A comprehensive mental status exam 

What is included in a mental status exam relevant to age?
1. Affect - current emotional state (full, labile, restricted, flat, inappropriate, suicidal/homicidal)
2. Appearance - overall impression, posture, clothes, grooming, health, apparent age, angry/afraid
3. Attention - concentration, attendance, digit recall
4. Attitude toward examiner - cooperative, hostile, defensive, seductive, evasive, ingratiating
5. Content of thought - preoccupations, obsessions, phobias, rituals, delusions, depersonalization
6. Form of thought - circumstantial, flight ideas, evasiveness, loosening associations, perseverance, blocking 
Do you ever see/hear/smell/taste/feel things that are not really there?
7. General Behavior - mannerisms, gestures, combative, rigid, twitching, psychomotor retardation
8. Insight - do they realize they are ill
9. Intellectual Functioning- fund of knowledge, calculations, abstraction (proverbs, similarities)
10. Judgment - errors in judgment. What is an error in judgment? A flawed decision
11. Memory - immediate (digit span), recent (three objects at 5 minutes), remote (days to years)
12. Mood - overall emotional state (sad, happy, depressed, elated, anxious, irritable)
13. Orientation - time, person, place, situation. What time, day, month, date, and year is it?
Where are you now? What location, building, floor, and room are you in? What location, building, floor, and room were you in on June 1, 2018, and December 1, 2018? What were the issues? What are the issues? 
14. Perceptions - misperceptions, illusions, hallucinations
15. Psychomotor Activity - increased, reduced, agitated, abnormal movements
16. Speech/Language - rate (increased, pressured, slow), tone (soft, angry), volume, articulation, language (aphasia). Appropriateness of conversation, rate of speech (more than 100 words per minute is normal, fewer than 50 words per minute is abnormal). Writing and reading appropriate to education level.
17. State of consciousness - alert, drowsy, very drowsy, obtundation, stupor, coma. Conscious means able to hear, see, and talk relevant to age.

Is the person conscious and oriented to time, place, person, and situation?
Most of such individuals are conscious and oriented to time, place, and person, but not oriented to situation.

What are the levels of human consciousness relevant to age?
1. Alert/Normal: the patient opens their eyes spontaneously, looks at you when spoken to in a normal voice, responds appropriately to stimuli, and demonstrates purposeful movements.
2. Lethargic/Drowsy: the patient appears drowsy but opens their eyes to loud verbal stimuli and looks at you, responds to questions, and then falls back asleep.
3. Somnolent/Very drowsy
4. Obtundation: the patient opens their eyes with tactile stimuli and looks at you, but responds to you slowly and may be confused.
5. Stupor: the patient awakens only after painful stimuli are applied (e.g., applying pressure to the nailbed). The patient’s verbal responses are slow or absent. The patient will fall into an unresponsive state when the stimuli stop.
6. Coma: No response to any stimuli. Pulse, respiratory rate, and temperature are evident. The patient is unarousable, and their eyes remain closed. There are no purposeful responses to internal or external stimuli. However, nonpurposeful responses to painful stimuli and brain stem reflexes may still be present.