Psychiatric Exam Template

Psychiatric Exam

An open-ended question provides the patient with flexibility in opening the interview, balanced against the clinician’s practical need to obtain relevant information. “What brings you to (see me/the hospital) today?” can have a wide variety of answers. Occasionally, a patient is unable to state clearly why he or she has actually come to visit. This frequently occurs in psychosis and cognitive impairment but may also be seen with intellectual disabilities or even depression with severe vegetative symptoms. A passive-aggressive or outright hostile chief symptom is an early sign of resistance to the interview, which can later be explored.

Exploring and expanding on the chief symptom is a reliable, patient-centered way to build rapport and begin gathering information. Recording a direct quote from the patient is best. Although recording “depression” is certainly acceptable, more descriptive phrases, such as “unable to stop crying for the past 3 days, ” is more memorable to a reader.

History of Present Illness

The history of present illness is the most important component of a modern diagnostic interview, yet it is approached differently depending on how the illness is defined. A longitudinal view of illness emphasizes obtaining a history of the course of the illness. Another approach involves looking only at the immediate events preceding the patient’s arrival for treatment; ie, a history of the patient's present illness episode.

Obtaining both is ideal; however, certain patient presentations make this a challenging task. If a patient is too disorganized (thought disordered) or otherwise impaired to participate fully, more emphasis should be placed on the current episode. If someone is presenting as a stable outpatient with an unclear diagnosis, the course of illness helps to clarify future treatment.

Although the depth may vary, every history of present illness should attempt to elicit information on certain topics. How the patient was functioning prior to his or her illness, current symptoms, if and when prior episodes occurred, and precipitating factors are a few that are particularly high yield. Remember that nearly every diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), requires the impairment of social, occupational, or academic functioning.Without a firm knowledge of where the patient was with regard to these domains, assessing the impact of the symptoms on his or her life is more difficult.

Briefly looking at the recent or chronic stresses that the patient may be experiencing is also important; these may contribute to the illness or its severity. Any sort of transition, such as medical illness, a new relationship, a new job, or a recent loss, can be a stressor that precipitates or exacerbates a mental illness.

However, not all patients are necessarily able to elaborate on precipitating factors. Moreover, illnesses may occur spontaneously, so not "willing" a cause on every aspect of a patient’s suffering is important. Even so, helping the patient to relate the stressors in his or her life to the symptoms of mental illness can be informational and therapeutic.

Psychiatric Review of Symptoms

The psychiatric review of symptoms seeks to reveal issues that the patient may have not brought up when describing the history of his or her present illness.

As in the rest of medicine, patients likely do not share an identical view with their physician of what constitutes an illness. Experiences that a practitioner would call pathologic may be experienced by the patient as "ego-syntonic." That is, they are not recognized as intrinsically different from how the patient would expect to act or feel. A person with bipolar disorder may not, for example, feel that the euphoric symptoms of mania represent anything wrong. If a significant positive response does occur during the review, it can be moved to the history of present illness when the practitioner is documenting his or her findings. The questions described below are also appropriate for delving deeper into a patient’s initial complaint.

Depression

Many practitioners are familiar with the SIGECAPS mnemonic. Depressive disorders can also be easily assessed with 2 questions, one regarding depressed or irritable mood and another regarding anhedonia.When asked "What sort of things do you like to do for fun?" the anhedonic patient often answers "nothing" or discusses activities that he or she used to do for pleasure.

Follow-up questions regarding guilt, decreases in energy level, concentration, and appetite are assessed if needed and are important to assess longitudinally. Psychomotor retardation or agitation can be screened for by asking "Have you or someone else noticed anything different about how you move?" Suicidality should also be addressed with all patients, but especially those with a positive depression screen.

Mania

A discussion of depression should be followed with one of mania. Given that manic episodes often do not feel pathologic to a patient, it can be challenging to collect this history. DIGFAST is a common mnemonic used in mania screening. (See Table 2, below).

Table 2. DIGFAST Mnemonic

Distractible
Irritability
Grandiosity
Flight of ideas
Activity (increase)
Sleep (decrease)
Talkative

Distractibility can be witnessed by the interviewer, by friends or family, or by the patients themselves. Increased risk taking can have many forms, but sex, spending, and substance use are common and are thus high-yield areas to explore.

Grandiosity can vary from just feeling superior to a true psychosis; a sensitive screen asks the patient if he or she has or has had any special abilities. Flight of ideas can be approached as a sort of internal distractibility.

Inquiring about sleep is one of the easiest ways to pick up a manic episode in the absence of substance abuse. If the answer to "What’s the longest period of time you’ve gone without sleeping but not feeling tired the next day?" is anything longer than 2 days, further assessment is warranted. Pressured speech should be immediately apparent in a person currently in a manic episode and easily recallable by friends or family members.

You might also like

Psych evaluation: Oscar Pistorius not mentally
Psych evaluation: Oscar Pistorius not mentally ...
Psychiatric evaluation, what to expect, what to do and
Psychiatric evaluation, what to expect, what to do and ...

Q&A

avatar
How do i sue a hospital that held me for psychiatric evaluation against my will and ny mental hygeine laws?

iI realize that you're very distraught, and it sounds like you have a right to be. I'd suggest that you contact an attorney who specializes in mental health (which really is a complicated field), who can obtain all of your files and, if necessary, have them reviewed by a psychiatrist retained on your behalf. Depending on the review, and the advise of your attorney, you'll be advised how to proceed.

Copyright © . All Rights Reserved