Mental Status Exam Builder
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What is a mental status exam?
A mental status exam (MSE) is a structured description of how a person presents during an interview, across appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight and judgment. Clinicians record what they observe and what the client reports, using standard terms such as euthymic mood or linear thought process.
Build the MSE
Check what you observed in each domain. Each descriptor has a short definition. The paragraph below updates as you go. This runs in your browser: nothing you choose or type is sent or saved. For full worked notes, see the mental status exam template with examples.
The within normal limits start leaves suicidal and homicidal ideation blank. Ask about SI and HI and record the answers separately.
Your MSE paragraph
Review and edit the paragraph so it reflects this client and this session before you put it in the record.
Next, paste this MSE into the free therapy progress note generator with the rest of the session details (one free note a day).
Mental status exam cheat sheet: terms and definitions
Common MSE descriptors by domain, with a plain definition of each. Use the terms that match what you observed, and add a short description or quote when a term alone would not tell the next reader enough.
Appearance
- Well groomed:
- Clean and neat, with hygiene and grooming suited to the setting.
- Appropriately dressed:
- Clothing suits the weather, setting and occasion.
- Disheveled:
- Untidy or unkempt appearance, such as uncombed hair or rumpled clothing.
- Poor hygiene:
- Visible lack of self-care, such as body odor or unwashed hair.
- Appears stated age:
- Looks about as old as their reported age.
- Appears older than stated age:
- Looks noticeably older than their reported age.
Behavior
- Cooperative:
- Willing to engage with the interview and answer questions.
- Calm:
- Settled, without visible distress or restlessness.
- Guarded:
- Reluctant to share information; cautious or suspicious in the interview.
- Withdrawn:
- Minimal engagement or interaction.
- Restless:
- Fidgeting or difficulty staying still.
- Good eye contact:
- Eye contact typical for the conversation and culture.
- Limited eye contact:
- Avoids or rarely makes eye contact.
- Psychomotor agitation:
- Excess, purposeless movement, such as pacing or hand wringing.
- Psychomotor retardation:
- Visibly slowed movements and reactions.
Speech
- Normal rate, rhythm and volume:
- Speech within the usual range for speed, flow and loudness.
- Pressured:
- Rapid, increased in amount and hard to interrupt.
- Slowed:
- Slower than usual rate of speech.
- Soft:
- Quieter than usual; may be hard to hear.
- Loud:
- Louder than the setting calls for.
- Monotone:
- Little variation in pitch or tone.
- Poverty of speech:
- Reduced amount of speech; brief answers with little elaboration.
- Slurred:
- Words run together or are poorly articulated.
- Increased latency:
- Noticeable delay before answering.
Mood
- Euthymic:
- Normal, stable mood: neither depressed nor elevated.
- Depressed:
- Low or sad mood.
- Anxious:
- Worried, nervous or tense mood.
- Irritable:
- Easily annoyed or angered.
- Dysphoric:
- Generally unpleasant mood, such as unease, dissatisfaction or sadness.
- Euphoric:
- Intensely elevated mood, beyond what the situation explains.
- Angry:
- Mood of anger or hostility.
Affect
- Full range:
- A normal variety of emotional expression.
- Congruent with mood:
- The emotion observed matches the mood the person reports.
- Incongruent with mood:
- The emotion observed does not match the reported mood.
- Appropriate to content:
- Emotional expression fits what is being discussed.
- Restricted (constricted):
- Reduced range or intensity of emotional expression; the two terms are often used interchangeably.
- Blunted:
- Markedly reduced intensity of emotional expression.
- Flat:
- Little or no emotional expression.
- Labile:
- Rapid, abrupt shifts in emotional expression.
- Tearful:
- Crying or close to tears during the session.
Thought process
- Linear and goal-directed:
- Ideas connect logically and reach the point.
- Circumstantial:
- Includes excessive or unnecessary detail but eventually reaches the point.
- Tangential:
- Drifts away from the question or topic and does not return to the point.
- Flight of ideas:
- Rapid shifts between loosely connected ideas, often with pressured speech.
- Loose associations:
- Shifts between ideas with no clear connection.
- Thought blocking:
- Sudden stops in the train of thought, often mid-sentence.
- Perseveration:
- Returns to the same word or idea despite a change in topic.
Thought content
- Denies suicidal ideation:
- Client states no thoughts of suicide.
- Reports suicidal ideation:
- Client reports thoughts of suicide. Document a risk assessment.
- Denies homicidal ideation:
- Client states no thoughts of harming others.
- Reports homicidal ideation:
- Client reports thoughts of harming others. Document a risk assessment.
- No delusions elicited:
- No fixed false beliefs were identified in the interview.
- Delusions:
- Fixed false beliefs held despite clear evidence otherwise and not explained by culture or religion.
- Paranoid ideation:
- Suspicious beliefs that others mean harm, short of a fixed delusion.
- Obsessions:
- Recurrent, intrusive, unwanted thoughts that cause distress.
- Preoccupation:
- Thinking focused on one topic or concern.
- Hopelessness:
- Expressed belief that things will not improve.
Perception
- No hallucinations:
- None reported by the client or observed.
- Auditory hallucinations:
- Hearing sounds or voices that others do not.
- Visual hallucinations:
- Seeing things that others do not.
- Responding to internal stimuli:
- Appears to react to things not present, such as looking around or answering unheard voices.
- Illusions:
- Misinterpreting a real sensory stimulus, such as seeing a coat as a person.
Cognition
- Alert:
- Awake and responsive.
- Oriented x4:
- Knows who they are, where they are, the date and the situation.
- Disoriented:
- Not oriented to one or more of person, place, time or situation. Specify which.
- Attention intact:
- Able to focus and sustain attention in the interview.
- Attention impaired:
- Easily distracted or unable to sustain focus.
- Memory grossly intact:
- No obvious problems recalling recent or past events.
- Memory impaired:
- Difficulty recalling recent or past events. Specify.
Insight
- Good insight:
- Recognizes their difficulties and the need for help or treatment.
- Fair insight:
- Partial awareness of their difficulties or their effects.
- Poor insight:
- Little awareness of their difficulties or their effects.
Judgment
- Good judgment:
- Makes sound decisions about daily life, safety and treatment.
- Fair judgment:
- Some decisions are sound and others are not.
- Poor judgment:
- Decisions that are likely to cause harm or that disregard consequences.
Where does the MSE go in a note?
In a SOAP note the MSE is part of the Objective section, because it records what the clinician observed. In DAP and BIRP notes it usually sits in Data. An intake or diagnostic evaluation carries a full MSE; routine progress notes often record a brief one, or note only what changed.
Keep observation and interpretation apart: "speech pressured, difficult to interrupt" is an observation, and any clinical impression belongs in the Assessment. For where the full MSE sits in a first session, see the intake assessment template. If you write SOAP notes, you can draft a SOAP note with the MSE in the Objective section.
The exam often shapes what treatment works on next. When it does, use the therapy goal builder to set goals from the assessment.
Frequently Asked Questions
What are the parts of a mental status exam?
The standard domains are appearance, behavior (including motor activity and eye contact), speech, mood, affect, thought process, thought content, perception, cognition, insight and judgment. Some formats split motor activity or orientation into their own headings, but the content is the same.
What does euthymic mood mean?
Euthymic means a normal, stable mood: neither depressed nor elevated. It is the usual descriptor for a mood within normal limits. Because mood is what the client reports, many clinicians also quote the client, for example: Client described their mood as "pretty good"; mood appeared euthymic.
What is the difference between mood and affect?
Mood is the emotion the person reports or that persists over time, often recorded in their own words. Affect is the emotion the clinician observes during the interview, described by range, intensity and whether it fits the mood and the content. Congruent affect means the observed emotion matches the reported mood.
What is the difference between tangential and circumstantial thinking?
Both wander. Circumstantial thinking adds excessive or unnecessary detail but eventually reaches the point. Tangential thinking drifts away from the question and does not come back to it. Flight of ideas is faster, with rapid shifts between loosely connected ideas.
How does the builder handle suicidal or homicidal ideation?
The thought content domain has fields for denied or reported suicidal ideation (SI) and homicidal ideation (HI). When either is marked present, the builder shows a note: positive SI or HI calls for a documented risk assessment, with links to the risk assessment template and the C-SSRS guide. The builder itself does not assess risk.
Is the MSE I build here saved?
No. The builder runs only in your browser. Selections and notes are kept in memory on this page and are not sent to WellNotes or stored, so they are gone when you reload or leave. Copy the paragraph into your note before you leave.
Assessment documents that sit beside the MSE
Sources
For documentation support, not clinical advice. The builder turns the descriptors you choose into a paragraph; it does not assess, diagnose or evaluate risk. Definitions are brief summaries of standard usage and do not replace clinical training or your agency's documentation standards. Entries stay in your browser and are not sent or stored.