Neuropsychiatric Mental State Examination: Procedure and Treatment

Core Components of the Mental Status Examination

The American Academy of Pediatrics recommends a systematic assessment of appearance, behavior, thought process, thought content, mood and affect, insight and judgment, followed by structured cognitive testing across multiple domains, with subsequent treatment determined by the specific deficits identified and their underlying etiology 1, 2
The assessment of cognitive function should include evaluation of attention, memory, executive function, language, and visuospatial abilities, with the use of validated screening instruments such as the MoCA or MMSE 7, 8

The Alzheimer's Association recommends the use of brief office-based tools, such as the AD8, IQCODE, MoCA, and MMSE, for cognitive screening 3, 7, 8
The use of behavioral and mood assessment tools, such as the Neuropsychiatric Inventory-Q, Center for Epidemiological Studies-Depression, and Geriatric Depression Scale, is also recommended 6, 2

The American College of Physicians recommends a careful evaluation for underlying medical conditions, including vital signs, physical examination, delirium screening, laboratory testing, and neuroimaging, for patients with altered mental status, new-onset psychiatric symptoms, or acute changes in behavior 1, 6

The American Psychiatric Association recommends determination of the level of care, including inpatient psychiatric admission, based on the presence of risk factors such as persistent suicidal ideation, severe agitation or psychosis, and comorbid substance abuse 1
The use of outpatient management options, such as partial hospital programs, intensive outpatient services, and regular follow-up with a mental health specialist, is also recommended 1, 7, 8

The Alzheimer's Association recommends referral to a dementia subspecialist when atypical features are present, including early-onset, rapid progression, prominent behavioral disturbance, or fluctuating course 4, 9
Additional referral triggers include atypical cognitive abnormalities, progressive cognitive decline with abnormal screening tests, family history of neurodegenerative disease, and neurological symptoms accompanying memory problems 9