Psychological Assessment in Acute Psychiatric Settings: From a Narrative Review to a Decision-Making Framework
DOI:
https://doi.org/10.12974/2313-1047.2025.12.02Keywords:
Psychological assessment, Acute psychiatric settings, Decision-making framework, Psychodiagnostic assessment, Psychiatric inpatientsAbstract
Psychological assessment in acute psychiatric settings plays a critical role in establishing accurate diagnoses, informing treatment planning, and improving clinical outcomes. Clinicians working in these high-intensity environments must evaluate patients presenting with severe psychiatric symptoms while navigating substantial challenges, including time pressure, fluctuating clinical presentations, and limited patient cooperation. This narrative review examines existing literature on psychodiagnostics assessment in psychiatric inpatients units and identifies key factors that influence decision-making. Building on this evidence, the review proposes a rapid decision-making framework designed to support clinicians in selecting and implementing appropriate assessment strategies. By integrating structured instruments, clinical judgement, and contextual information this framework aims to standardize assessment practices, enhance diagnostic accuracy, and facilitate treatment adherence and continuity of care. A clear decision-making framework is necessary to propose unambiguous psychotherapeutic treatments that clarify treatment paths and facilitate achievement of objectives in the short and long term.
References
Amore M, Menchetti M, Tonti C, Scarlatti F, Lundgren E, Esposito W. Berardi D. Predictors of violent behavior among acute psychiatric patients: clinical study. Psychiatry Clin Neurosci 2008 Jun; 62(3): 247-55. https://doi.org/10.1111/j.1440-1819.2008.01790.x
Baethge C, Goldbeck-Wood S, Mertens S. SANRA—A scale for the quality assessment of narrative review articles. Res. Integr. Peer Rev. 2019, 4, 5. https://doi.org/10.1186/s41073-019-0064-8
Banjo J, Madson K, Hromis S. Effective management of patients with borderline personality disorder in a busy acute inpatient ward using dialectical behaviour therapy principles. Australas Psychiatry 2023 Dec; 31(6): 771-775. https://doi.org/10.1177/10398562231209822
Berg JE. Psychometric testing of immigrants and natives in a acute psychiatric facility. Mental Illness 2018 Jan 3; 9(2): 6987. https://doi.org/10.4081/mi.2017.6987
Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, Hartmann-Boyce J, Ryan R, Shepperd S, Thomas J, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. BMJ 2020, 368, l6890. https://doi.org/10.1136/bmj.l6890
Chaplin R, Clarke H, Docherty M, Lucas-Motley H, Thompson P. Standards for Inpatient Mental Health Services - Fourth Edition. The Royal College of Psychiatrists https: //www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/ccqi-resources/ ccqi-core-standards-in-2022.pdf?sfvrsn=ae828418_8
Cukrowicz KC, Reardon ML, Donohue KF, Joiner TE. MMPI-2F scale as a predictor of acute versus chronic disorder classification. Assessment 2004 Jun; 11(2): 145-51. https://doi.org/10.1177/1073191104264961
Della DF, Allison S, BidargaddibN, Wa SK, Bastiampillai T. An umbrella systematic review of seasonality in mood disorders and suicide risk: The impact on demand for primary behavioral health care and acute psychiatric services. Prim Care Companion CNS Disord 2023 May 25; 25(3): 22r03395. https://doi.org/10.4088/PCC.22r03395
Dols A, Kupka RW, van Lammeren A, Beekman AT, Sajatovic M, Stek ML. The prevalence of late-life mania: a review. Bipolar Dis 2014 Mar; 16(2): 113-8. https://doi.org/10.1111/bdi.12104
Esque J, Rasmussen A, Spada M, Gopalan P, Sarpal D. First-episode psychosis and the role of the psychiatric consultant. J Acad Consult Liaison Psychiatry 2022 Jan-Feb; 63(1): 32-35. https://doi.org/10.1016/j.jaclp.2021.07.003
Fowler LH, Jackson-Burns S. Acute psychosis: medical clearance evaluation and initial management. Nurse Pract 2024 Dec 1: 49(12): 13-22. https://doi.org/10.1097/01.NPR.0000000000000252
Galderisi S, Riva MA, Girardi P, Amore M, Carpiniello B, Aguglia E, Fagiolini A, Mucci A, Vita A. Schizophrenia and “unmet needs”: From diagnosis to care in Italy. Eur Psychiatry 2020 Mar 13; 63(1): e26. https://doi.org/10.1192/j.eurpsy.2019.8
Gatov E, Koziel N, Kurdyak P, Saunders NR, Chiu M, Lebenbaum M, Chenm S, Vigod SN. Discharge and post-discharge outcomes of psychiatric inpatients with a lifetime history of exposure to interpersonal trauma: a population-based study. Gen Hosp Psychiatry 2020 Jul-Aug: 65: 82-90. https://doi.org/10.1016/j.genhosppsych.2020.05.015
Gaudiano BA, Ellenberg S, Johnson JE, Mueser KT, Miller IW. Effectiveness of acceptance and commitment therapy for inpatients with psychosis: implementation feasibility and acceptability from a pilot randomized controlled trial. Schizo Res 2023 Nov; 261: 72-79. https://doi.org/10.1016/j.schres.2023.09.017
Hamann J, Holzhuter F, Blakaj S, Becker S, Haller B, Landgrebe M, SchmauB, Heres S. Implementing shared decision-making on acute psychiatric wards: a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS). Epidemiol Psychiatr Sci 2020 Jun 16: 29: e137. https://doi.org/10.1017/S2045796020000505
Hopko DR, Averill PM, Small D, Greenlee H, Varner RV. Use of the Brief Psychiatric Rating Scale to facilitate differential diagnosis at acute inpatient admission. J Clin Psychiatry, 2001 Apr; 62(4): 304-12; quiz 313-4. https://doi.org/10.4088/JCP.v62n0415
Johnson S, Dalton-Locke C, Baker J, Hanlon C, et al. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022 Jun; 21(2): 220-236. https://doi.org/10.1002/wps.20962
Kyron MJ, Hooke GR, Page AC. Daily assessment of interpersonal factors to predict suicidal ideation and non-suicidal self-injury in psychiatric inpatients. J Consult Clin Psychol. 2018 Jun; 86(6): 556-567. https://doi.org/10.1037/ccp0000305
Kraft CM, Morea P, Teresi B, Platts-Mills TF, Blazer NL, Brice JH, Strain AK. Characteristics, clinical care, and disposition barriers for mental health patients boarding in the emergency department. Am J Emerg Med 2021 Aug: 46: 550-555. https://doi.org/10.1016/j.ajem.2020.11.021
Kumar M, Sawhney I, Chester V, Alexander R, Mitchell J, Shankar R. Outcome measures in intellectual disability: a review and narrative synthesis of validated instruments. Int J Soc Psychiatry 2025 March; 71(2): 239-253. https://doi.org/10.1177/00207640241291517
Maercker A, Cloitre M, Bachem R, Schlumpf YR, Khoury B, Hitchcock C et al. Complex post-traumatic stress disorder. Lancet 2022 Jul 2; 400(10345): 60-72. https://doi.org/10.1016/S0140-6736(22)00821-2
Marawi T, Ainsworth NJ, Zhukovsky P, et al. Brain-cognition relationships in late-life depression: a systematic review of structural magnetic resonance imaging studies. Transl Psychiatry 2023 Aug 19: 13(1): 284. https://doi.org/10.1038/s41398-023-02584-2
Marcó-García S, Ariyo K, Owen GS, David AS. Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis. Psychol Med. 2024 Apr; 54(6): 1074-1083. https://doi.org/10.1017/S0033291724000242
Marcus SC, Chuang CC, Ng-Mak DS, Olfson M. Outpatient follow-up care and risk of hospital readmission in schizophrenia and bipolar disorder. Psychiatr Serv 2017 Dec 1; 68(12): 1239-1246. https://doi.org/10.1176/appi.ps.201600498
Marquardt CA, Ferrier-Auerbach AG, Schumacher MM, Arbisi PA. MMPI-2-RF validity scales add utility for predicting treatment engagement during partial psychiatric hospitalization. Psychol Assess 2024 Feb; 36(2): 124-133. https://doi.org/10.1037/pas0001285
Richards DA; Bee P, Barkham M, Gilbody SM, Cahill J, Glanville J. The prevalence of nursing staff stress on adult acute psychiatric in-patient wards. A systematic review. Soc Psychiatry Psychiatr Epidemiol 2006 Jan; 41: 34-43. https://doi.org/10.1007/s00127-005-0998-7
Rodriguez-Seijas C, Morgan TA, Zimmerman M. Associations between maladaptive personality domains and premature termination in an acute clinical setting. Personality Disorders: Theory, Research, and Treatment, 2000,11(5): 339-347. https://doi.org/10.1037/per0000387
Rufino KA, Ellis TE. Contributions of Cognitions, Psychological Flexibility, and Therapeutic Alliance to Suicidal Ideation in Psychiatric Inpatients. Suicide Life Threat Behav. 2018 Jun; 48(3): 271-280. https://doi.org/10.1111/sltb.12353
Sangiorgio P, Mosticoni S, Gruppo di Lavoro del Coordinamento SPDC Regione Lazio. Contenzioni ed emergenze psichiatriche a Roma. Riv Psichiatr 2011; 46(2): 97-121.
Simpson SA, Goans CRR, Loh RM, Ryall KA, Middleton M, Dalton A. Use of an agitation measure to screen for suicide and self-harm risk among emergency department patients. J Acad Consult Liaison Psychiatry 2023 Jan-Feb; 64(1): 3.12. https://doi.org/10.1016/j.jaclp.2022.07.004
Stukenberg K, Brady C, Klinetob N. Psychiatric inpatients and the MMPI-2: providing benchmarks. J Clin Psychol 2000 Jun; 56(6): 747-56. https://doi.org/10.1002/(SICI)1097-4679(200006)56:6<747::AID-JCLP5>3.0.CO;2-O
Suntharalingam S, Johnson D, Suresh S, Thierrault FL, De Sante S, Perinpanayagam P, Salamatmanesh M, Pajer K. Rates of Dual Diagnosis in child and adolescent psychiatric inpatients: a scoping review. J Addict Med 2022 Jan-Feb 01; 16(1): 101-109. https://doi.org/10.1097/ADM.0000000000000818
Svanborg P, Ekselius L. Self-assessment of DSM-IV criteria for major depression in psychiatric out-and inpatients. Nord J Psychiatry 2003; 57(4): 291-6. https://doi.org/10.1080/08039480307281
Vyas CM, Petriceks AH, Paudel S, Donovan AL, Stern TA. Acute psychosis: differential diagnosis, evaluation, and management. Prim Care Companion CNS Disord 2023 Mar 23; 25(2): 22f03338. https://doi.org/10.4088/PCC.22f03338
Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, Trevillion K, Lloyd-Evans B, Johnson B. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalization: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry 2019; 6: 1039-53. https://doi.org/10.1016/S2215-0366(19)30406-7
Whitney JA, Kunik ME, Molinari V, Lopez FG, Karner T. Psychological predictors of admission and discharge global assessment of functioning scale scores for geropsychiatric inpatients. Aging Ment Health. 2004 Nov; 8(6): 505-13. https://doi.org/10.1080/13607860412331303784
Wood L, Williams C, Enache G, Withers F, Fullarton K, Salehi D, Draper M. Examining cognitive functioning of adult acute psychiatric inpatients through a brief screening assessment. Psychiatr Rehabil J. 2019a Mar; 42(1): 64-70. https://doi.org/10.1037/prj0000315
Wood L, Williams C, Billings J, Johnson S. The role of psychology in a multidisciplinary psychiatric inpatient setting: perspective from the multidisciplinary team. Psychol Psychoter 2019b Dec; 92(4): 554-564. https://doi.org/10.1111/papt.12199
Lucattelli R, Pecorari M, Mentuccia V, Biello C, Riggio F, Sagliano T, Marino G, Nicolò G, Bernabei L. Emotional psychoeducational group for psychiatric inpatients. Findings from a Clinical study. Journal of Psychology and Psychotherapy Research, 2023 E_ISSN: 2313-1047/23. https://doi.org/10.12974/2313-1047.2023.10.10
