Mental health Assessment questions

Mental health assessment

Conducting an interview hastily and indifferently with closed-ended queries (following a rigid system review) often prevents patients from revealing relevant information. Tracing the history of the presenting illness with open-ended questions, so that patients can tell their story in their own words, takes a similar amount of time and enables patients to describe associated social circumstances and reveal emotional reactions.

The interview should first explore what prompted the need (or desire) for psychiatric assessment (eg, unwanted or unpleasant thoughts, undesirable behavior), including how much the presenting symptoms affect the patient or interfere with the patient's social, employment, and interpersonal functioning. The interviewer then attempts to gain a broader perspective on the patient’s personality by reviewing significant life events—current and past—and the patient’s responses to them (see Areas to Cover in the Initial Psychiatric Assessment). Psychiatric, medical, social, and developmental history is also reviewed. A review of systems to check for other symptoms not described in the psychiatric history is important. Focusing only on the presenting symptoms may result in missing either psychiatric or medical comorbidities.

Areas to Cover in the Initial Psychiatric Assessment

Previous treatments, including drugs and hospitalizations

Known disorders and chronic conditions

New-onset physical symptoms

Current drugs and treatments

Education level and educational history (eg grades, difficulties making it through school)

Marital history, including quality and stability of marriage or marriages or significant relationships

Employment history, including stability and effectiveness at work

Legal history, including arrests and incarcerations

Living arrangements (eg, alone, with family, in group home or shelter, on street)

Pattern of social life (eg, quality and frequency of interaction with friends and family)

Known diagnoses, including mental disorders

Response to the usual vicissitudes of life

Divorce, job loss, death of friends and family, illness, other failures, setbacks, and losses

Family composition and atmosphere during childhood

Behavior during schooling

Handling of different family and social roles

Sexual adaptation and experiences

Use or abuse of alcohol, drugs, and tobacco

Potential for harm to self or others

Suicidal thoughts, plans, and intent

Prior suicide attempts and means used

The personality profile that emerges may suggest traits that are adaptive (eg, resilience, conscientiousness) or maladaptive (eg, self-centeredness, dependency, poor tolerance of frustration) and may show the coping mechanisms used. The interview may reveal obsessions (unwanted and distressing thoughts or impulses), compulsions (urges to do irrational or apparently useless acts), and delusions (fixed false beliefs) and may determine whether distress is expressed in physical symptoms (eg, headache, abdominal pain), mental symptoms (eg, phobic behavior, depression), or social behavior (eg, withdrawal, rebelliousness). The patient should also be asked about attitudes regarding psychiatric treatments, including drugs and psychotherapy, so that this information can be incorporated into the treatment plan.

The interviewer should establish whether a physical condition or its treatment is causing or worsening a mental condition (see Medical Assessment of the Patient With Mental Symptoms). In addition to having direct effects (eg, symptoms, including mental ones), many physical conditions cause enormous stress and require coping mechanisms to withstand the pressures related to the condition. Many patients with severe physical conditions experience some kind of adjustment disorder, and those with underlying mental disorders may become unstable.

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