Factors associated with cognitive impairment for people with mental health disorders: screening from general hospitals and an emergency care unit in Brazil

Emergency services and mental health units in general hospitals play a central role in the initial care and treatment of individuals with mental disorders. Early diagnosis and treatment of mental disorders and substance abuse can reduce cognitive deficits in this population. This study aims to investigate the factors associated with cognitive impairment for people with mental health disorders and addictions. This is a cross-sectional study performed in two general hospitals and an Emergency Care Unit (UPA) in cities in the metropolitan region of Porto Alegre, Rio Grande do Sul, Brazil. The interRAI Emergency Screener for Psychiatry (ESP) was used to describe the study population and to build an adjusted logistic model for the risk factors of cognitive impairment. A total of 324 persons participated in the study (mean age: 41.8 ± 14.27, 50,2% female). The profile of people admitted to the different locations varied in several aspects according to the interRAI scales. The UPA received patients with acute conditions and higher scores on the Aggressive Behavior Scale, Mania Scale, the Scale of Harm to Others, and the Scale of Positive Symptoms. Patients at the university hospital had the highest rates of social withdrawal and a higher proportion of individuals with no insight into their mental health problems. The factors with the highest odds ratio were a diagnosis of schizophrenia (O.R.: 3.07; C.I. 1.13; 8.32), followed by self-care inability (O.R.: 2.87, 1.43; 5.77) and the aggressive behavior scale (2.85, 1.10; 7.44). A history of discharges, the Mania Scale and sleeping problems were also significantly associated with cognitive impairment. People being admitted to the UPA had lower odds of having cognitive impairment (O.R.: 0.18; 0.07; 0.45). People diagnosed with schizophrenia were at very high risk of cognitive impairment. A prior history of discharges, inability to self-care, aggressive behavior, symptoms of mania and sleeping disturbances were also identified as risk factors. The interRAI EPS instrument showed to be useful to identify people with mental health disorders and substance abuse who were at risk of cognitive impairment. By early detecting these clients, professionals can refer them to adequate treatment, before symptoms increase.