Abstract
Abstract This article reviews 12 studies that have used brief mental status exams in competency determinations. When possible, sensitivity and specificity values for determining incompetence were calculated from the available data. Although lower mental status scores were generally associated with incompetence and higher scores were generally associated with findings of competence, the mean sensitivity and specificity values of 69.4% and 74.6%, respectively, reflect that about one-quarter of patients under study would have been misclassified. In no single study did both sensitivity and specificity exceed 75%. The results of bedside mental status measures in competency determinations were particularly misleading in patients with frontal lobe pathology or psychiatric disorders. Although the brevity and simplicity of mental status measures are potentially enticing, clinicians are advised that the exclusive use of mental status exams, regardless of cutoff scores, in competency determinations will lead to a hi...
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