Orientation is central to the Mental Status Exam. Individuals' awareness of their surroundings, their location temporally, and their own identity is 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, you need to note this as a significant finding that must be explored further.

Assessment of orientation always includes person, place, and time (this is referred to as "oriented x3"). Questions of person generally include the identity of the patient and who you are. Orientation to place may include the city, state, or town where the patient lives and where he/or she is now. For some patients, it may be appropriate to ask "what planet is this?" Time orientation includes 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. Including the current situation in the person, place, and time assessment is referred to as "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 track of time by several days or even weeks. Further, there is a difference between confusion and delusion about person, place, and time. Both patients suffering from Schizophrenia and Major or Mild Neurocognitive Disorder may exhibit either delusions or confusion in their orientation.

It is sometimes important to be able to quickly evaluate a person's intelligence. This can be difficult if other more acute issues are primary (prominent suicide ideation with a plan, acute psychosis, or 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 (e.g. serial sevens, multiplication word problems). 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. A few examples of proverbs that may be used are: "still waters run deep" or "a rolling stone gathers no moss".

Orientation and intellectual functioning are extremely important in the hospital setting. Delirious patients 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 patient's mental status.