Agreement and conversion formula between mini-mental state examination and montreal cognitive assessment in an outpatient sample

AIM To explore the agreement between the mini-mental state examination(MMSE) and montreal cognitive assessment(Mo CA) within community dwelling older patients attending an old age psychiatry service and to derive and test a conversion formula between the two scales.METHODS Prospective study of consecutive patients attending outpatient services.Both tests were administered by the same researcher on the same day in random order.RESULTS The total sample(n = 135) was randomly divided into two groups.One to derive a conversion rule(n = 70),and a second(n = 65) in which this rule was tested.The agreement(Pearson's r) of MMSE and Mo CA was 0.86(P < 0.001),and Lin's concordance correlation coefficient(CCC) was 0.57(95%CI:0.45-0.66).In the second sample Mo CA scores were converted to MMSE scores according to a conversion rule from the first sample which achieved agreement with the original MMSE scoresof 0.89(Pearson's r,P < 0.001) and CCC of 0.88(95%CI:0.82-0.92).CONCLUSION Although the two scales overlap considerably,the agreement is modest.The conversion rule derived herein demonstrated promising accuracy and warrants further testing in other populations.

Ecological Momentary Assessment with smartphones for measuring mental health problems in adolescents

AIM To analyze the viability of Ecological Momentary Assessment(EMA) for measuring the mental states associated with psychopathological problems in adolescents.METHODS In a sample of 110 adolescents,a sociodemographic data survey and an EMA Smartphone application over a oneweek period(five times each day),was developed to explore symptom profiles,everyday problems,coping strategies,and the contexts in which the events take place.RESULTS The positive response was 68.6%.Over 2250 prompts about mental states were recorded.In 53% of situations the smartphone was answered at home,25.5% of casesthey were with their parents or with peers(20.3%).Associations were found with attention,affective and anxiety problems(P < 0.001) in the participants who took longer to respond to the EMA app.Anxious and depressive states were highly interrelated(rho = 0.51,P < 0.001),as well as oppositional defiant problems and conduct problems(rho = 0.56,P < 0.001).Only in 6.2% of the situations the subjects perceived they had problems,mainly associated with inter-relational aspects with family,peers,boyfriends or girlfriends(31.2%).We also found moderate-high reliability on scales of satisfaction level on the context,on positive emotionality,and on the discomfort index associated with mental health problems.CONCLUSION EMA methodology using smartphones is a useful tool for understanding adolescents' daily dynamics.It achieved moderate-high reliability and accurately identified psychopathological manifestations experienced by community adolescents in their natural context.

Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan

AIM: To clarify the components of hospitalization for assessment(HfA) and the management changes from the beginning of the scheme to the present.METHODS: This study is composed of two surveys. In 2013 survey, we created two paper questionnaires(facility and case questionnaires) for psychiatrists working in psychiatric hospitals accepting HfA patients. Questionnaires were sent to 205 hospitals that were identified as accepting the Hf A cases, and responses were requested via mail. The facility questionnaire was designed to clarify the following specifications and characteristics of each facility: the facility organizer(public sector or private hospital), and the number of beds, psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, psychotherapists, public health nurses, and patients treated through Hf A during the survey period. The case questionnaire was then used to collect data of the patients under Hf A based on the Medical Treatment and Supervision(MTS) Act who were discharged between July 1, 2012 and June 30, 2013. Gathered information included: legal information of each case, demographic data, past history of the offenders, issued offense and the relationship to the victim, information regarding past psychiatric testimonies, psychiatric diagnoses, contents of the treatment during Hf A, information regarding seclusion and restraint during the Hf A, the verdict of the District Court panel, and so forth. Next, we compared those results with relevant data obtained in 2007. The 2007 survey comprised data of Hf A patients from July 15, 2005(the date the MTS Act was enforced) to January 15, 2007.RESULTS: We obtained 171 cases, approximately a half of whole contemporary cases of HfA, from 134 facilities, of which 46 were national, prefectural, or semi-official hospitals, and 88 were private hospitals, in 2013 survey. The majority of subjects were male, schizophrenic, and experienced previous psychiatric treatment. The most frequent type of the offense was injury, followed by arson. Most of the subjects were medicated, and a few cases took psychotropic injection during the Hf A. The frequency of injection was decreased in 2013(χ2 = 7.54, df = 1, P = 0.006) than in 2007. Psychiatric testimony was more likely to be conducted in 2013(χ2 = 8.56, df = 1, P = 0.004). The examiner psychiatrist was more likely to belong to the Hf A facility to which the patient was hospitalized(χ2 = 5.32, df = 1, P = 0.02). Hospitalization orders were more frequently selected in 2013(χ2 = 19.76, df = 3, P < 0.001), although the characteristics of the subjects had not changed.CONCLUSION: Although the management of HfA has improved in recent years, structural problems remain.

Health Professionals’ Attitudes towards Electronic Psychosocial Assessments in Youth Mental Healthcare

Psychosocial assessments can help mental health professionals establish good therapeutic relationships while simultaneously conducting holistic assessments of their young clients. Using technology to conduct assessments may increase disclosure by young people;however, the uptake of new technologies into current face-to-face practice has been slow. In the current study, we were interested in exploring the attitudes of mental health workers to using an electronic psychosocial assessment tool (e-tool) within face-to-face service delivery with adolescents and young adults. An exploratory design was used to identify and qualitatively describe the views of 46 mental health workers from services across the ACT and Victoria, Australia. Data were coded using an inductive thematic approach. Comments indicated that mental health workers held both positive and negative views about the e-tool. Some participants believed that it would allow disclosure to occur in a stepped process, normalize questions, give youth greater input, and be time efficient. However, the majority believed that the e-tool would infringe on their work because they needed to respond to their clients immediately, it would not provide an accurate representation of the client, young people did not have the necessary capabilities to engage in the process, they would miss non-verbal cues from the young person, and they were more likely to gain information from organic conversations. The results suggest that many mental health professionals may be fearful of incorporating new technologies in current practice. Specific training and supportive implementation guidelines must be developed to support use of these new technologies and change practice.

Mental Health Assessment of Elderly People Attending Geriatric Clinic in Medical City

Background: Worldwide elderly population and their life expectancy are increasing gradually. Longevity in most cases brings down poorer health as well as functional status. Thus, it is necessary to understand the problems as well as social, psychological, and medical needs of elderly people in order to plan their optimal care. Objectives: To assess the mental health status (depression and memory state) of elderly people attending Geriatric clinic in medical city, and to determine the influence of some sociodemographic factors on elderly mental health status. Subjects and Method: A cross-sectional study was conducted among elderly people aged 60 years and more who attended geriatric clinic of medical city in Baghdad, from 1st of April to the end of June 2015. Special questionnaire form had been used for data collection via direct interview. The evaluation of the mental state was performed by using modified version of Wechsler Memory Scale and geriatric depression scale. Results: A total of 400 elderly persons were enrolled in the study, 109 (27.3%) of them had impaired memory. The analysis of data revealed that the age and marital status had statistical significant association with memory state. Nearly three quarter (72.8%) of study group had depression according to geriatric depression scale. The majority of studied women had depression (90%), and the same percentage was observed among widowed elders joining in the study.

Intelligent Student Mental Health Assessment Model on Learning Management System

A learning management system(LMS)is a software or web based application,commonly utilized for planning,designing,and assessing a particular learning procedure.Generally,the LMS offers a method of creating and delivering content to the instructor,monitoring students’involvement,and validating their outcomes.Since mental health issues become common among studies in higher education globally,it is needed to properly determine it to improve mental stabi-lity.This article develops a new seven spot lady bird feature selection with opti-mal sparse autoencoder(SSLBFS-OSAE)model to assess students’mental health on LMS.The major aim of the SSLBFS-OSAE model is to determine the proper health status of the students with respect to depression,anxiety,and stress(DAS).The SSLBFS-OSAE model involves a new SSLBFS model to elect a useful set of features.In addition,OSAE model is applied for the classification of mental health conditions and the performance can be improved by the use of cuckoo search optimization(CSO)based parameter tuning process.The design of CSO algorithm for optimally tuning the SAE parameters results in enhanced classifica-tion outcomes.For examining the improved classifier results of the SSLBFS-OSAE model,a comprehensive results analysis is done and the obtained values highlighted the supremacy of the SSLBFS model over its recent methods interms of different measures.

The Potential of Simulation to Enhance Nursing Students’ Preparation for Suicide Risk Assessment: A Review

Suicide risk assessment is a critical skill in preventing suicide. Yet most nurses do not feel confident in assessing suicide risk. Development of this potentially life-saving skill needs to begin at the undergraduate nursing level. As simulation is an effective pedagogical tool utilised within nursing education, the aim of this paper was to explore the potential of simulation in preparing student nurses’ for suicide risk assessment. Literature was examined to identify what simulation modalities were employed within nursing education and the outcomes associated with these. The findings suggest that to varying degrees all simulation modalities have the potential to decrease student anxiety, and increase student confidence, knowledge and communication skills when working with people at risk of suicide. However the use of Standardised Patient (SP) simulation adds an authenticity to the experience and allows for the assessment of a wider range of human responses, including key nonverbal communication skills. The sense of realism provided by SP allows for more in-depth understanding into the person’s experiences, which is critical in the assessment of a person’s mental health needs and risk of suicide. The majority of simulations identified were located within a mental health setting. Given that student nurses may encounter a person who is suicidal in any clinical setting, further research is needed on simulation which integrates mental health assessments and suicide risk assessment into a variety of clinical areas.

A Brief Clinical Assessment of Cognitive Deficit with Impaired Daily Living Functioning in Parkinson’s Patients with and without Dementia

Cognitive decline in Parkinson’s disease (PD) is defined as dementia which affects activities of daily living (ADL) function. Dementia is one of the recognized issues in the treatment of Parkinson’s disease patients (PDP) as it is becoming a major contributor to morbidity. The objective of our study was to evaluate the cognitive decline in Parkinson’s disease patients (PDP) and the influence of cognition on daily living function deterioration in cognitively impaired and cognitively unimpaired PDP. Cognitively impaired PDP (n = 24), and cognitively unimpaired PDP (n = 16) were administered MoCA and MMSE performance based tests for cognitive measurements and Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) to determine everyday functioning. The significances of MoCA and MMSE among cognitively impaired PDP and cognitively unimpaired PDP in univariant analysis were P < 0.001 and P < 0.05. In partial correlation, MoCA was strongly related to ADL function as compare to MMSE (r = 0.623, P = 0.001). Cognitively impaired PDP showed significantly lower score on visuo-construction and attention. Among all variables of MoCA domains, attention is strongly associated with instrumental activity daily living (IADL) scores (logistic regression coefficient = 0.672, P = 0.01). These results suggest that dementia affects daily living performances especially the IADL tasks like attention and execution. Therefore, the assessment of complex daily activities particularly IADL is probably useful for the diagnosis of early stage cognitive impairment in PDP. Further MMSE test is less sensitive than MoCA for detecting significant cognitive decline in PDP and impaired attention is an important determinant of ADL functions in cognitively impaired PDP.

Need for education of psychiatric evaluation of offenders with mental disorders:A questionnaire survey for Japanese designated psychiatrists

BACKGROUND The management of offenders with mental disorders has been a significant concern in forensic psychiatry.In Japan,the introduction of the Medical Treatment and Supervision Act in 2005 addressed the issue.However,numerous psychiatric patients at risk of violence still find themselves subject to the administrative involuntary hospitalization(AIH)scheme,which lacks clarity and updated standards.AIM To explore current as well as optimized learning strategies for risk assessment in AIH decision making.METHODS We conducted a questionnaire survey among designated psychiatrists to explore their experiences and expectations regarding training methods for psychiatric assessments of offenders with mental disorders.RESULTS The findings of this study’s survey suggest a prevalent reliance on traditional learning approaches such as oral education and on-the-job training.CONCLUSION This underscores the pressing need for structured training protocols in AIH consultations.Moreover,feedback derived from inpatient treatment experiences is identified as a crucial element for enhancing risk assessment skills.

Evaluation and treatment of altered mental status patients in the emergency department:Life in the fast lane

BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS： This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months （June 2009 to June 2011）. Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively.RESULTS： In 1934 patients with AMS recruited, accounting for 0.93% of all emergency department （ED） patients, 1 026 （53.1%） were male, and 908 （46.9%） female. Their average age was 51.95±15.71 years. Etiologic factors were neurological （n=641; 35.0%）, pharmacological and toxicological （n=421; 23.0%）, systemic and organic （n=266; 14.5%）, infectious （n=167; 9.1%）, endocrine/metabolic （n=145; 7.9%）, psychiatric （n=71; 3.9%）, traumatic （n=38; 2.1%）, and gynecologic and obstetric （n=35; 1.9%）. Total mortality rate was 8.1% （n=156）. The death rate was higher in elderly patients （≥60） than in younger patients （10.8% vs. 6.9%, P=-0.003）.CONCLUSION： Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.

Help received from relatives and services to satisfy needs of adults with severe mental disorders

Background: Few studies have considered the impact of demographic and clinical variables on help received respectively from services and relatives to satisfy needs of adults with severe mental disorders (SMD). Purposes: To identify major needs receiving help and, using the Andersen’s Behavioural Model of Health Service Use, to identify and compare predisposing, enabling and need factors associated with help given respectively by services and relatives. Methods: 352 adults with SMD from Montreal (Canada) were interviewed using six standardized instruments. Clinical records were consulted. Multiple linear regression analyses were processed to measure level of help received from relatives and services. Results: Factors significantly associated with help from relatives were: higher number of perceived needs;fewer diagnoses;better community functioning;being younger, and in a conjugal relationship;living autonomously;having social support and better quality of life;and, marginally, being an immigrant. Factors significantly associated with help from services were: higher number of perceived needs, better quality of life, supervised housing, adjustment disorder and schizophrenia. Conclusions: Help overall is insufficient to meet users’ needs. Services are more helpful than relatives, in particular regarding health needs. Comparatively to help from services, help from relatives is associated with predisposing factors like age, marital status and nationality.

学校心理健康测评标准化研究

学校心理健康测评工作对于帮助学校了解学生的心理状况、制定教育计划以及提供必要的心理干预具有重要意义。文章阐述了学校心理健康测评工作背景,通过问卷调查分析了现状和目前存在的主要问题,构建了学校心理健康测评标准化体系,旨在促进学校心理健康测评标准化、规范化。

典型蔬菜基地土壤重金属污染风险评估及其源解析

为探究典型蔬菜基地土壤重金属的污染特征,评估其生态风险,以黄山市徽州区蔬菜基地表层土壤为研究对象,采用多种污染评价方法对其土壤重金属进行风险评价,利用相关性分析与主成分分析法对其进行源解析.结果表明,蔬菜基地土壤pH整体呈酸性,土壤重金属含量平均值大小为Cr>Zn> Cu> Pb> Ni> As> Cd;除Cd含量超过国家标准外,其余均合格,但均超出了安徽省土壤环境背景值,其中,Cd与As分别超标为422.68%与264.33%.土壤重金属污染指数平均值均大于1,其中,Cd与As的潜在污染指数值均大于3,达到重度污染水平.地累积指数评估结果显示,除重金属Cd为中度污染外,其余重金属均在轻度污染以下水平.重金属Cd的潜在生态风险等级在较强及以上,其余均为轻度.重金属来源途径多种,主要与人类生产活动和成土母质有关,其中,Cd、As污染主要来自于人为源.综上可见,蔬菜基地土壤整体生态风险较高,土壤重金属存在积累趋势,应防范其潜在危害.

前庭性偏头痛患者认知功能测评及眼震视图分析

目的测评前庭性偏头痛(VM)患者认知功能水平,分析、探讨眼震视图(VNG)在VM患者认知功能中的评估价值。方法选择2022年3月—2023年6月在启东市人民医院诊疗的60例VM患者为研究对象(VM组),同期纳入无眩晕、偏头痛或其他神经系统疾病的60例正常者作为对照(NC组)。采用简易精神状态评价量表(MMSE)、蒙特利尔认知评估量表(MoCA)来评估VM组和NC组的总体认知水平,并使用重复性神经心理状态评定量表(RBANS)进行神经心理及多领域认知功能的全面测评,利用VNG观察VM患者眼动特征。结果与NC组相比,VM组患者轻度认知障碍(MCI)的发生率明显增加,MoCA评分显著降低,差异具有统计学意义(P<0.01);在即刻记忆、视觉广度、语言功能、注意力、延时记忆、处理速度和执行功能多个认知域均存在明显受损,差异具有统计学意义(P<0.05);与NC组相比,VM组患者MMSE评分偏低,但差异无统计学意义(P>0.05)。从VNG结果分析,VM组患者扫视试验、平稳跟踪试验、视动试验、位置性眼震的发生率均高于NC组,差异具有统计学意义(P<0.05);而自发性眼震、凝视试验的发生率与NC组相比差异无统计学意义(P>0.05)。结论VM患者认知功能损害较明显,体现在记忆力、语言能力、视觉广度、注意力、处理速度及执行功能等方面;分析VNG特征,发现前庭系统对VM患者的认知功能有显著影响。

青少年参加体育兴趣班的健康效应研究

利用青少年健康主题数据库的调查数据,采用OLS回归、工具变量法、中介效应检验法等,从身体健康、心理健康、自评健康三个维度实证检验参加体育兴趣班对青少年健康的影响及作用机制。研究发现:青少年参加体育兴趣班具有健康效应,体现在参加体育兴趣班对青少年体质健康得分和自评健康具有显著的正向影响,对精神症状自评得分具有显著的负向影响;中介机制检验发现参加体育兴趣班是通过促进青少年参加课余体育活动进而提高其体质健康得分、自评健康和降低其精神症状自评得分;异质性分析发现参加体育兴趣班影响青少年健康不存在性别及城乡差异,但参加体育兴趣班提高初中生体质健康得分的效果更明显,提高高中生自评健康的效果更明显。

关爱未来:家校社全方位护航——美国儿童青少年心理健康服务概述

美国儿童青少年心理健康问题的现状是一个备受关注的议题。文章概括了美国儿童青少年的心理问题类别及现状,梳理了美国政府有关心理健康问题的职能、应对措施及关注儿童青少年心理健康问题的机构和政策,并在此基础上重点介绍了美国学校、社区、社会和家庭心理健康服务,以及信息化手段在儿童青少年心理健康的咨询、评估和治疗中的重要应用。总体而言,美国以其多层次的机构共建和家校社的全方位护航,为儿童青少年的健康发展赋予希望和未来。

黄河口国家公园湿地土壤重金属污染评价

为了研究黄河口国家公园湿地土壤污染状况和生态风险,沿黄河故道东营段、黄河入海口以及沿海处共设20个采样点进行土壤采集,对铅、镉、铬、铜、锌、镍、汞、砷8种重金属含量进行检测,并利用综合污染指数法、地累积指数法和潜在生态风险指数法进行土壤污染评价。结果表明:研究区铅、镉、铬、铜、锌、镍、汞、砷元素的质量比分别为16.4、0.11、57.3、14.0、46.9、20.0、0.014、7.71 mg/kg,均符合农用地土壤污染风险管控标准要求;研究区土壤综合污染指数为0.57,地累积指数为-0.23,潜在生态风险指数为65.54,表明研究区属于无污染土壤,存在轻微潜在生态风险。

基于现状—背景—评估—建议模式的心理护理对老年糖尿病患者心理状态及疾病不确定感的影响

目的:探讨基于现状—背景—评估—建议(SBAR)模式的心理护理对老年糖尿病患者心理状态及疾病不确定感的影响,为临床护理提供依据。方法:选取2019年1月—2021年12月郑州大学第一附属医院内分泌及代谢病科收治的100例老年糖尿病患者作为研究对象,按照随机原则将其分为对照组与研究组,每组各50例。对照组实施常规护理干预,研究组在常规护理基础上实施基于SBAR模式的心理护理干预。比较两组患者干预前后心理状态[中文版简明心境量表(BPOMS)评分]、疾病不确定感[Mishel疾病不确定感量表(MUIS-A)评分]及健康赋权(老年慢性病患者健康赋权量表评分)情况。结果:干预后,研究组患者BPOMS各维度评分及总分均明显低于对照组,差异有统计学意义(t=3.818、4.702、5.516、5.189、6.289、6.403、3.602,P<0.05)。干预后,研究组患者MUIS-A各维度评分及总分均明显低于对照组,差异有统计学意义(t=11.773、11.522、12.224、9.832、13.670,P<0.05)。干预后,研究组患者健康赋权量表各维度评分及总分均明显高于对照组,差异有统计学意义(t=7.773、8.676、7.282、7.905、8.704、6.782,P<0.05)。结论:基于SBAR模式的心理护理干预能够有效改善老年糖尿病患者的心理状态,减轻患者的疾病不确定感,提高患者的健康赋权水平。

心理健康管理策略与进展

心理健康管理是一门新兴学科,系运用健康管理学理念、强调心理健康变化的全生命周期管理,其重点在于分级预防与分层管理策略、突出重点人群、实施心理健康筛查、反对精神疾病的诬名化和歧视、应用新技术及新服务模式。该专业方向目前方兴未艾,在“健康中国”目标下,构建以三级医疗体系为主、其他心理健康服务机构并存的服务体系,从群体和个体两个层面打造针对广大人民群众的有效、精准、体验佳的服务大有可为。

腔隙性脑梗死患者认知功能障碍与颅脑MRI显示脑白质变化的关系

目的:分析腔隙性脑梗死患者认知功能障碍与颅脑磁共振成像(MRI)显示脑白质变化的关系。方法:选取2021年1月—2023年12月广西壮族自治区江滨医院收治的98例腔隙性脑梗死患者作为研究对象,均接受MRI检查,并采用简明精神状态检查量表(MMSE)及蒙特利尔认知功能评估量表(MoCA)评估患者认知功能,并依据MRI检查结果将患者分组,比较不同分组患者临床资料,并采用Spearman相关性分析腔隙性脑梗死MRI脑白质变化与上述量表评分的关系。结果:98例患者经MRI检查,依据脑白质病变分级标准,0级19例(0级组),1级26例(1级组),2级30例(2级组),3级23例(3级组)。四组临床资料比较,差异无统计学意义(P>0.05)。四组MMSE评分、MoCA评分比较,差异有统计学意义(P<0.05);Spearman相关性分析显示,腔隙性脑梗死患者脑白质病变程度与MMSE评分、MoCA评分呈负相关(r=-0.823、-0.808,P<0.05)。结论:腔隙性脑梗死患者认知功能障碍与其脑白质病变有关,相关认知功能评分与脑白质病变严重程度呈负相关,临床可依据脑白质病变情况对患者认知功能损害进行预估。