The following categories of the Mental Status Exam can usually be obtained by interviewing the client about almost any topic.  Direct questions are ordinarily not needed.

Appearance:

General looks, dress, hygiene, appropriateness

Behavior:

Verbal (speech qualities) - fluid, blocked, melodious, quivering, overwhelming, impoverished, slow, rapid, stuttering

Nonverbal - bizarre, eye contact, facial expression, gait, gestures, posture

Affect (see objective mood below):

What emotions are expressed or shown during the interview?
Are these emotions appropriate or inappropriate to the content?
Is there blunted or flat affect?

Thought Content:

What the client talks about.  Thought content may be either "normal" (e.g., life, work, self-concept) or pathological (e.g., delusions of grandeur or persecution, depersonalization or estrangement, obsessions).

The following categories can usually be obtained by interviewing the client about almost any topic.  Sometimes, it may be necessary to ask direct questions depending on the suitability of doing so.

Orientation:

Who, where, what time is it (usually obvious if the client knows; if there is a question, then ask).

Memory:

Immediate - a digit-span test (from 3 to 8 digits)

Recent - over 10 s but within the past few months (ask at the end of the hour something that happened at the beginning of the hour)

Remote - unable to recall important events that occurred months or years past (it will usually be obvious if there is a problem with memory as the client may forget the question or repeat himself/herself; if you have questions, question directly if the circumstances are appropriate)

Sensorium:

Senses - sight, sound, smell, taste, touch (you will probably have to ask if appropriate)

Attention and concentration - can be noted without questioning (Does the client appear distractible or seem to "fade in and out"?)

Judgement:

How adequate does it seem to be during the interview?  What is the quality of judgement (e.g., impulsive, logical)?

Is there evidence that the client cannot adequately meet his/her physical needs?  (In the case of suicide risk, the client's judgement must be evaluated via direct questions.)

Mood:

The client's prevailing feeling state during the interview and outside the session.  There are two dimensions to the evaluation of mood - objective and subjective.  Objective determinants (see affect above) pertain to how the client appears (e.g., aloof, angry, anxious, depressed, expansive, happy, irritable, perplexed, sad, self-satisfied, suspicious, tense).

Subjective determinants pertain to statements by the client about how he/she feels and frequently must be obtained by direct inquiry.

Thought Processes:

Information about thought processes can ordinarily be obtained by interviewing the client about almost any topic.

If there are some questions about thought processes, direct questions are sometimes needed to determine how much control the person has over them.  If there is a problem with thought processes, you will become aware that the client does not seem to "make sense" or that you become lost when trying to follow the client's line of thinking.

Insight:

Insight refers to the client's psychological mindedness.  Does the client seem capable of making sense of his/her behavior, feelings, and thoughts?  If the client has problems, is he/she aware of them and aware of his/her role in them?

Intellectual Functioning:

Notice the client's vocabulary, general fund of information, ability to reason, etc.  Intellectual functioning can be estimated by close attention to the previously noted functions, but if there are concerns, you can ask directly, if appropriate.

Knowledge - "Why does oil float?"  "What does C.O.D. mean?"

Reasoning - analyze a proverb (e.g., "What does, 'Don't count your chickens until they're hatched.' mean?")

Calculation - count backwards by 7 from 100 (serial 7's)

Reading and writing - have the client read something and take dictation

The next category often has to be asked for.  The best question for getting at this material is, "Do your eyes or ears ever play tricks on you?"

Perceptual processes:

Hallucinations (auditory, visual, kinesthetic); if auditory, what do the voices say (e.g., are they persecutory?)

Depersonalization and derealization

Depersonalization affects the perception of oneself.  The client may say he/she feels vaguely "different": disembodied, unattached, dead, robot-like, like a lifeless cardboard figure, made of cotton-wool, a spectatot, etc.  Derealization is a change in an individual's experience of their environment, where the world around him/her feels unreal and unfamiliar; it is a subjective sensation that the environment appears to have changed.  People and things appear unreal, far away, changed in size, shape, color, or brightness.