NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

Mini-Mental State Exam (MMSE)

Health care providers alway use the Mini-Mental State Exam (MMSE)While gathering subjective and objective data to evaluate the mental health status of the elderly. MMSE is a standardized tool used to assess cognitive function changes over time. The 11 items measuring orientation, registration, attention and calculation, recall, ability to follow commands, and language it takes approximately 5 to 10 minutes to administer. The maximum score is 30. A score 20 or less may be associated with dementia, and a score of 26 or higher is not associated with dementia.Higher education is associated with higher MMSE scores, even when dementia is present. MMSE has been translated into multiple languages and adapted for many cultures, and in some cases external validity, sensitivity, and specificity have been evaluated (Ball et al., 2019).

 This test is often used to help diagnose Alzheimer’s disease and dementia. This quantitative-styled survey scores one’s as either zero (incorrect), one (correct), six (item administered, participant does not answer), or nine (test item not administered/unknown). Out of thirty points, a score that ranges between twenty to twenty-four marks mild dementia; thirteen to twenty defines moderate dementia; and anything less than twelve is classified as severe dementia (Alzheimer’s Association, 2019). This tool is often used to get a baseline on the degree of dementia and used to evaluate the effectiveness of medications that function to delay the progression of the disease. While the MMSE provides useful information that adds to a mental health diagnosis, this test should not be the only information used. The National Institute on Aging (2017) asserts that in addition to neuropsychological tests such as the MMSE, providers also use laboratory tests and brain scans to validate a diagnosis of dementia.

The MMSE method has many advantages. The method is popular and it has a large quantity of data that is readily available to find standards that can be used for comparison in various circumstances and settings. It has been made popular because of its standardized structure that can be applied universally that has enabled it to be accepted by many as a measurement unit and a basis for assessing the severity of CI and DEM (Palsetia et al., 2018). Again its structure enables assessment of various cognitive aspects and its rating scale has been accepted globally for measuring mental functioning  It is very quick and easy to practice where it involves less instructions which can be administered in ten minutes and therefore it can be administered with less training and is widely taught in most institutions.. Their scoring system is standardized which makes it easy to calculate the results. The method can be applied using different languages since instructions are simple and can be applied

       The test method also has several disadvantages. The main disadvantage is the fact that the method is not very useful in identifying mild impairment (Palsetia et al., 2018). It also offers problems in detecting changes that occur in severe dementia. The method does not give accurate information for people who are educated because of the ceiling effect (Palsetia et al., 2018). Furthermore, the method does not offer fine details for impairments such as neglect, aphasia and apraxia that occur for people in post-stroke. The method does not put more emphasis for memory loss since it is given only three points while orientation and language are given more most points (Palsetia et al., 2018). This shows that the method is not dedicated to assess the core domain for cognitive ability (Palsetia et al., 2018). Furthermore, the lack of full standardization for the method offers another problem. Three words for the registration stage are critical in the memory stage but there are no criteria for choosing these words. Freedom is given to the examiner to choose these three words of which the choice can be affected by several factors such as frequency of use, familiarity, imaginability others. Other items that are not standardized are drawings and calculations. Besides, some of the instructions require reading and writing skills which limits its use on illiterate people.

In conclusion, MMSE has become a very popular tool for assessing cognitive impairment for older people. Some of the reasons for its popularity is because of shorter instructions, ease of administering and ease of translating the instructions into different languages all over the world. The method fits well for the older generation because it takes a few minutes to complete it. The method reliability was proved to be adequate and its validity was also adequate with a high sensitivity and specificity.


 Alzheimer’s Association. (2019). Medical tests. Retrieved from

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to

physical examination: An interprofessional approach (9th ed.) St Louis, MO: Elsevier


 National Institute on Aging. (2017, December 31). Basics of Alzheimer’s disease and dementia.

Retrieved from

 Palsetia, D., Rao, G. P., Tiwari, S. C., Lodha, P., & De Sousa, A. (2018). The clock drawing test

versus mini-mental status examination as a screening tool for dementia: A clinical

comparison. Indian journal of psychological medicine, 40(1), 1-10.

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

To Prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
  • Consider the elements of the psychiatric interview, history, and examination.
  • Consider the assessment tool assigned to you by the Course Instructor.
By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!


Week 2 initial post Positive and Negative Syndrome Scale

          This week’s resources give us as students a plethora of information that can help us to diagnose many different psychiatric disorders that we will experience as advance nurse practitioners. The key is to use the tools that will be the most effective and give us the best outcomes for our clients and their families. The decisions we make will help us to diagnose and treat clients effectively and to determine the best tools to use we will be examining those tools individually and together through this discussion forum. The Positive and Negative Symptom Scale may be a tool that can help with the diagnosis of Schizophrenia, Schizoaffective disorder and Schizophreniform however It seems that the reliability of this tool has not been proven to be consistent with different diagnosticians (Kølbæk et al, 2018). Not because it is ineffective, but due to the time constraints which are not always amenable to the client’s condition in a crisis (Kølbæk et al, 2018).

According to Sadock, Benjamin et al., the psychiatric interview is the most valuable element of the evaluation and care of clients with mental illness (2017). However, without the medical and mental history as well as the examination of the client and questioning of family or people close to the client the diagnosis may be skewed. Many clients with schizophrenia or any diagnosis that has delusional aspects or hallucinations may have knowledge that is corrupt in nature due to the nature of their illness (Andresen et al., 2006). Additionally, a patient may have a medical condition that is causing their psychosis. For this reason, the medical including drug or alcohol use need to be considered and ruled out prior to diagnosing a client with a psychotic disorder (Psychiatry Lecture, 2020).

The Medical history is the first component I feel is important to the interview of a patient that is having psychosis simply to rule out any organic causes for the psychosis such as infection, trauma or tumor. These things can be ruled out by taking completing blood tests, diagnostic imaging, and a system review. Taking care of the client’s physical needs may be the answer to help resolve his psychosis (Sadock et al, 2017).

The psychiatric history of the client and the family is a second component that is especially important with psychotic patients. Knowing the history and how long the client has been suffering with the symptoms will help to determine the diagnosis of the client. If the client has been dealing with his or her current symptoms for more than 6 months, and they have a family history of schizophrenia, then the risk for the patient regarding schizophrenia is much higher (American Psychiatric Association, 2013).

The third component which is particularly important is the history and current use of substances including alcohol, medication, and illegal substances. I believe it is important to talk about all substances including medications the patient is currently taking as well as the amounts they are taking. The client could be taking their prescribed medications incorrectly, causing an exaggerated reaction or side effect which can be remedied easily by educating the client on proper use and dosing (American Psychiatric Association, 2016).

The assessment tool assigned to me is the Positive and Negative Symptom Scale (PANSS). This tool is one of many primarily used for diagnosis by giving a reliable method of determining the severity of the symptomology presented by clients in psychosis (Fleishhacker, 2016). The second purpose of the tools for diagnosis of schizophrenia and other psychotic diagnosis’ is to determine the effectiveness of treatment (Fleishhacker, 2016). The PANSS tool which was published in 1987 (Ostergaard, Opler & Correll, 2017) is considered the gold standard for diagnosis of psychotic mental health issues once medical reasons for the psychosis is ruled out (Takeuchi et al, 2016). The psychometric properties of the PANSS have proven this to be an exceptionally reliable and valid instrument for determining the factors in schizophrenia and other psychotic disorders especially for research (Østergaard, Opler, & Correll, 2017). However, the practicality of using this tool with clients who are presenting in crisis is questionable. It requires 45 to 60 minutes of uninterrupted time with a client to administer this test which makes it impractical in many psychiatric intake settings (Kølbæk et al., 2018.)

This instrument is valuable for research and to help evaluate clients who are stable and able to verbalize their feelings and symptoms. In clinical practice it may be more effective for us as advance practice nurses to use an abbreviated version of this tool such as the 6-item positive and negative syndrome scale (PANSS-6) or the Simplified negative and positive symptom interview (SNAPSI) (Ostergaard, Opler & Correll, 2017).

The PANSS is a 30 item Positive and Negative as well Global symptoms. Positive symptoms are those that are added to a clients’ “normal” These consist of things like hallucinations, delusions, disorganized concepts, hostility, grandiosity, suspicion, and excitement Negative symptoms are when the client is lacking where his or her personality is concerned. For instance, if a client is not socializing with others. Negative symptoms included on the PANSS are blunted affect, emotional withdrawal, poor rapport, apathy or social withdrawal, problems with abstract thinking, no spontaneity and stereotypical thinking. The third factor of the PANSS is the general psychopathology scale. This consist of 16 items which include anxiety, somatic concerns, depression, poor attention, poor impulse control and preoccupation. The lowest that can be scored on any one of the items is 1. So, the lowest score possible is 30 (Kay, Fiszbein, & Opler, 1987).

To have a high degree of reliability with this instrument, there must be training for those rating the clients using said instrument (Opler, Yavorsky, & Daniel, 2017). In the case of the PANSS raters there are 4 principles that are required.

  1. Each item definition and points must be interpreted as literally as possible.
  2. The highest rating possible must be given if it applies.
  3. The reference period and time frame must be considered for each item.
  4. All information given in the interview must be considered for each item, therefore the instrument must be completed after the interview is completed.

The training for rating this instrument should be included in clinical training (Opler, Yavorsky, & Daniel, 2017).

This instrument and the other many instruments that are available in psychiatric practice helps me to understand there is still so much to learn. I know that this is only the tip of the iceberg and I am looking forward to using the different tools available to us.



American Psychiatric Association. (2013). Section I DSM-5 basics. In Diagnostic and statistical manual

of mental disorders (5th ed., pp. 5-29). Author.

The American Psychiatric Association. (2016). Practice Guidelines for the Psychiatric Evaluation of

Adults (3rd ed.).

Andresen, B., Moritz, S., Moritz, S., & Woodward, T. S. (2006). Positive and Negative and Disorganized

Symptoms Scale. Journal of Abnormal Psychology115(1), 15–25. N

Fleischhacker, W. W. (2016). The usefulness of rating scales in patients with schizophrenia. Acta

          Psychiatrica Scandinavica133(6), 435. https://doi- 12588

Kay, S.R., Fiszbein, A, Opler, L.A. (1987). The positive and negative syndrome scale (PANSS) for

schizophrenia. Schizophr Bull. 1987;13:261-276.

. Kølbæk, P., Blicher, A. B., Buus, C. W., Feller, S. G., Holm, T., Dines, D., O’Leary, K. M., Sørensen,

R.S., Opler, M., Correll, C. U., Mors, O., Bech, P., & Østergaard, S. D. (2018). Inter-rater

reliability of ratings on the six-item Positive and Negative Syndrome Scale (PANSS-6) obtained

using the Simplified Negative and Positive Symptoms Interview (SNAPSI). Nordic Journal of

          Psychiatry72(6), 431–436. https://doi-  de

Opler, M.G.A., Yavorsky, C., & Daniel, D.G. (2017). Positive and Negative Syndrome Scale (PANSS)

Training: Challenges, Solutions, and Future Directions. Innovations in Clinical

          Neuroscience14(11/12), 77–81.erg/watch/schizophrenia-and-other-psychotic-

Østergaard, S. D., Opler, M. G. A., & Correll, C. U. (2017). Bridging the Measurement Gap

Between Research and Clinical Care in Schizophrenia: Positive and Negative Syndrome Scale-6

(PANSS-6) and Other Assessments Based on the Simplified Negative and Positive Symptoms

Interview (SNAPSI). Innovations in Clinical Neuroscience14(11/12), 68–72.

Psychiatry Lecture: How to do a Psychiatric Assessment Retrieved December 7, 2020 from

Sadock, Benjamin, et al. Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry, Wolters

Kluwer, 2017. ProQuest Ebook Central,

Takeuchi, H., Fervaha, G., Lee, J., Agid, O., & Remington, G. (2016). A preliminary examination of the

validity and reliability of a new brief rating scale for symptom domains of psychosis: Brief Evaluation

of Psychosis Symptom Domains (BE-PSD). Journal of Psychiatric Research80, 87–92. https://doi-

Classroom Productions (Producer2015). Schizophrenia and other psychotic disor

Open chat
chat us now
Whatsapp Online Nursing Papers
We will write your work from scratch and ensure it's plagiarism-free, you just submit.