Integrating the Brief Mental State Examination with the General Physical Examination: A Practical Framework for Holistic Clinical Care

Abstract

Psychiatric disorders among patients with physical or general medical conditions are a frequent occurrence; however, they are seldom recognized in non-psychiatric consultations, especially in low and middle-income countries. Globally, the point prevalence of mental disorders is one in eight, with a substantially higher rate among people diagnosed with general medical conditions. Diagnostic oversight of these comorbid mental health conditions can have devastating consequences, including difficulty adhering to treatment, diagnostic delays, higher health care utilization, and higher morbidity and mortality. This manuscript contends for a brief mental state examination to be routinely integrated into the general physical examination conducted by all physicians. An ultra-short and simplified four-item screening psychometric tool for the mood, orientation, and psychotic symptoms is advocated for as a possible assessment framework that can be integrated into the general clinical practice without rigorous specialist psychiatric training.

Integrating a brief mental state examination as part of physical examination will promote comprehensive care, facilitate prompt detection, and timely referral. This form of clinical practice has the potential to better affirm the definition of the World Health Organization about health as a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity.