Student Name: _____________________________________________________________
Patient initials: ______________________________________________________________
Bipolar disorder, with manic depression
Diagnosis: _________________________________________________________________
MENTAL STATUS ASSESSMENT:Mental Health Examination include these four main sections:
Appearance (5 points), Behavior (5 points), Cognition (5 points) and Thought Processes (5
points) (A, B, C, T). Mental Status Examinations are important to complete when patients have
abnormal affects or behaviors in certain situations. Must complete all sections with resource
tools attached to form to identify your ratings for depression, anxiety, suicidal tendencies, mood
and cognitive issues.
------------------
APPEARANCE AND BEHAVIOR:(Attach depression scale.)
Agitated
cooperative and reasonable
disheveled
grooming appropriate
psychomotor retardation
hostile/threatening
unusual/bizarre
Rationale for Findings: Dominic knows that he is depressed and needs medical attention. He
feel like a burden to his wife and children. He is alert and oriented despite his diagnosis/
condition. He has had bizarre/ unusual behaviors such as walking in a public place shouting and
singing along with skipping. He wants to get the help that is needed to ensure he is alive to
watch his children grow.
ORIENTATION AND CONSCIOUSNESS: (Attach mini mental exam)
alert and attentive
lethargic
obtunded
oriented x3
disoriented to place
disoriented to time
Rationale for Findings: Dominic knows what is happening around him and is coherent/ aware
of the fact that he has mental health problems. He is cooperative with the treatment that the
doctor has recommended for him and is able to think for himself/ is not cognitively impaired
despite his condition.
SPEECH:
normal rate/rhythm
dysarthric
increased latency of response
mute
poverty of speech
pressured/pushed speech
slow
Slurred
Rationale for Findings: Dominic can hold a stable and relatively calm/ composed conversation.
He speaks clearly and coherently.
LANGUAGE:
intact
expressive aphasia
partially aphasic
receptive aphasia
Dr. Hetzel | FLORIDA STATE COLLEGE AT JACKSONVILLE UPDATED 10/2019
Patient initials: ______________________________________________________________
Bipolar disorder, with manic depression
Diagnosis: _________________________________________________________________
MENTAL STATUS ASSESSMENT:Mental Health Examination include these four main sections:
Appearance (5 points), Behavior (5 points), Cognition (5 points) and Thought Processes (5
points) (A, B, C, T). Mental Status Examinations are important to complete when patients have
abnormal affects or behaviors in certain situations. Must complete all sections with resource
tools attached to form to identify your ratings for depression, anxiety, suicidal tendencies, mood
and cognitive issues.
------------------
APPEARANCE AND BEHAVIOR:(Attach depression scale.)
Agitated
cooperative and reasonable
disheveled
grooming appropriate
psychomotor retardation
hostile/threatening
unusual/bizarre
Rationale for Findings: Dominic knows that he is depressed and needs medical attention. He
feel like a burden to his wife and children. He is alert and oriented despite his diagnosis/
condition. He has had bizarre/ unusual behaviors such as walking in a public place shouting and
singing along with skipping. He wants to get the help that is needed to ensure he is alive to
watch his children grow.
ORIENTATION AND CONSCIOUSNESS: (Attach mini mental exam)
alert and attentive
lethargic
obtunded
oriented x3
disoriented to place
disoriented to time
Rationale for Findings: Dominic knows what is happening around him and is coherent/ aware
of the fact that he has mental health problems. He is cooperative with the treatment that the
doctor has recommended for him and is able to think for himself/ is not cognitively impaired
despite his condition.
SPEECH:
normal rate/rhythm
dysarthric
increased latency of response
mute
poverty of speech
pressured/pushed speech
slow
Slurred
Rationale for Findings: Dominic can hold a stable and relatively calm/ composed conversation.
He speaks clearly and coherently.
LANGUAGE:
intact
expressive aphasia
partially aphasic
receptive aphasia
Dr. Hetzel | FLORIDA STATE COLLEGE AT JACKSONVILLE UPDATED 10/2019
