Mental Status Examination

Appearance and Behavior

The patient’s appearance gives the first impression of their mental state. This includes hygiene, clothing, posture, and movements. For example, a disheveled appearance may suggest depression or psychosis. Behavior such as agitation, eye contact, or motor restlessness can indicate anxiety or mania. For the advanced practice nurse, these observations help form hypotheses about underlying psychiatric conditions and guide the direction of further evaluation.

Mood and Affect

Mood refers to the patient’s reported emotional state, such as “sad” or “angry,” while affect is the nurse’s observation of their emotional expression. For instance, a patient might report feeling fine, but appear tearful or flat. A mismatch between mood and affect may signal underlying disorders. This information is vital for diagnosing mood disorders and assessing the risk of harm or emotional instability.

Thought Process and Content

Thought process evaluates the flow and organization of ideas—whether it is logical, coherent, or disorganized. Thought content assesses what the patient is thinking about, such as delusions, obsessions, or suicidal ideation. For example, a patient stating they are being followed by the government reflects paranoid delusions. Recognizing abnormal thought patterns enables the nurse to initiate appropriate interventions and referrals.

Cognition and Insight

This section covers orientation, memory, attention, and insight into one’s condition. For example, asking the patient to recall three words after five minutes checks short-term memory. A lack of insight, such as denying illness despite clear symptoms, impacts treatment adherence. Assessing cognitive function and insight helps the nurse determine the patient’s ability to participate in their care plan and make informed decisions.