Nova Mental Status Exam (Clinicals) PDF

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Summary

Clinical document for MSE assignment template and sample
Broward Health MSE can be found in the chart of each patient...

Description

Mental Status Exam Revision Date: 1-17-13 Page |1

Organization Name:

Program Name:

Individual’s Name (First MI Last): A. G.

Date:

Record #:

DOB:

MENTAL STATUS EXAM (MSE) General Observations WNL Well Groomed Comment/Other: WNL Thin

Appearance Build/Stature Posture

WNL

Eye Contact Activity Attitude Toward Examiner

Unkempt

Slumped

Overweight

Short

Rigid

Tense

Appears younger than age

Comment/Other:

Unremarkable/age appropriate

Euthymic

Impulsive

Agitated

Anxious

Not Applicable

Positive interaction Ignores Parents Comment/Other: Separation (for Children/Adolescent) Not Applicable

Disinhibited/does not care

Appears older than age

Tall Comment/Other: Atypical

Average Avoidant Intense Intermittent Comment/Other: WNL Accelerated Slowed Stereotyped/Peculiar Comment/Other: Hostile Defensive Evasive Cooperative Mistrustful Demanding Manipulative Seductive Comment/Other: Confused Ingratiating

Attitude Toward Parent/Guardian:

Mood -

Disheveled

Disrespectful

Demanding

Clingy to parent/guardian, but separates

Immature

Lack of spontaneity

Cannot separate

Comment/Other: Depressed

Anxious

Angry

Euphoric

Affect Full Comment/Other:

Constricted

Flat

Inappropriate

Labile

Speech -

Loud

Irritable

Silly

Comment/Other:

Soft

Clear

Slurred

Comment/Other: Clear,

Thought Process -

Pressured

Overproductive

Underproductive

Echolalic

slow, intact

Logical

Incoherent

Rapid

Circumstantial

Concrete

Tangential

Blocked

Loose

Flight of Ideas

Racing

Poverty of Content

Slowed Thinking

Comment/Other: Perception

WNL

Hallucinations

Auditory

Comment/Other: Thought Content

Illusions

WNL

None reported Persecution

Phobic

-

Control

Reexperiencing

Olfactory Obsessional

Tactile

Depressive

Gustatory

Paranoid

Self-Deprecatory

Comment/Other: Thought Insertion Thought Broadcasting Religious Comment/Other:

Thought Withdrawal

Reference Somatic

Derealization

Visual

Preoccupations/Ruminations

Grandiose Delusions

Depersonalization

Command

Grandeur

Risk Assessment None Reported or Observed OR: Danger To: Self: Ideation Plan Intent Attempt /

Others:

Ideation

Plan

Intent

Erotic

Attempt

Comments:

Cognition WNL OR Check all that apply below Impairment of: Orientation

Memory

Attention/Concentration

Visuospatial ability

Reading and Writing

Calculation Ability

Intelligence Estimate Insight Judgment

WNL WNL

MR

Borderline Mostly blames others for problems

Impaired ability to make reasonable decisions:

Elaboration on Positive Mental Status Findings:

Average

Ability to Abstract

Fund of Knowledge

Above Average

Difficulty acknowledging presence of psychiatric problems Mild

Moderate

Severe

Mental Status Exam Revision Date: 1-17-13 Page |2 Completed By - Print Name/Credentials:

Staff Signature:

Date:...