Psychiatric Evaluation

Psychiatric Evaluation

Summary

Psychiatric evaluations are meetings between a mental health professional (e.g., psychiatrist, psychologist) and a child, adolescent or adult  in which the professional tries to glean information necessary to diagnose an emotional, behavioral or developmental disorder.

The major feature of a psychiatric evaluation is one or more face-to-face interviews in which the mental health professional asks the patient open-ended and diagnosis-specific questions to elicit answers that may be relevant in diagnosing a mental health condition. The goal is to learn more about the patient’s current problems and symptoms as well as their personal and family psychiatric and medical histories.

In addition to the interview, a physical examination may be performed and other tests (e.g., blood tests, x-rays) and evaluations may be ordered.

There are three major types of psychiatric evaluations: a general psychiatric evaluation, an emergency evaluation and a clinical consultation. A general evaluation is intended to collect enough data about the patient to develop an initial psychiatric diagnosis and an initial treatment plan. An emergency evaluation is performed when the patient has thoughts or feelings that are intolerable, or when the patient displays harmful behavior that requires a prompt response. A mental health consultation is an assessment requested by another health professional, the patient, a family member or others as a means of helping diagnose, treat or manage a patient with a suspected mental disorder or behavioral problem.

Psychiatric evaluations may be performed in either an inpatient (hospital) or an outpatient setting. Once information from the evaluation has been gathered and analyzed, a diagnosis of the condition and treatment plan may be formulated.

About psychiatric evaluation

A psychiatric evaluation is a method of gleaning information from children, adolescents or adults that can be used to diagnose emotional, behavioral or developmental disorders. It typically consists of one or more face-to-face interviews in which the psychiatrist or other mental health professional asks the patient open-ended and diagnosis-specific questions to elicit answers that may be relevant in diagnosing a mental health condition. Sometimes, a more structured method of questioning is also used, such as when trying to gather information about substance abuse or history of trauma in a patient’s life.

During a psychiatric evaluation, the mental health professional focuses on gathering several types of information, including:

  • Present problems and symptoms. Includes a chronologically organized history of any present illnesses, including symptoms or syndromes, history of worsening or remission of symptoms, recent stressors and possible triggers.
  • Personal psychiatric history. Includes a chronological summary of all previous episodes of mental illness and details of a patient’s past treatments and response to those therapies.
  • General medical history. Includes information about all known illnesses and hospitalizations, procedures, treatments and medications. The general medical history includes relevant information regarding significant injury or trauma, sexual and reproductive history, and history of neurologic (nervous system) disorders, allergies, drug sensitivities and conditions that have caused pain or discomfort.
  • Family health and psychiatric histories. Includes information about any general medical or psychiatric illnesses in close relatives. Particular attention is paid to any family history of mood disorder, psychosis, suicide and substance abuse disorders. Treatment and response to treatment on the part of family members is also explored.
  • History of substance use. Focuses on both legal and illegal substances, including alcohol, caffeine, nicotine, marijuana, cocaine, opiates, sedatives, hypnotic agents, stimulants, solvents and hallucinogens.
  • Psychosocial and developmental history. Includes a review of the stages in a patient’s life. Particular attention is paid to milestones and how the patient responds to life transitions and major life events. Other details that are noted include the patient’s education history, important cultural and religious influences, any history with the criminal justice system, any history of abuse or other trauma, and other relevant topics.
  • Social history. Includes information about relationships with family and other loved ones and the patient’s living arrangements.
  • Occupational history. Includes a sequence of jobs held and reasons for job changes, as well as information about usual physical or psychological stresses that may have been experienced in the workplace. Any patient history of military service also falls under this category.
  • Physical examination and testing. Used to assess patients’ general medical status, including their neurological health. Health information may also be revealed by blood tests, x-rays or special assessments such as psychological, educational, speech and language tests.

In addition, the psychiatrist will observe the patient’s behavior before, during and after the interview as part of a mental status examination. Information in the mental status examination includes the patient’s appearance and behavior, expressions of mood and affect, characteristics of speech and language, rate of movement, and the presence of any purposeless, repetitive or unusual movements or postures.

The patient’s thoughts and perceptions – including spontaneously expressed worries, cognitive or perceptual symptoms related to specific mental health disorders, and violent or self-injurious thoughts – will be noted. Assessment of patients’ cognitive functions – including their level of consciousness, language function, and attention and concentration – is another essential part of the psychiatric evaluation.

In many cases, other members of the clinical team may help the psychiatrist compile data, with nurses, psychologists, occupational therapists, social workers, substance abuse counselors and case managers all contributing assessments based on their area of expertise.

Once all of the information from a psychiatric evaluation and other assessments has been collected and analyzed, the psychiatrist uses guidelines outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) to make an appropriate diagnosis. An initial treatment plan may also be formulated if the evaluation is conducted to help guide treatment. In some cases, a patient who has symptoms that appear to indicate a mental health disorder may also have comorbid medical conditions (e.g., brain tumor, thyroid dysfunction). It is important for mental health professionals to be aware of these conditions and to refer the patient to an appropriate physician for necessary follow-ups if these conditions are suspected.

Types and differences of psychiatric evaluation

There are three major types of psychiatric evaluations, including general evaluation, emergency evaluation and clinical consultation.

A general evaluation is intended to collect enough data about the patient to develop an initial psychiatric diagnosis and an initial treatment plan. In some cases, a psychiatric evaluation is a reassessment in which new information is gathered and alterations to a previous treatment plan are made.

The main feature of a general evaluation is one or more face-to-face interviews of the patient by a psychiatrist or other mental health professional. During the interview(s), patients provide important information about their condition by telling their own story about their symptoms. In addition, the interviewer can ask appropriate questions about specific symptoms and events that might help clarify a diagnosis.

In addition to the interview, several other diagnostic tools will be used during a psychiatric evaluation. These include a review of medical records and medical history, a complete physical examination and possibly diagnostic tests.

A general psychiatric evaluation takes at least an hour to complete, and often involves multiple sessions. The complexity of the mental health problem that is present and a patient’s willingness and/or ability to cooperate with the mental health professional largely determine how long it will take to complete the evaluation.

An emergency evaluation is performed when the patient has thoughts or feelings that are intolerable, or when the patient displays harmful behavior that requires a prompt response. Examples include violent or self-destructive behavior, threats to others or oneself, failure to care for oneself, deteriorating mental status, bizarre or confused behavior or intense feelings of distress.

During an emergency evaluation, a psychiatrist or other mental health professional tries to determine what is causing the emergency and to identify diagnostic possibilities. In addition, there is an attempt to identify social, environmental and cultural factors that may impact treatment decisions and to develop a plan for both immediate and follow-up treatment based on the patient’s ability and willingness to cooperate.

Emergency evaluations vary greatly in length, but are usually brief and symptom-specific. In general, patients who will not be hospitalized require longer emergency evaluations than those who will receive follow-up assessment in a hospital setting.

A psychiatric consultation is an assessment requested by another health professional, the patient, a family member or others as a means of helping diagnose, treat or manage a patient with a suspected mental disorder or behavioral problem. In some cases, a clinical consultation is comprehensive whereas in others, the focus may be narrowed. An example of the latter is an assessment to determine the best medication for treating a patient’s condition.

Psychiatric consultations are performed much in the same way as a general psychiatric evaluation. The information gleaned from these consultations may result in a diagnosis, treatment advice or a recommendation for change in a treatment plan.

Psychiatric evaluations may be performed in either an inpatient (hospital) or an outpatient setting. Each type of evaluation has its advantages. Inpatient evaluations tend to be more intense, with more frequent interviews and access to laboratory services. They also typically involve numerous mental health professionals and health professionals from other fields. In addition, the psychiatrist has the opportunity to more closely observe the patient in an inpatient setting. Outpatient evaluations tend to be shorter, offer the patient greater autonomy and give the mental health professional an opportunity to monitor the patient over a longer period of time. The involvement of family or significant others can help close some of the gaps in a provider’s knowledge about the patient’s condition that may otherwise be obtained through more intense observation in an inpatient setting.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to psychiatric evaluations:

  1. Why are you recommending a psychiatric evaluation?
  2. Can you recommend a psychiatrist or other mental health professional to perform the evaluation?
  3. Where will the evaluation be performed? How long will it take?
  4. What types of questions will I be asked? What type of information will the psychiatrist seek to uncover?
  5. Are there different types of psychiatric evaluations? In which type will I participate?
  6. How many psychiatric evaluations will I require?
  7. What happens after I have a psychiatric evaluation?
  8. I am concerned about the stigma of having a psychiatric evaluation? Is there some other way of determining if I have a problem?
  9. Will anything be done without my consent during or after the psychiatric evaluation?
  10. Who will have access to the records of my psychiatric evaluation?
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