Mental Status Examination

Abstract

The mental status examination is an interview method psychiatrists use to gather and organize their observations about the patient’s mental functioning. The mental status examination grows out of the general psychiatric tradition of noting mental signs and symptoms of psychiatric and neurological illness. Psychoanalysis adds observations about emotionally dynamic mental contents of ideas and affects. Psychoanalysis focuses especially on the process of this material as it reveals itself in sequential associations and in patients’ fantasies about the interviewer. Some psychoanalysts, like general psychiatrists, also observe aspects of the mental organization of this process, called structure, that might reflect severity of illness or even illness type (Reich, 1945; Jacobson, 1971; Bellak et al., 1973; Kernberg, 1975). Some have written about the relationship between symptoms, structure, transference, and dynamics (MacKinnon and Michaels, 1971; Kernberg, 1975). I follow this latter tradition because the structural road map is so important in diagnosis and treatment of psychotic and near psychotic conditions. I include, therefore, as part of the mental status examination, the careful assessment of certain ego functions damaged in psychosis and near psychosis. This damage leads to the characteristic mental manifestations of these illnesses and their dynamics.