Examining cognitive functioning of adult acute psychiatric inpatients through a brief screening assessment.

Abstract

Objective: Psychiatric inpatients present with multiple difficulties, including comorbid diagnoses, social problems, trauma, and high levels of psychiatric medication use. All of these factors have been associated with poorer cognitive functioning, which is rarely assessed. The aim of this study was to examine the acceptability of a brief cognitive screening assessment, and identify the cognitive and psychological profile of current psychiatric inpatients. Method: A cross-sectional design was adopted. Participants (N = 75) were administered brief measures of cognitive functioning, the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), and psychological global distress, Clinical Outcomes of Routine Evaluation–Outcome Measure, (CORE-OM; Evans et al., 2002) within the first 4 weeks of their hospital admissions. Results: The MoCA was identified as acceptable for the inpatient environment. Most of the participants (79%) met the cut-off for mild cognitive impairment. No significant differences were found across diagnoses in regard to cognitive functioning, but participants with diagnoses of personality disorder experienced the most psychological global distress. Conclusion and Implications for Practice: Acute psychiatric inpatient wards should consider mild cognitive impairments when assessing and treating people with serious mental illness and make appropriate adaptations to their care.

Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study

“…Depressive symptomatology has also been shown to negatively impact MoCA ® performance in a non-SUD population [ 87 ]. Moreover, a total of 79% of patients admitted to an acute psychiatric ward demonstrated cognitive impairment according to MoCA ® , indicating that MoCA ® is sensitive to a wide range of mental illnesses [ 88 ]. Comorbid PTSD and SUD may also reduce the criterion-related validity of the MoCA ® in terms of its correspondence with the Repeatable Battery for the Assessment of Neuropsychological Status [ 89 ].…”

Piloting a ‘Timeline of Crisis Tool’ with service users on admission to an acute psychiatric ward

“…Although the Back in the Saddle approach (Birchwood et al, 2000) includes 55 different warning signs in the card sort exercise, we were aware of the need to make the tool quick and easy to complete for an acute setting. This was important in meeting the needs of people who had experienced a recent crisis, who commonly experience problems with their concentration and thinking skills (Wood et al, 2019) due to multiple factors (e.g. intensity of symptoms, sedative medication).…”

What should inpatient psychological therapies be for? Qualitative views of service users on outcomes

“…People experiencing severe mental health difficulties who are admitted to acute inpatient settings often come from marginalised groups 9,10 and a large proportion (44%) of adult acute admissions involve detentions under the Mental Health Act 11 . Also, service users often experience moderate to severe levels of emotional distress and mild cognitive impairment 12 . This might lead to knowledge produced by service users being questioned due to a credibility deficit and epistemic injustice (where someone is unfairly assumed to be an unreliable knower or is unable to add to, and therefore access, concepts that make sense of their experience within mainstream society) 13,14 can transpire.…”

“…11 Also, service users often experience moderate to severe levels of emotional distress and mild cognitive impairment. 12 This might lead to knowledge produced by service users being questioned due to a credibility deficit and epistemic injustice (where someone is unfairly assumed to be an unreliable knower or is unable to add to, and therefore access, concepts that make sense of their experience within mainstream society) 13 , 14 can transpire. Also, ideological power, which operates when people's thoughts, beliefs and feelings are manipulated, ignored or disbelieved, and alternative interpretations are offered or imposed, 15 can occur.…”