Evaluation Of Mental Status Research Articles

A Pilot Study of the Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool for Neurocritical Care Patients.

Delirium occurs frequently in patients with stroke and neurocritical illness but is often underrecognized. We developed a novel delirium screening tool designed specifically for neurocritical care patients called the fluctuating mental status evaluation (FMSE) and aimed to test its usability and accuracy in a representative cohort of patients with intracerebral hemorrhage (ICH). We performed a single-center prospective study in a pilot cohort of patients with ICH who had daily delirium assessments throughout their admission. Reference-standard expert ratings were performed each afternoon using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and were derived from bedside assessments and clinical data from the preceding 24 h. Paired FMSE assessments were performed by patients' clinical nurses after receiving brief one-on-one training from research staff. Nursing assessments were aggregated over 24-h periods (including day and night shifts), and accuracy of the FMSE was analyzed in patients who were not comatose to determine optimal scoring thresholds. We enrolled 40 patients with ICH (mean age 71.1 ± 12.2, 55% male, median National Institutes of Health Stroke Scale score 16.5 [interquartile range 12-20]), of whom 85% (n = 34) experienced delirium during their hospitalization. Of 308 total coma-free days with paired assessments, 208 (68%) were rated by experts as days with delirium. Compared with expert ratings, FMSE scores ≥ 1 had 86% sensitivity and 73% specificity on a per-day basis, whereas FMSE scores ≥ 2 had 68% sensitivity and 82% specificity. Accuracy remained high in patients with aphasia (FMSE scores ≥ 1: 83% sensitivity, 77% specificity; FMSE scores ≥ 2: 68% sensitivity, 85% specificity) and decreased arousal (FMSE scores ≥ 1: 80% sensitivity, 100% specificity; FMSE scores ≥ 2: 73% sensitivity, 100% specificity). In this pilot study, the FMSE achieved a high sensitivity and specificity in detecting delirium. Follow-up validation studies in a larger more diverse cohort of neurocritical care patients will use score cutoffs of ≥ 1 as "possible" delirium and ≥ 2 as "probable" delirium.

Influence of rehabilitation on mental state in patients with lumbar intervertebral disc damage.

The present study aims to investigate the mental state changes in patients with lumbar intervertebral disc damage after rehabilitation program using a self-administered questionnaire IRES-3. The study was conducted in the Specialized Hospitals for Rehabilitation - National Complex EAD, branches Hissar and Banite, Bulgaria. It included 124 patients - 34 men and 90 women, aged from 35 to 85 years. The questionnaire IRES-3, validated by the authors for the Bulgarian population, was used for measurement of the subjective evaluation of the rehabilitation effect. Measurements were performed at the beginning, end and three months after rehabilitation (RH). The subjective evaluation of the patients' mental state included the following scales: depression, fear, exhaustion of vitality, self-confidence and symptom: cognitive functioning. We found a statistically significant improvement of the scores three months after rehabilitation compared to the beginning of rehabilitation for all scales. The only exceptions are the scales exhaustion of vitality and symptom: cognitive functioning. We found a statistically significant improvement of the self-rated mental state after performed rehabilitation in patients with chronic diseases.

Receipt of Recovery-Oriented Care Practices During Hospitalization for Sepsis.

Observational cohort study. Michigan Medicine, a tertiary academic medical center. Adult patients discharged alive from a hospitalization with a primary diagnosis of sepsis or septic shock in 2019. We further limited our cohort to patients receiving longitudinal care viewable in the Michigan Medicine electronic health record to ensure ability to capture posthospital care and outcomes. None. Three-hundred sixty-five sepsis hospitalizations met study inclusion criteria. Using structured chart review, we determined receipt of the following recovery-based care practices during hospitalization: medication optimization, functional status evaluation at discharge, sepsis education, and scheduled follow-up within 2 weeks. The cohort was 46.6% female, 81.1% White, with a median age of 64 years. 51.2% were treated in the ICU. Medication optimization occurred in 93.7%, functional status evaluation in 82.7%, sepsis education in 20.0%, and scheduled follow-up within 2 weeks in 54.5%. ICU-treated patients had lower receipt of medication optimization and follow-up scheduling but greater receipt of functional and mental health status evaluations. In multivariable models, ICU treatment was associated with lower odds of receiving medication optimization (adjusted odds ratio, 0.72; 95% CI, 0.03-0.69) and not associated with receipt of other care practices. Our study shows incomplete receipt of recommended recovery-based care practices during sepsis hospitalization in both ward and ICU-treated patients. Sepsis education and mental health evaluation were particularly uncommon.

Sensitivity and specificity of the new Geriatric Dehydration Screening Tool: An observational diagnostic study

Objectives: The aim of this study was to evaluate the diagnostic accuracy of the Geriatric Dehydration Screening Tool–Modified (GDST-M) in detecting dehydration in older people and, if possible, to simplify the tool and make it easier to use.Methods: This was a monocentric diagnostic accuracy study. We involved people ≥65 y of age with a Mini Mental State Evaluation (MMSE) score >24 and who were hospitalized in five medical wards of a large teaching hospital in Milan (Italy). We administered the GDST-M to hospitalized older people who met the inclusion criteria and compared outcomes with the values of serum osmolarity to evaluate their dehydration status and the accuracy of the tool.Results: A total of 299 older people were recruited, of which 202 were dehydrated and 97 were hydrated. The GDST-M, with a cutoff value of 6, showed a sensitivity of 61.9% and a specificity of 47.2%. Multiple correspondence analysis and cluster analysis enabled extraction of 9 items from the 23 items present in the GDST-M. The new tool had a moderate diagnostic accuracy in detecting dehydration in older people aged over 75 y, with a sensitivity of 63.4% and a specificity of 69.6%.Conclusions: The short form of the tool is simple and contains minimally invasive assessments of low fluid intake dehydration in older people. The new GDST could also be easily used by lay people after a short training session.

Gender differences in the health status of the imprisoned population in Kot Lakhpat Jail in Pakistan

Background: The prison population of any country is a high-risk population because of a lack of access to regular health care facilities. This research was planned to assess the gender differences in the health status of the imprisoned population of Lahore.Patients and methods: An analytical cross-sectional study was conducted in Kot Lakhpat Jail in the province of Punjab, near Lahore, from January to August 2019. After getting permission from Inspector General, Police of Punjab, a sample of 320 inmates of Kot Lakhpat Jail was collected through a simple random sampling technique. Data was collected on a structured questionnaire based on history and examination. Data was entered in SPSS version 23, and the chi-square test was applied to assess the gender differences in health status, p-value ≤ 0.05 was taken as significant.Results: General examination revealed that 143 (44.7%) had refractory errors, and 34 (10.6%) had mild deafness. Common infection in males were scabies (p = 0.002), Sore throat (p =0.015) and urinary tract infections (p=0.015). Hepatitis C was present in high frequency (9.1%). Assessment of sexually transmitted diseases showed discharge in 10.6%, vesicular herpetic eruptions in 8.8%, and ulcers in private parts in 3.8% of the sample. Males showed a significantly high frequency of hypertension (p =0.052) and arthritis (p=0.024). Evaluation of mental health status revealed significant high rates of depression in females (p =0.000) and a high frequency of insomnia (p=0.000). Social health problems revealed a high frequency of smoking in males (p=0.000) and feeling of stigmatization in females (p=0.000).Conclusion: Male jail inmates showed high frequencies of scabies, sore throat and urinary tract infection, and hypertension. Females showed higher rates of depression, insomnia, and feeling of stigmatization.

Sportsman’s Mental State Evaluation and Early Warning Method Based on Intelligent CNN

Aiming at the intelligent needs of psychological state assessment of university students, the text information-based psychological problem identification approach is investigated in the paper. This approach uses the text of student forums within universities as the database and introduces the convolutional neural network (CNN) model in deep learning, which contains a convolutional layer, a pooling layer, and a fully connected layer. After the convolution is completed, the convolution result is delinearized by the activation function, and then, pooling is performed to improve the fitting ability of the network for nonlinearities. For data processing, behavioral features, attribute features, content features, and social relationship features are extracted from text information as the input of the CNN. The psychological lexicon of expertise (LIWC) is used to enhance the efficiency of text word frequency statistics when performing text content extraction. To evaluate the performance of the proposed method, simulations are performed in the open dataset of CLPsyh2017 ReachOut Forum, and the FastText method is used as a comparison. The results show that the CNN model achieves an accuracy of 0.71 in the full-sample domain, which is significantly higher than that of the FastText model at 0.64. In the early warning evaluation of mental states, the CNN performance is better than that of FastText.

Abstract WP116: A Pilot Study Of The Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool For Patients With Stroke

Background: Delirium occurs frequently in patients with stroke but is often underrecognized. We aimed to develop a novel delirium screening tool designed specifically for stroke patients, and to test its feasibility and accuracy in a pilot study. Methods: We designed an easy-to-use 5-point instrument called the Fluctuating Mental Status Evaluation (FMSE) and tested it in a cohort of patients with intracerebral hemorrhage (ICH) who had daily delirium assessments throughout their admission. Expert ratings were performed by an attending neurointensivist or behavioral neurologist each afternoon using DSM-5 criteria, and were derived from bedside assessments and clinical data from the preceding 24 hours. Paired FMSE assessments were performed by patients’ clinical nurses after brief training on the use of the tool. Nursing assessments were aggregated over 24-hour periods (including day and night shifts), and accuracy of the FMSE was analyzed on both a per-assessment day and per-patient basis. Results: Among the 40 enrolled patients (mean age 71.1±12.2, median initial NIHSS score 16.5 [IQR 12-20]), 34 experienced delirium during their hospitalization. There were 306 total coma-free days with paired assessments, of which 208 (68%) were rated as days with delirium. Compared to expert ratings, an FMSE score ≥1 had 86% sensitivity and 74% specificity on a per-day basis, while a score ≥2 had 68% sensitivity and 83% specificity. On a per-patient basis, a score ≥1 at any point during admission had 97% sensitivity and 67% specificity in identifying patients who experienced delirium, while a score ≥2 had 94% sensitivity and 67% specificity. Conclusion: The FMSE is a feasible delirium screening tool in ICH patients, with high real-world sensitivity and specificity. Based on these results, we plan to validate the tool in a larger, more diverse cohort of stroke patients, using score cutoffs of ≥1 as “possible” delirium and ≥2 as “probable” delirium.

The role of association between the cholinergic precursor choline alphoscerate and sulodexide in vascular dementia

Dementia is a syndrome of acquired intellectual deficit resulting in significant impairment of social or occupational functioning. Vascular dementia (VaD) is the second most common causes of dementia after Alzheimer’s disease, causing around 15% of cases. However, unlike Alzheimer’s disease an involvement of the cerebral cholinergic system in the pathophysiology of VaD has been hypothesized and there is no standard treatment. In the Vascular Dementia Italian Sulodexide Study (VA.D.I.S.S.) the positive results obtained with the sulodexide are worthy of note. In this study 40 elderly subjects with recent onset (less than 9 month) slight to moderate mental deterioration due to vascular origin were observed for nine months during oral treatment with sulodexide and choline alphoscerate with the aim of analyzing whether therapeutic effects can be enhanced. These preliminary results suggest that the additional therapy of choline alphoscerate with sulodexide represents a way to increase the beneficial effects of cholinergic therapies in the VaD and improve all the different examinate score: mini mental state evaluation (MMSE), basic activities of daily living (ADL), instrumental activities of daily living (IADL).

Prevalence of anxiety and depression among patients with thyroid disorder

Background Thyroid dysfunctions have been recognized to cause significant manifestations in mental health. They may lead to disturbances in emotions and cognition. Both increase and decrease in thyroid function can cause mood abnormalities. Symptoms of anxiety and depression are more common, as well as increased scores on depression and anxiety self-rating scales. Indian studies are scarce exploring the association of anxiety and depression and its severity with hypo or hyperthyroid status of the patients. Hence this study was carried out to find the prevalence of anxiety and depression among patients with thyroid abnormalities and its association with hypo or hyperthyroid status. Methods The present is a hospital based cross-sectional study carried out in the Endocrinology outpatient unit of a tertiary care hospital in south India between March 2014 and March 2015. A total of 132 patients underwent endocrine and mental state evaluation by using standard tools. Results The mean (SD) age of the population was 40 (12) year with majority of the patients were from the age group of 35-49 year (38%). There was preponderance of females (60%). The overall prevalence was higher among the patients with thyroid disorder as compared to the general population with around half of the patients having at least one psychiatric illness. The most common illnesses were major depressive disorder/dysthymia and generalized anxiety disorder present in 20% and 13% of the patients respectively. The number of patients developing major depressive disorder and generalized anxiety disorder was similar between hypothyroid and hyperthyroid category (p>0.05). Anti TPO positivity didn’t have any statistically significant association with presence of anxiety and depressive disorder. Conclusion The overall prevalence was higher among the patients with thyroid disorder as compared to the general population with around half of the patients having at least one psychiatric illness. Hyper or hypo thyroid status do not change the prevalence of major depressive disorder and generalized anxiety disorder.

Mental capacity including testamentary capacity.

Mental capacity including testamentary capacity.

Prediction of Physical Characteristics, Cognitive Function and Community Participation on Mental Health State of Frail Male Elderly Outpatients

Background: It has been pointed out that the elderly with frailty are more likely to be at risk of depression than the elderly without frailty. There are few researches that explored the predictability of physical characteristics, cognitive function, and community participation on the mental health state of male elderly outpatients with frailty. The purpose of this study was to explore the predictability of the basic attributes, physical characteristics, cognitive function, and community participation on the mental health state of male elderly outpatients with frailty. Methods: Through purposive sampling, the questionnaires were distributed and collected in the internal medicine clinic of a teaching hospital in northern Taiwan to include a total of 190 male elders as the cases of this study. The data collection included basic attributes, physical characteristics, cognitive function, community participation, and mental health state evaluation. Results: The results of the study show that scores of the male elderly with frailty were statistically different in mental health state in terms of age (t = –3.54, p < 0.001), domicile (t = 15.99, p < 0.001), income (t = 7.81, p < 0.005), self-perceived health status (t = 35.39, p < 0.001), drinking (t = 7.03, p < 0.05); left hand muscle strength (t = 2.15, p < 0.05), average muscle strength of both hands (t = 2.03, p < 0.05); in terms of physical characteristics between the instrumental activities of daily living total score (t = 5.03, p < 0.001) and instrumental activities of daily living scale grouping (t = 14.82, p < 0.001), and cognitive function score (t = 2.87, p < 0.005), as well as for community participation in Control (t = 2.57, p < 0.05), wholehearted devotion (t = 2.13, p < 0.05) and Community participation grouping (t = 5.66, p < 0.05). In addition, self-perceived good and normal health status (OR = 0.09, p = 0.004; OR = 0.12, p = 0.026), mild disability (OR = 4.74, p = 0.021), and mild dementia (OR = 0.18, p = 0.044) can all predict the mental health state of the elderly. Conclusions: Self-perceived health status, mild disability, and mild dementia could predict the mental health state of the male elderly with frailty and is worthy of attention.

The Tree Drawing Test in Evolution: An Explorative Longitudinal Study in Alzheimer's Disease.

To study the evolution of the Tree Drawing Test (TDT) in a group of Alzheimer's disease (AD) patients. A total of 33 AD patients were consecutively evaluated by Mini Mental State Evaluation (MMSE) and TDT. The evolution of the TDT parameters, trunk-to-crown (TC) and space occupation (SO) index, were analyzed. The median age at first visit was 79years. Globally, trees drawn by patients showed an evolution characterized by a progressive reduction of the crown compared to the trunk. TC index showed a significant linear growth change (2.52 points per year) while SO index did not significantly increase. No significant associations were found examining the relations between MMSE and TC and SO index. TDT could represent a complementary technique to the main neuropsychological screening tests for orienting cognitive impairment diagnosis and an aid in following the evolution of cognitive impairment over time in AD patients.

Children’s cognitive function and mental health based on finite element nonlinear mathematical model

Abstract This article uses a finite element nonlinear mathematical model to analyse the psychological conditions of children with certain physical defects. The thesis uses exercise and psychological intervention to intervene in children with material defects and scores the children’s mental state and cognitive status after the intervention. After our training and psychological intervention, the study found that the psychological evaluation scores of children with physical defects increased significantly. Before and after the intervention, there are apparent differences in children’s cognition in vocabulary and arithmetic. There is a nonlinear negative correlation between children’s cognitive abilities with physical defects and the scores of mental health status and neuropsychological evaluation. For this reason, the study concluded that movement and psychological intervention play a significant role in improving the cognitive function of children with physical defects.

An Abrupt Change in Mental Status.

Dr. Hazar Khidir: Today's case is that of a 35-year-old woman brought to the Emergency Department (ED) for evaluation of altered mental status. She was brought in by her partner, who provided the entirety of the initial history, given her altered mental status. Per her partner, she did not have any preceding medical history and was a full-time graduate student. Her symptoms started 5 days prior to presentation when she complained of muscle pain, a mild headache, and nausea. Later that evening, she also developed a fever to 38.3°C (101°F).

Label-Based Alignment Multi-Source Domain Adaptation for Cross-Subject EEG Fatigue Mental State Evaluation.

Accurate detection of driving fatigue is helpful in significantly reducing the rate of road traffic accidents. Electroencephalogram (EEG) based methods are proven to be efficient to evaluate mental fatigue. Due to its high non-linearity, as well as significant individual differences, how to perform EEG fatigue mental state evaluation across different subjects still keeps challenging. In this study, we propose a Label-based Alignment Multi-Source Domain Adaptation (LA-MSDA) for cross-subject EEG fatigue mental state evaluation. Specifically, LA-MSDA considers the local feature distributions of relevant labels between different domains, which efficiently eliminates the negative impact of significant individual differences by aligning label-based feature distributions. In addition, the strategy of global optimization is introduced to address the classifier confusion decision boundary issues and improve the generalization ability of LA-MSDA. Experimental results show LA-MSDA can achieve remarkable results on EEG-based fatigue mental state evaluation across subjects, which is expected to have wide application prospects in practical brain-computer interaction (BCI), such as online monitoring of driver fatigue, or assisting in the development of on-board safety systems.

Grocery Shopping Has Become Complicated. Managing Dual-tasks in a Supermarket for Patients with Alzheimer’s Disease

The executive functions neuropsychological assessment with paper and pencil tests is particularly sensitive to the lack of ecological validity. If the purpose of the clinician is not to get a merely theoretical measure, but to assess the deficit impact on patient’s life, the classical tests for executive functions are not very informative. A more ecological measure could be provided by the direct observation of the patient in his daily life, but this practice is largely cost-demanding and difficult to implement. Moreover by assuming an enactive cognition approach, the role of interaction between the embodied behaviors and the affordances provided in the coupling with the environment in which the agent’s activity is placed remains unrevealed from classical neuropsychological tests. Recently, the introduction of virtual reality simulations in clinical neuropsychology seems to provide peculiar opportunities for the evaluation of the ecological impact of disease in neurological patients, while introducing new inputs for the research on embodied cognition and enactive knowledge acquisition. This contribution aims in analyzing how a virtual reality dual-task test, set in the scene of a supermarket, can be used to assess executive functions in adult/elderly population and in patients with Alzheimer disease. The results show that the test has convergent validity, compared to the Mini Mental State Evaluation and Tower of London tests and discriminant validity in identifying the degenerative disease, compared to healthy subjects matched for age, sex and education.

The Gaps Between the Self and Professional Evaluation in Mental Health Assessment of COVID-19 Cluster Cases.

Objective: To analyze the discrepancy between self-rating and professional evaluation of mental health status in coronavirus disease 2019 (COVID-19) cluster cases.Method: A total of 65 COVID-19 cluster cases admitted to Beijing Ditan Hospital Capital Medical University from June 14, 2020 to June 16, 2020 were included in the study. Mental health assessment was completed by self-rating and professional evaluation. The gaps between self-rating and professional evaluation in different demographic characteristics were compared.Results: The results of self-rating were inconsistent with those of professional evaluation. The gap was statistically different among certain demographic subgroups. As for anxiety, the gaps had remarkable statistics differences in subgroups of sex, monthly income, infection way, and anxiety/depression medical history. Similarly, in the terms of depression, the gaps had significant statistic differences in the subgroups of the medical history of anxiety/depression, history of physical disease, employment status and the insurance type, marriage, education (year), residing in Beijing (year), and the monthly income.Conclusion: Compared to the professional evaluation, patients had a higher self-rating, which may be related to some demographic characteristics. It suggests that screening can be conducted in patients with COVID-19 by self-rating first, and then professional evaluation should be carried out in the patients with suspicious or positive results.

Nutrition Therapy in Non-intubated Patients with Acute Respiratory Failure.

Purpose of ReviewA challenging aspect of the care for patients with acute respiratory failure is their nutrition management. This manuscript consists of a literature review on nutrition therapy in non-intubated patients with acute respiratory failure receiving high-flow nasal cannula oxygenation or non-invasive positive pressure ventilation.Recent FindingsStudies show that non-intubated patients with acute respiratory failure either on non-invasive ventilation or high-flow nasal cannula are largely underfed in the initial phase of their hospitalization. Although data is limited, the available evidence suggests the feasibility of initiating oral diet in the majority of these patients in the early phase.SummaryInitial evaluation includes mental status evaluation, the Yale swallowing screening protocol, and an assessment of severity of illness. The goal should be to initiate oral diet within 24 h. If patient cannot initiate oral diet, the reason for not initiating oral diet should dictate the next step. For instance, if the reason is failure of the swallow screening, further evaluation with fiberoptic endoscopy is warranted. The inability to provide oral diet for a patient in respiratory distress may a harbinger of failure of non-invasive oxygen therapy and should prompt consideration for endotracheal intubation. We suggest placement of a small-bore feeding tube for enteral nutrition if patient is unable receive oral diet after 48 h.ConclusionsThe nutrition management of these patients is better provided by a multidisciplinary team in a protocolized manner.

Investigation on the Mental Health Status of ICU Practitioners and Analysis of Influencing Factors During the Stable Stage of COVID-19 Epidemic in China.

Objective: To understand the impact of COVID-19 epidemic on the mental health status of intensive care unit (ICU) practitioners in China, and to explore the relevant factors that may affect the mental health status of front-line medical workers so as to adopt efficient and comprehensive measures in a timely manner to protect the mental health of medical staff.Methods: The study covered most of the provinces in China, and a questionnaire survey was conducted based on the WeChat platform and the Wenjuanxing online survey tool. With the method of anonymous investigation, we chose ICU practitioners to participate in the investigation from April 5, 2020 to April 7, 2020. The respondents were divided into two groups according to strict criteria of inclusion and exclusion, those who participated in the rescue work of COVID-19 (COVID-19 group) and those who did not (non-COVID-19 group). The SCL-90 self-evaluation scale was used for the evaluation of mental health status of the subjects.Results: A total of 3,851 respondents completed the questionnaire. First, the overall mental health status of the targeted population, compared with the Chinese norm (n = 1,388), was reflected in nine related factor groups of the SCL-90 scale, and significant differences were found in every factor in both men and women, except for the interpersonal sensitivity in men. Second, the overall mental health of the non-COVID-19 group was worse than that of the COVID-19 group by the SCL-90 scale (OR = 1.98, 95% CI, 1.682–2.331). Third, we have revealed several influencing factors for their mental health in the COVID-19 group, current working status (P < 0.001), satisfaction of diet and accommodation (P < 0.05), occupational exposure (P = 0.005), views on the risk of infection (P = 0.034), and support of training (P = 0.01).Conclusion: The mental health status of the ICU practitioners in the COVID-19 group is better than that of the non-COVID-19 group, which could be attributed to a strengthened mentality and awareness of risks related to occupational exposure and enforced education on preventive measures for infectious diseases, before being on duty.

A grocery list learning and memory screening test: Initial performance data stratified by age and IQ

Patients frequently verbalize memory complaints that require evaluation. A brief objective screening test of short-term aka episodic memory would be useful. Assessment of verbal episodic memory is a central factor in neurocognitive status, frequently evaluated with list learning and memory tests. Currently, normed list learning tests of verbal episodic memory are mostly high demand, long, and composed of unrelated items and thus can be onerous and disinteresting for certain populations, such as those who are cognitively limited, elderly, or poorly motivated. Presented here are initial performance data for a brief, low demand, readily accepted nine-item grocery list test, derived from the Dementia Assessment Battery, including three learning trials and one delayed recall trial. With this data set, the test can thus be useful in a wide range of assessment circumstances including screening, brief evaluations, mental status evaluations, and bedside deployment.