare conditions you’ve never heard of, and trying to learn all you can on the fly while doing your best to treat and deal with the known, and often still very predictable problems that result- like respiratory distress, hypoxia, inadequate cardiac output, shock, bleeding, and Altered Mental Status…) and sometimes known algorithms or diagnostic procedures are useful for higher-level providers (I've seen MD's, and particularly PA's, resort to set diagnostic checklists when trying to decide the proper treatment approaches for, whether to admit, etc. patients with well-known diseases on more than one occasion…) Heuristics (pragmatic mental shortcuts) of various kinds are not unknown to medicine either- and occasionally quite useful for treating common illnesses with ordinary presentations (after all, “when you hear hoofbeats, think horses, not zebras”— see the related video below).Bur none of these things make a healthcare practitioner into a “robot”— none of them usurp a doctor, nurse, or even EMT's ability or indeed requirement to think quickly and on their feet as to the best course of treatment for a patient (admittedly EMT's operate within a *VERY* narrow Scope of Practice- but even then, we are still required to make a great many judgment calls…) None of them provide an easy answer all the time and with every patient as to what is wrong with them (indeed EMT's on 9-1-1 calls or with suddenly unstable transfer patients probably have the hardest job of all in this regard— we carry very little equipment with us that can provide useful information as to a patient's condition, and have to do our best to keep that patient alive and do no further harm to them, all while getting them to the ER as quickly as possible.)The same treatment, such as Oxygen, can be helpful or harmful for the same symptoms- such as rapid and labored breathing- depending entirely on the underlying cause… (The current opinion of many MD's is that Heart Attack and Stroke patients can be harmed by excessive dosages of Oxygen in the prehospital setting due to re-perfusion effects, for instance…) Learning the newest science in the field, learning from experience, and making judgment-calls are still extremely important to healthcare professionals- and will be far into the foreseeable future…So, whoever told you that doctors have become “like robots”— I wouldn't listen to them. They couldn't be farther from the truth. Medicine is a noble profession that is extremely rewarding- and requires creative, flexible thinking. I would strongly encourage you to consider entering into it (shadow some doctors, volunteer in a hospital- see if you like it).As I've written about previously, the world needs more doctors, and it needed them yesterday- even the United States is facing close to 1 in 3 doctors retiring in the next 10-20 years (more than 1 out of 3 doctors in the USA are over age 55), a problem exasperated by an aging population, population growth, growing rates of obesity, increasing paperwork requirements (which eat up valuable physician time), decreasing insurance payments for medical care (at the same time, ironically, insurance premiums and insurance company profits are hitting record highs), high rates of suicide and burn out among younger physicians.To meet and overcome these challenges, a record-sized cohort of young doctors with new and innovative ideas is needed— and getting more young people interested in medicine is a key step in this direction (although, with record numbers of pre-meds already vying to become doctors, increasing medical school class sizes and creating new residency slots are *MUCH* higher priorities as these are the current bottlenecks in training more doctors…)In summary, David, I would strongly encourage you to investigate a career in medicine by observing a number of healthcare professionals firsthand- and then decide based on EXPERIENCE whether a career in medicine is right for you. I didn't shadow a doctor until I was 21 years old, despite a nagging feeling in my gut most of my life that I should at least consider a career in medicine- and it was one of the biggest mistakes of my life…