From bedside to risk board: Harmonizing mental status, neurological findings and risk assessment in contemporary psychiatric practice
Year: 2025
Type: article
Abstract: Fragmented psychiatric assessments—separating the mental status examination (MSE), neurological screening, and risk formulation—drive diagnostic delay, safety incidents, and inequity, particularly in emergency and primary-care interfaces and low-resource settings. We conducted a narrative review informed by realist synthesis, mapping determinants to CFIR and reach/sustainment to RE-AIM. Evidence and guidance were synthesized into a pragmatic pathway that standardizes the first clinical hour: history/MSE, a brief neurological screen with explicit thresholds (e.g., delirium screen, rapid EEG rules for suspected nonconvulsive status epilepticus), and structured risk (e.g., C-SSRS, BVC/HCR-20) translated into an actioned plan. Handover uses a minimum dataset (working diagnosis, MSE anchors, neuro red flags, risk formulation, named follow-up ≤7 days). Measurement emphasizes run/SPC charts, audit-and-feedback, and equity stratification (e.g., HEAT). This standardized core with locally adaptable periphery is feasible under mhGAP task-sharing, supports safer disposition, reduces restraints/readmissions/self-harm, and strengthens ethical, rights-based care while minimizing costs. Done well, bedside reliability becomes risk-board assurance, linking first cues to system-level learning and sustained improvement.
Authors: Duma, James, Paita, Samuel, Kila, Maria, Waine, Betty, Henao, Daniel, Kidu, Ruth, Waine, Joseph, Henao, Anna, Kila, Maria, Namah, David, Somare, Peter, Somare, Lucy, Marape, Grace, Marape, Michael, John, John Kila, Oala, Naomi
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
OpenAlex ID: W7105538253
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