A young psychiatrist recently joined our busy outpatient psychiatry office. Our clinicians see multiple patients daily with limited time available for initial evaluations and follow-ups. Fresh out of residency, he shared a central concern: is it truly possible to gather sufficient information during an initial traditional 30-minute psychiatric evaluation? Can this information be enough to support accurate diagnosis, appropriate treatment planning, and safe pharmacological decision-making? He feared diagnostic uncertainty and the risk associated with treatments that may later prove ineffective.
This young psychiatrist's education was comprehensive, his knowledge base extensive, and his observational skills sharp, so I understood why he was concerned about potential information gaps during patient assessments. Recognizing these challenges, I reassured him that our clinic had recently incorporated new assessment tools into our workflow that would help to close these gaps.
I explained that by integrating digital cognitive screening assessments into his workflow, he would gain increased confidence in his ability to diagnose patients, monitor their progress, and tailor specific treatment interventions. I reminded him that these tools serve as an adjunct—not a replacement—to the traditional psychiatric assessment, which remains an efficient, effective, and reliable method in psychiatric settings.
Although I have witnessed countless psychiatric advances over the years, the traditional psychiatric workflow remains largely unchanged. From busy inpatient units, consultation liaison services, and psychiatric emergency rooms to bustling outpatient settings, partial programs, and intensive outpatient programs, psychiatrists appreciate the workflow’s effectiveness, efficiency, and ease of implementation in any setting.
There is nothing as spectacular as conducting one’s very first psychiatric evaluation, and there is comfort in consistently following the traditional workflow. When we introduce this standardized process of assessing, diagnosing, and treating psychiatric patients to nervous medical students on their first day of their psychiatric clinical rotations, it quickly becomes second nature. The psychiatric interview forms the bedrock upon which we determine diagnoses and formulate treatment plans. However, despite our best efforts, there are things we simply can’t learn about our patients through observation and self-report alone. Even under optimal conditions, we may receive incomplete information regarding cognitive functioning during the traditional diagnostic interview.
This can occur for many reasons, including the episodic nature of psychiatric assessments, practitioner reliance on patient self-report of symptoms, limited clinician ability to observe more than just obvious symptomatology due to time constraints, shorter appointments, and increased workloads, and limited access to adjunctive screening tools such as digital cognitive assessments.
When vital information regarding cognitive functioning is missing, clinicians can over- or underdiagnose psychiatric illness, miss important opportunities for treatment, and patients’ quality of life can be negatively impacted as a result.
Psychiatrists are master listeners. We rely on advanced listening and observational skills to guide diagnosis and treatment, often under significant time and resource constraints. While the traditional face-to-face clinical interview remains central to psychiatric practice, it may not detect early, subtle cognitive impairments, potentially leading to missed diagnoses and suboptimal outcomes.
Historically, clinicians have turned to formal neuropsychological testing to fill information gaps. This testing can supplement clinical judgment but is frequently costly, time-consuming, and difficult to access. Digital assessment platforms offer a practical alternative by providing objective cognitive data that can reveal early changes often missed through observation alone.
Incorporating objective cognitive measures into traditional psychiatric workflows helps identify emerging impairments earlier and supports more informed clinical decision-making.
Broadly, cognition can be thought of as the way in which our brains support essential neural functions using interconnected dynamic neural networks (domains) that make up what we call the cognitive core. These domains each play a role in regulating cognition and are governed by a hierarchy that is controlled at the highest level by executive functioning.
Key components of the networks include:
The default mode network: this is involved in emotional regulation.
The salience network: this helps detect and prioritize important stimuli.
Other networks that collectively maintain attention, memory, and adaptive behaviors.
Together, these dynamic networks enable the brain to integrate information efficiently, respond to changing environments, and support overall mental health.
Important cognitive functions like orientation, learning, problem-solving, reasoning, memory, and judgment rely on these domains working properly—something that is often disrupted when psychiatric conditions exist. This resulting cognitive disruption is a core characteristic of psychiatric conditions.
Cognitive deficits are, however, transdiagnostic in nature, meaning they are not disorder-specific and cannot be used in isolation to establish a diagnosis. That being said, understanding the cognitive profiles commonly associated with each disorder remains essential since early identification and intervention improve patient outcomes and support accurate differential diagnosis and effective treatment planning.
Some examples of disorders with notable cognitive deficits include:
Psychiatrists assess cognition through observation and patient self-report as part of the traditional initial evaluation but often lack access to the tools, time, and resources needed to formally measure cognitive deficits in any quantifiable way, which makes identifying and tracking cognitive deficits a daunting task.
The traditional approach to psychiatry relies heavily upon symptom identification and diagnostic frameworks. It is comforting in its consistency and utility but limited in its ability to catch subtle changes in cognition. Such changes are often imperceptible to both patients and clinicians and therefore go unreported, further complicating accurate assessment and longitudinal tracking.
Even the best clinicians may find it difficult or impossible to identify signs of deteriorating cognition when relying solely on patient-reported symptoms. Self-report is inherently limited by a patient’s insight, awareness, and ability to recall information and identify feelings. And when it comes to cognitive decline specifically, expecting patients to recognize and report subtle cognitive changes is especially unrealistic, as such changes often precede noticeable symptoms by years.
Because patients can only report what they perceive, relying on self-reported symptoms for early detection of cognitive decline hampers clinicians’ ability to act proactively. Implementing objective assessment strategies can help ensure that cognitive impairment is identified and managed early, allowing for more effective interventions and better outcomes.
As psychiatrists, we evaluate patients through interviews and in-person observation. In the traditional practice, this occurs episodically, during too-short, infrequent appointments that force us to rely upon information we glean in brief snapshots of time. Further, there are limits to the type and amount of information we can assess through observation during these encounters.
Early deficits in cognition can be so subtle in nature they evade recognition by even the most experienced clinicians, particularly when patients themselves are unable to recognize or report early changes. These challenges create meaningful gaps in clinical information and hinder comprehensive assessment.
These constraints underscore the need for information gathering approaches that extend beyond the clinic. When thoughtfully integrated into the psychiatric workflow, data derived from digital cognitive assessments can fill these gaps, augment traditional evaluations, improve sensitivity to early or fluctuating symptoms that might otherwise go undetected, and provide valuable longitudinal context over time.
In my own practice, I find relying on subjective surveys and self-reported symptoms incredibly frustrating. While I can make diagnoses and formulate successful treatment plans based on this limited information, I am often left questioning the accuracy and completeness of what is shared. When my treatment decisions hinge on sporadic, self‑reported symptom accounts and observation alone, important nuances can be missed, and negative consequences can occur.
For example, if cognitive impairment goes unnoticed during the initial evaluation, the treatment plan may fail to address a patient’s underlying needs, increasing the risk of poor treatment adherence, symptom exacerbation, and impaired quality of life. Because cognitive function directly affects a patient’s ability to understand their diagnosis, engage in treatment, and adhere to medication regimens, systematic assessment of cognition is a critical component of comprehensive clinical care.
Consequences of unaddressed subtle cognitive changes include:
Incorporating the use of objective measures into routine psychiatric assessments enhances clinical judgment and elevates the standard of care we provide for our patients. Obtaining quantifiable data regarding cognitive functioning and psychiatric disorders through standardized digital screening tools can:
When integrated with traditional subjective assessments, these measures also offer valuable longitudinal insight to guide care over time.
Clinicians working in high-demand settings with limited time are understandably skeptical about adding new elements to psychiatric assessment workflows, particularly when existing processes already strain available time. Indeed, those of us who have worked in too-busy settings with too-little time have a healthy amount of skepticism when it comes to the idea of incorporating something new into our psychiatric assessment routines. We barely have enough time to get through the traditional workflow as it is!
However, routine screening for the early detection of serious physical illness is a well-established standard of care across medical specialties, regardless of symptom presentation or patient self-report. Preventive screenings such as mammography and colonoscopy demonstrate that early identification enables timely intervention and improves outcomes. The same principle can apply to the early detection and treatment of cognitive impairment and mental illness, where proactive screening can meaningfully improve patient prognosis and quality of life.
We can integrate digital cognitive screening assessments into psychiatric settings in a variety of ways. From remote administration to standardized scoring, it is easy to see how validated platforms like Creyos fit seamlessly into even the busiest psychiatric settings.
Whether administered in the office as part of the initial assessment appointment or taken remotely at home on the patient’s own time, features such as immediate reporting and easy-to-interpret results allow us to elevate the standard of care we offer our patients with minimal burden.
As mental health clinicians, we strive daily to provide the best psychiatric care possible to our patients, a goal that is best achieved when we access every tool at our disposal. Cognitive screening supports early identification of cognitive decline, reduces reliance on episodic observations and subjective reports, allows longitudinal tracking of cognitive change, supports more precise, individualized interventions, and aligns treatment goals with patient expectations.
Embedding standardized digital cognitive assessments into psychiatric workflows represents an important step toward more precise, data-informed, and patient-centered psychiatric care. Over time, this integration has the potential to transform psychiatric care by enabling earlier intervention, more targeted treatment, and sustained measurement of meaningful outcomes.
Dr. Rebecca Reyes is a psychiatrist and leader in behavioral healthcare with dual degrees in medicine and law. She has held leadership roles across inpatient and outpatient settings, directed military/PTSD and substance abuse treatment programs, and served as both principal and sub-investigator in several phase 3 neuropsychiatry clinical trials. She is committed to evidence-based care, collaborative leadership, and advancing patient outcomes across diverse healthcare environments.