Orientation

Orientation is central to the Mental Status Exam. One's awareness of his/or her surroundings, location temporally, and own identity are primary to general functioning. Of course, everyone occasionally loses track of the date, but when an individual who you are interviewing believes it is 1983, or that it is summer when the coat rack in the corner is full, this is a significant finding that must be explored further.

Assessment of orientation always includes person, place, and time (oriented X3). Questions of person generally include the identity of the client and who you are (doctor, counselor, etc.). Orientation to place may include the city, state, or town where the client lives and where he/or she is now. For some clients, it may be appropriate to ask "What planet is this?" If the person say Jupiter, then you may have an alien (or a psychotic individual) on your hands. Time orientation include day of the week, date, month, year, etc. (The interviewer may also ask about the current situation, why a person is in your office, etc. This would be oriented X4.)

As a rule, confusion about person is more significant than confusion about time, place, or situation. Problems in orientation are often the result of organicity. However, some very depressed individuals may lose tack of time by several days or even weeks. Further, there is a difference between confusion and delusion about person, place, and time. Individuals with either Schizophrenia or Major/Mild Neurocognitive Disorder may exhibit either delusions or confusion in their orientation.

Intelligence

It is often important to quickly evaluate a person's intelligence. This can be difficult (as well as unimportant) if other more acute issues are primary (prominent suicide ideation with a plan, acute psychosis, or if the person is very distressed and tearful). However, in a routine MSE, intelligence is an important aspect of treatment planning.

Quick and easy intellectual capacity can be obtained through asking the person to perform some simple calculations in his/or her head (serial sevens, multiplication word problems, etc.). It is also important to know if an individual is able to reason abstractly. Proverbs are one of the simplest and best ways of getting information about concrete versus abstract reasoning ability. The responses may be literal, concrete, personalized, or bizarre. Example of proverbs that may be used are: "still waters run deep" and "a rolling stone gathers no moss."

Orientation and intellectual functioning are extremely important in the hospital setting. Delirious clients will often be quite disoriented. The MSE can be used for baseline functioning and tracking of the symptom pattern. In delirium, there is often a fluctuation of consciousness throughout the day. In this case, the MSE can quite useful. Further, it can be used to narrow down medications that might be negatively or positively affecting a client's mental status.