6635-W2-D16

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Thorough psychiatric interviews form the basis of the provider-patient relationship, helping to establish rapport, formulate a diagnosis and plan, and influence treatment outcomes. To gain a multidimensional understanding of the biopsychosocial interactions for any patient and their resultant mental health, it is crucial to gather many types of information systematically and comprehensively while maintaining empathy, trust, and confidentiality. Three particularly important components of the psychiatric interview include the patient’s psychiatric history, the personal and social history, and the formulation portion. The patient’s psychiatric history can give valuable insight into previous and current psychiatric diagnoses, prior psychiatric treatments or hospitalizations, and insights into high-risk behaviors such as previous suicidal attempts or violence/aggression toward others. The personal and social history can identify factors such as birth or developmental issues, adverse life experiences such as parental abuse, personal habits such as alcohol or substance use, relationship history and current support system, and insights into the patient’s personality. This portion helps to form a complete picture of the individual and gives the provider valuable information about stressors, risks, and potential sources of support in the patient’s life. Formulation, or a summary of the key aspects of the interview, can help to identify potential biopsychosocial factors that may be playing a role in the patient’s mental health problems as predisposing, precipitating, or maintaining factors (Psychiatry lectures, 2015). This component of the interview also typically includes a risk assessment in which the provider attempts to rate the risk of the patient in regard to themselves and others as well as determine the patient’s risk of being abused or exploited by other parties. According to the American Psychiatric Association (2016), this is also the time in the interview to educate the patient about their potential diagnosis and collaborate regarding treatment options including the risks and benefits of treatment versus untreated illness. Another important part of the interview is the mental status examination, and my assigned rating scale, the Mini Mental State Exam (MMSE) can be a valuable tool for the provider when attempting to establish the mental state and cognitive functioning of an individual. The MMSE is a well-known and commonly used screening test since 1975 for cognitive decline such as that occurs with dementia, and is well regarded for its ease of administration, reliability, ease of translation into many other languages, and validity across multiple cultures (Nagaratnam et al., 2022). Additionally, evaluation proved that reliability is still excellent whether it is administered traditionally (in person) or remotely, making it ideal for telemedicine and the ability to help screen underserved or rural populations (Gallegos et al., 2022). A set of 11 questions and exercises assessing cognitive ability in 6 areas, the MMSE tests the individual’s ability to understand and follow instructions, orientation to time and place, concentration and attention span, immediate and short-term memory, language, and visual and spatial abilities. The MMSE is a cognitive examination, included as a part of the mental status examination, that gives the provider valuable information about the patient’s current mental state as well as the ability to track potential changes or declines in cognitive abilities over time. While the MMSE is theoretically appropriate for all adult populations and may be performed after illnesses/infections that could affect cognition such as head injury, Nagaratnam et al. (2022) state that there is a well-established ceiling effect in young and cognitively healthy individuals that makes it less reliable for subtle cognitive decline or subtle changes in cognition. These individuals begin to have significant cognitive declines before a significant change in their MMSE scores. This effect ends after middle age, and MMSE scores are particularly reliable in assessing for dementia in the older population. A systematic review by Creavin et al., (2016) estimated that 85% of individuals with dementia were correctly identified with the MMSE and

90% of those without dementia were correctly identified as well. Thus, after decades of evaluation, the MMSE is still proving to have good psychometric properties, particularly for elderly adults. References American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults. (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760 ( https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760 ) Creavin, S. T., Wisniewski, S., Noel, S. A. H., Trevelyan, C. M., Hampton, T., Rayment, D., Thom, V. M., Nash, K. J. E., Elhamoui, H., Milligan, R., Patel, A. S., Tsivos, D. V., Wing, T., Phillips, E., Kellman, S. M., Shackleton, H. L., Singleton, G. F., Neale, B. E., Watton, M. E., & Creavin, S. T. (2016). Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews, 1. DOI: 10.1002/14651858. Gallegos, M., Morgan, M. L., Cervigni, M., Martino, P., Murray, J., Calandra, M., Razumovskiy, A., Caycho- Rodríguez, T., & Gallegos, W. L. A. (2022). 45 Years of the mini-mental state examination (MMSE): A perspective from Ibero-America. Dementia & neuropsychologia, 16(4), 384–387. https://doi.org/10.1590/1980-5764-DN-2021-0097 ( https://doi.org/10.1590/1980-5764-DN-2021-0097 ) Nagaratnam, J. M., Sharmin, S., Diker, A., Lim, W. K., & Maier, A. B. (2022). Trajectories of mini-mental state examination scores over the lifespan in general populations: A systematic review and meta- regression analysis. Clinical Gerontologist: The Journal of Aging and Mental Health, 45(3), 467–476. https://doi.org/10.1080/07317115.2020.1756021 ( https://doi.org/10.1080/07317115.2020.1756021 ) Psychiatry Lectures. (2015). Psychiatry lecture: How to do a psychiatric assessment [Video]. YouTube. https://www.youtube.com/watch?v=IRiCntvec5U ( https://www.youtube.com/watch?v=IRiCntvec5U )

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