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Three Part Question

In [patients suffering from agitation with a psychiatric cause] is [the mini mental state exam][effective at reliably identifying non-organic causes?]

Clinical Scenario

An agitated and/or hostile patient enters the emergency room. You wonder if there is an underlying non-organic cause to their heightened state of aggression and perform the Mini Mental State exam to identify or exclude these causes.

Search Strategy

MEDLINE 1950 to June week 2 2010 using the OVID interface, EMBASE 1980 to week 24 2010 using the OVID interface, psycINFO 1806 to June week 3 2010 using the OVID interface
[exp Psychiatric Status Rating Scales/ or exp Mental Disorders/ or exp Mental Status Schedule/ or exp Cognition Disorders/ or exp Neuropsychological Tests] AND ["organic".mp.] AND [exp Antipsychotic Agents/ or exp Psychomotor Agitation/ OR "agitation".mp.] AND ["mini mental state".mp.]

Search Outcome

26 papers were found, of which none were relevant

Comment(s)

At present there is no definitive screening process to determine whether a patient in a state of heightened agitation or aggression is suffering from an organic or inorganic cause. Such a paradigm would, in all likelihood, prove to be an invaluable tool for the emergency physician seeking to determine the cause of their patient's aggression or psychosis in order to treat them effectively. The Mini Mental State exam at present is used primarily when dementia is suspected; it could, however, be modified to serve as a screening tool for non-organic causes of psychosis, agitation or aggression. Alternatively new screening scales could be created to serve this purpose.

Clinical Bottom Line

further research is needed.