Build an MSE write-up
This builder is a documentation aid. It does not replace clinical judgment, supervision or a standardized suicide risk assessment. Nothing you type leaves this page, but leave out names and other identifying details, and remember that copied text can end up in clipboard history.
On the NCMHCE, mental status findings sit inside the case story. See how in one free case, with every answer explained.
Try a free caseMSE cheat sheet
A mental status exam describes what you observe and elicit in the session, at that point in time. It is a snapshot, not a diagnosis.
| Domain | What to note | Common descriptors |
|---|---|---|
| Appearance | How the client looks at rest | Apparent age, build, dress, hygiene, grooming, notable physical features |
| Behavior | How the client acts | Posture, eye contact, mannerisms, tics, activity level, psychomotor slowing or agitation, restlessness, tremor |
| Attitude | How the client relates to you | Cooperative, engaged, guarded, evasive, irritable, hostile, entitled |
| Speech | How the client talks, not what they say | Rate (slowed to pressured), volume, rhythm, latency, articulation |
| Mood | The client's own report of their emotional state | Quoted in the client's words |
| Affect | The emotion you observe | Type (euthymic, dysphoric, anxious, irritable, elevated); range (full, constricted, blunted, flat); stability (stable, labile); congruence with stated mood; appropriateness to content |
| Thought process | How thoughts connect | Linear and goal-directed, circumstantial, tangential, loose associations, flight of ideas, thought blocking, perseveration |
| Thought content | What the client thinks about | Suicidal and homicidal ideation (with intent, plan, means), delusions and their type, obsessions, preoccupations, phobias |
| Perception | Disturbances of perception | Hallucinations (auditory, visual, command), illusions, depersonalization, derealization, responding to internal stimuli |
| Cognition | Alertness and basic cognitive function | Level of consciousness, orientation to person, place, time and situation, attention, memory, abstraction |
| Insight | The client's awareness of their situation, illness and options | Full, partial or limited, none |
| Judgment | The client's decision-making, from history and recent behavior | Excellent, good, fair, poor |
Mental status exam examples
Two short write-ups, one unremarkable and one with findings that matter. Use them to check the level of detail, not as wording to copy into a chart.
| Domain | Finding |
|---|---|
| Appearance | Adult appearing stated age, casually dressed, well groomed. |
| Behavior | Cooperative, good eye contact, no psychomotor agitation or slowing. |
| Speech | Normal rate, volume and tone. |
| Mood | “Pretty good, just busy.” |
| Affect | Euthymic, full range, congruent with mood. |
| Thought process | Linear and goal-directed. |
| Thought content | Denies suicidal and homicidal ideation. No delusions elicited. |
| Perception | Denies hallucinations; not responding to internal stimuli. |
| Cognition | Alert and oriented to person, place, time and situation. Attention and memory grossly intact. |
| Insight and judgment | Good. |
| Domain | Finding |
|---|---|
| Appearance | Man appearing stated age, casually dressed; reports an eight-pound weight loss. |
| Behavior | Cooperative, limited eye contact, mild psychomotor slowing. |
| Speech | Soft and slow, little spontaneous speech, coherent. |
| Mood | “I just do not see much point in waking up.” |
| Affect | Dysphoric, constricted, congruent with mood. |
| Thought process | Linear, somewhat slowed. |
| Thought content | Fleeting wishes not to wake; denies intent, plan, preparation or past attempts. Unsecured rifle in the home, addressed in the safety plan. Themes of being a burden. No delusions. |
| Perception | No hallucinations reported or observed. |
| Cognition | Alert and oriented to person, place, time and situation. Reports trouble following television plots; no gross deficit. |
| Insight and judgment | Fair insight: names the depression. Fair judgment: completed a written safety plan and agreed to a cable lock on the rifle. |
Notice what Example 2 does with risk: the passive wish, what was denied, and the access to means are all written down, along with what was done about it. A reader can see the reasoning, not only the conclusion. Example 2 is adapted from the client in our free practice case, where the next clinical decisions are yours to make.
Writing a useful MSE
| Do | Instead of | Write |
|---|---|---|
| Describe before you label | “Manic speech” | “Speech rapid, hard to interrupt” |
| Quote the mood | “Mood depressed” | Mood: “I just feel empty.” |
| Record normal findings | Leaving perception blank | “Denies hallucinations; not responding to internal stimuli” |
| Document risk fully | “+SI” | Intent, plan, means, history, protective factors, and what you did |
On the NCMHCE, MSE findings sit inside the case story. Questions turn on reading them: does affect fit the mood, does the thought process point to a differential, does a risk finding change the next step?
Mental status exam FAQ
What is the difference between mood and affect?
Mood is the client's own report of their emotional state, recorded in their words. Affect is what the clinician observes: the expressed emotion, its range, how it shifts, and whether it fits what the client is saying.
What are the parts of a mental status exam?
Appearance, behavior and attitude; speech; mood and affect; thought process; thought content; perception; cognition; insight; and judgment.
How do you write a mental status exam?
Go domain by domain: appearance, behavior, speech, mood (in the client's words), affect, thought process, thought content including suicidal and homicidal ideation, perception, cognition, insight and judgment. Describe what you observed before you interpret it, note normal findings as well as abnormal ones, and document any risk finding with what you did about it.
What is a normal mental status exam?
A typical unremarkable write-up reads: appears stated age, well groomed, cooperative, normal speech, mood reported in the client's words, euthymic and congruent affect, linear thought process, no suicidal or homicidal ideation, no hallucinations, alert and oriented, good insight and judgment. Example 1 on this page shows it domain by domain.
Sources
- Association of Directors of Medical Student Education in Psychiatry (ADMSEP), Mental Status Exam: Definitions. Accessed September 23, 2026.
- Cleveland Clinic, Mental Status Exam. Accessed September 23, 2026.
Taking the NCMHCE? The free practice case is one full case: 14 questions, about 20 minutes, no account needed.
Try the free case