Mental Health Assessment Questions: Discussion Of Depression May Be Followed With One Of Mania

Maggie Tay is the original author of this article. Please visit peakofhealth.blogspot.com/ for advice on health problems and the simple things you can do to improve it. Occupational history should ideally follow the patient from depending on their relationships to school and work.

Periods of incarceration and military service must also be detailed. Goals for future education, occupation, and similar opportunities for growth must also be explored. Social planning further includes goals for the patient’s residence, work, education, or filing for disability, among many others. By the way, the social plan details how support networks, including friends and family, among others, going to be used or shored up. For instance, relying on the setting, legal filings may also be noted here, including any involuntary holds. Basically, how have these thoughts or feelings affected your life?

Determine if the patient has ever been involved in an event in which either the patient or somebody else was facing potential death or serious injury.

Asking Do you often have thoughts, feelings, or dreams about this event, if this first question has a positive response.

Trauma related’ anxiety can be discussed without stressfully detailing the entire event. I know it’s of particular importance given the lack of clinically relevant lab or imaging studies for many psychiatric diagnoses, that are actually syndromes of historical data and objectively observed symptoms. This is the case. Mental status examination is often and accurately described as the physical examination of psychiatry. Generally, the anticipated timing of this next visit can serve as an endpoint for the plan. Now pay attention please. Any remaining problems or questions that were not fully answered throughout the course of the psychiatric interview going to be left in the plan as a reminder for either the interviewer and similar clinicians at the patient’s next visit. Ok, and now one of the most important parts. Sources for additional information in most of the domains and how they might be reached will be described. Plenty of patients welcome the chance to get right to the point and seek relief from these distressing thoughts. Asking if he has had serious thoughts of death and dying can start a stepwise approach ward exploring suicidality, I’d say in case the patient appears overly anxious or withholding.

It’s usually enough to begin a discussion of avoidant or hyperarousal symptoms of posttraumatic stress disorder. Eg, the practitioner may address it by asking a question like How do you think your feelings are different from those of other people, The emotionally numbing fact of PTSD may require a somewhat subtle approach to elicit. I would like to ask you something. What sort of things have these providers done for you? Ask about the past providers, if so.a great followup question regardless of the answer to the first is Have you ever seen a mental health provider similar to a psychiatrist, psychologist, or social worker before? Provisional diagnoses are common and accepted in the early stages of treatment, Do not hurry to a diagnosis if further investigation, information, or longitudinal assessment is needed. For example, including at least a few sentences on the current and historical stressors in the patient’s life that can be contributing to either the presence or the exacerbation of the current illness is also usually important.

Diagnostic and treatment considerations that are part gonna be placed on the appropriate location for treatment when doing an emergency assessment. Gonna be an explicit part of the treatment plan, interventions can range from hospitalization to more frequent follow up visits. Will be thought of as extended social histories, as disordered relationships and past traumas are examined and explored. For I’m sure that the depth of this portion of the interview might be limited by time and goals. For example, strong working relationships are built by patients not simply in their pathology. Although, a lot more is to be gained from a thorough medical history review with a hospitalized, delirious patient, let’s say. Specific behaviors are important to note as they can be after effect of psychiatric medications.

Therefore an extrapyramidal symptom that, these include muscle rigidity may also point to the more serious neuroleptic malignant syndrome.

Sex, spending, and substance use are common and are thus ‘highyield’ areas to explore, increased risk taking can have many forms.

Distractibility can be witnessed by the interviewer, by friends or family, or by the patients themselves. From the outset, confidentiality must be discussed with everyone and firm ground rules laid out. Interview involving adolescents ain’t gonna was initiated by the patient and will likely involve interacting with the entire family. Adolescent must feel comfortable speaking openly with the interviewer.

I’m sure that the examination of affect looks at stability and range of displayed emotion across the interview.

a patient with limited affect or no affect might be described as blunted or flat.

Now look, an affect is compared to the stated mood and congruence noted. Besides, the appropriateness of a patient’s emotional appearance to the pics being discussed is also a part of the affective examination. Now look. Therefore an incarcerated patient being brought in for treatment by the custody staff is less going to have good judgment than an outpatient who scheduled amount of functioning. You can find some more info about this stuff on this site. Begin the interview with an assessment of the patient’s understanding as to why a psychiatrist was consulted. Considering the above said. These might be addressed before any history is collected, if the patient has any concerns about being seen for a psychiatric assessment. With that said, other sources of support in the patient’s life might be explored in the context of a social history. Also, a religious or spiritual history from childhood onward is helpful to establish how a patient’s spiritual worldview developed, if time permits.

Using a broader term similar to spirituality or faith tradition gives a patient more flexibility in answering the question without concern for the clinician’s biases.

You belong to any particular religion, right?

In addition to family and akin communities, that said, this includes faith or religious tradition. Anyway, the relative or tal absence of speech should be notable and indicate depression or severe psychotic disorders. Mania may also present with increased ne or volume. Anyways, accents provide some information to be further examined in the social history. Anyway, in mania, rapid or pressured speech might be noted. Although,, these patients may not bring this up as a symptom to their physician, a decline in sexual interest can be viewed by some elderly patients as normal or even expected.

Now this realization, in turn, may allow the interviewer to begin to probe more deeply into the root cause of these symptoms, just like depression.

Simply raising the question should be enough normalization for the patient to realize that something is wrong.

Interviewer will be vigilant for minimization/dismissal of symptoms as normal aging. Anyways, of note, patients may not clearly recognize mental illness in family members, and a discussion of relevant symptoms in lay language might be more valuable than asking about specific illnesses. Patients may not have identical degree of knowledge about family members as they might about themselves, and definitive diagnoses or treatment history might be elusive. It is asking all patients if they ever see or hear things that other people don’t is appropriate. Generally, terms like hallucinations or delusions can have either very little or an extremely stigmatized meaning attached to them and might be avoided.

Delusions can be difficult to elicit from a patient if ego syntonic and not spontaneously offered.

a ‘in depth’ screen can be necessary to pick up prodromal symptoms or uncommon presentations, frank psychosis ain’t often missed during a psychiatric interview.

Now this should be asked in the most normalizing manner possible. On p of this, whenever asking directly about marriage, can unfortunately indicate a bias ward heteronormativity and lead to a patient withholding otherwise pertinent information, despite common. Often related. Sexual action are separate. Ok, and now one of the most important parts. Asking about longterm relationships can provide a lot more information, instead of using this interview shortcut. I’m sure that the patient may be given the option to decline answering. They gonna be explored equally with questions sensitive to the possibility that men, women, or both are involved, and so it is a straightforward way of phrasing such queries.

Inquiring about sleep is the easiest ways to pick up a manic episode in the absence of substance abuse.

Pressured speech gonna be immediately apparent in a person currently in a manic episode and easily recallable by friends or family members.

Therefore in case the answer to What’s the longest time period you’ve gone without sleeping but not feeling tired the next day? Everyone should understand that outside of the adolescent posing harm to himself/herself or others, the clinician will share information only at the patient’s discretion. There’s more information about this stuff on this site. Information sharing among all other parties will be encouraged, and the patient gonna be given the option to share himself/herself or to allow the interviewer to summarize findings.

While acquiring a list of substances used, more important is the role that these substances play in the patient’s overall life. Accordingly an interviewer should ask for clarification if the patient begins to use terminology that is unfamiliar, use of vernacular should be appropriate for with intention to put the present into context, the patient’s mental state at the time should’ve been looked into. That said, this includes obtaining a history of suicide attempts and of prior violent acts actually. If no previous behaviors existed, suicidal or violent thoughts occurred in the past or exist in the present, it can be appropriate to ask What stopped you. That said, similar questions should’ve been asked going to be examined in detail. Of particular importance is the use and effectiveness Now look, an assessment of seizures, metabolic disorders, early death and suicide, or violence is also gonna be useful.

Severity, including hospitalizations, is also important to determine with regard to family members, as it may provide some information concerning prognosis.

Namely, depression, mania, psychosis, and anxiety in first degree relatives, The family history must cover pics similar to those of the psychiatric review of systems. The patient’s own words, lead the patient onto separate topics, usually in quick succession, flight of ideas is an extreme type of tangential thought process, in which not only the question posed. Normal associations are referred to as tight. Keep reading. The overall thought process will be described as tangential, circumstantial, or goal directed. Thought blocking and derailment are ‘thoughtprocess’ disorders classically seen in schizophrenia. Clinician and patient benefit from the improved relationship and diagnostic accuracy that a thorough assessment provides.

Regardless, the essential goals for data collection within a psychiatric interview remain similar, and a consistently applied format is valuable. Let’s say, the length and depth of the interview with an acutely psychotic inpatient varies considerably from that of an outpatient struggling with many years of anxiety, Each interview might be unique. Please see the Medscape Reference pic History and Mental Status Examination for additional information on collecting the mental status examination. Generally, do any of your friends use drugs, Drug use can start happening in kids your age. Fact, they should be best discussed at interviews subsequent to the first meeting, Therefore if possible.

They gonna be initially broached in reference to peers.

This sort of question gives the interviewer an opening to more directly discuss the patient’s own experiences with drugs.

Pics like sexual activity and drug use covered during an one to one interview provide significant opportunities for behavioral counseling but also pose a risk of the patient becoming more withdrawn. Notice that more emphasis gonna be placed on the current episode, if a patient is course of illness helps to clarify future treatment, if someone is presenting as a stable outpatient with an unclear diagnosis. You see, the plan addresses any intervention needed to improve a patient’s symptoms or functioning, and considering the biopsychosocial assessment will must also be described. Follow up’ questions regarding guilt, decreases in energy level, concentration, and appetite are assessed if needed and are important to assess longitudinally. Nevertheless, psychomotor retardation or agitation can be screened for by asking Have you or other people noticed anything different about how you move? Now let me tell you something. Especially those with a positive depression screen, suicidality must also be addressed with all patients. Given that manic episodes often do not feel pathologic to a patient, it can be challenging to collect this history. DIGFAST is an ordinary mnemonic used in mania screening. Besides, a discussion of depression could be followed with one of mania. I know it’s helpful to have additional information from family members to Now look, a logical place to begin is the patient’s developmental history. So this could start with questions about drug exposures in utero and similar prenatal history but will most often begin with birth.

These questions and early childhood developmental milestones may not be popular to the patient.

Axis IV includes psychosocial stressors that contribute to the severity of a patient’s mental illness or its perpetuation.

Some amount of particular note to include are levels of social support, financial resources, legal problems, and housing. Axis II includes any significant general medical conditions that may relate to the patient’s current presentation. Anyways, the designations of medical and mental illness have practical value only in that they allow a practitioner to subdivide illness for the sake of staying organized. All mental illness is biologic, and the separation of mental and physical illness with regards to etiology or legitimacy is a false dichotomy. Generally, while not structurally different from that obtained in other specialties, a medical history obtained in psychiatry, does have some important focuses. With that said, this format is most appropriate for new patient interviews but can also be of value for existing patients whose psychiatric history has never been fully explored.

It’s the authors’ intention to also provide additional hints in how to effectively obtain information during that interview. Following text provides an overview of the basic components and key concepts of the psychiatric interview. All psychiatric assessments should end with the 5 axis diagnoses, that summarize findings in a very brief list format. That said, axis I includes the patient’s psychiatric disorders and can include the provisional diagnosis followed by the diagnoses under consideration, like schizophrenia versus schizoaffective disorder versus substance induced psychosis. Did you hear of something like that before?, in this section, it’s common to refrain from a formal diagnosis and to identify only prominent traits suggested by history and examination, Personality disorders are rarely diagnosed in the first psychiatric interview with a patient. Loads of clinicians defer Axis I, I’d say in case no clear traits manifest throughout the course of the interview. Nonetheless, axis I includes personality disorders and mental retardation.

Insight and judgment can be assessed throughout the entirety of the interview.

s/he might be deemed to have poor insight, I’d say if a patient presents with clear symptoms of a mental illness but rejects the diagnosis.

Proxy measurement can be why or how the patient came to see the interviewer. Of course judgment is narrowly defined as the active demonstration of insight, just like willingness to take medication or accept other treatments. Normally, insight in this context references the patient’s mental illness and the patient’s awareness of it. Psychological plan includes the nonpharmacologic treatment of psychiatric conditions. However, this may vary from something as simple as breathing exercises for anxiety to something as complex as ‘long term’ psychodynamic psychotherapy.

Accordingly a more accurate view of the pics that are crossing the patient’s mind can be ascertained by simply letting the patient talk.

Details of psychosis are defined as follows.

Record any pics the patient identifies as significant or spends significant time on. Using the first 5 the interview minutes in this way is of great benefit. For example, hallucinations are also included under thought content. Usually, any active thoughts that the patient has about harming himself or herself or others will be directly investigated and noted in this section if such thoughts are currently present. Hallucinations from all sensory domains might be queried.a lot of sufferers recognize some foreign aspect to the sensory experience and will reply affirmatively to the question Do you ever see or hear things that other people don’t, a hallucination may not always be directly evident to a patient. Known any delusion might be detailed and categorized as bizarre and nonbizarre on the basis of the possibility of it being accurate. Basically the route and amount consumed are important for illicit and prescribed medications. Illicit drugs, prescription medication usage may be examined with a simple do you ever find yourself using more of a medication than your doctor prescribes or using other people’s prescriptions? You should take it into account. Open questions just like what does your body feel like when you are having one of these panic attacks?

Determine what a panic attack means to this particular patient, if the patient identifies panic attacks.

a concrete place to start is in the concept of panic.

Did you know that the presence of anxiety suggests many diagnoses to consider. Now this section of the examination often begins with a statement on the patient’s amount of alertness and orientation to s/he is. Memory going to be assessed in the short term, often through recall of number or word sequences, and in the long time, possibly through the recalling of important dates in the patient’s life as verified by a family member. Insight and judgment might be limited by cognitive ability, that is assessed separately. Concentration can be assessed through simple arithmetic or by spelling words backwards. Then again, given this difficulty, the patient and provider should limit themselves to no more than 2 3 sentences at a time before pausing for interpretation.

Goal is to interpret what the patient is saying as closely as possible but to recognize the difficulty that the interpreter may have in conveying feelings and thoughts that may not easily be communicated in English.

It is more appropriate than talking about the patient in clinician and interpreter can discuss most of the translation difficulties they encountered, as well as discuss any cultural problems that may have arisen, right after the interview. Eg, boss, coworker, and family, A feel for the depth and length of multiple kinds of relationships types may be obtained. Sexual history is a challenging pic for the patient and the interviewer. Ok, and now one of the most important parts. Adult relationships are an important part of the patient’s social history as well.

More than many areas of the interview, with that said, this portion calls for questions that are neither judgmental nor overtly supportive, in order not to burden the patient with the clinician’s emotions in addition to every aspect of a patient’s suffering is important, illnesses may occur spontaneously. Tattoos, ‘makeup’, jewelry, and any physical abnormalities are included and should be pics of further inquiry. Then, attire and overall hygiene are noted next. For example, punk rock hair is a less objective description than light purple hair styled into 2 inch spikes.

Make each attempt to be descriptive and not interpretive to minimize subjectivity.

Apparent race/ethnicity, age, and gender are usually noted first.

Mental status examination begins upon first seeing the patient and noting might be noted.. Compulsive movements, just like picking at the skin or rearranging items or clothing, can be helpful in a differential. Usually, documentation of the interview is at least as important as the process of the interview itself. Further, the ‘writeup’ will serve as evidence of the patient interaction for billing purposes, and it can be an important source for at least the minimum degree of information required by any involved insurance programs. Now regarding the aforementioned fact… It provides a reference during ‘followup’ visits for the interviewing clinician, and at least parts of it will likely be seen by other medical providers, like the patient’s primary care provider.

Description by the interviewer of he may be interacting with the patient in the future becomes even more important than in most interviews.

An interview with a potentially assaultive person may best be accomplished with multiple interviewers.

That’s a fact, it’s for that of the patient. Significant therapeutic benefit can often be obtained simply by giving the provider a space to discuss if interpersonal conflicts was frequent. Challenges with communication between staff members will be looked for.

By the way, the social history occasionally degrades into very straightforward inventory of vices.

With a brief assessment of housing and finances, a harried physician may take the time to ask only about sex. Abuse.

With a more holistic view, the social history should provide a longitudinal view of the patient’s life, as do the psychiatric and medical histories. Remember, to say that this gives an incomplete view of the patient must be an understatement. Birds outside my window were loud this morning, are often associated with mania. Usually, loose associations like I’ve read that driving a car is more dangerous than flying in an airplane. Very loose associations have connections understood only by the patient. Keep reading. Associations are a part of the thought process wherein a patient connects meaning to words and sentences. Acute stressors can be medication changes or substance use or can be social in nature and are reasonable to ask about if the patient ain’t immediately forthcoming.

Whenever becoming a combined biologic and social stressor, substances are also able to rapidly escalate psychiatric problems to the degree of crises.

Any physicians involved in the patient’s care, additional information gonna be obtained from nursing and identical ancillary staff.

Consultation evaluation to a general medical hospital or clinic is usually focused on a specific question. Clear description of the significant poser from the patient’s primary provider is a significant piece of information needed in formulating this question. Patients likely do not share an identical view with their physician of what constitutes an illness, as in some of medicine. Questions described below are also appropriate for delving deeper into a patient’s initial complaint. Did you know that a person with bipolar disorder may not, for instance, feel that the euphoric symptoms of mania represent anything wrong. Here is, they are not recognized as intrinsically different from how the patient would expect to act or feel.

It can be moved to the history of present illness when the practitioner is documenting if a significant positive response does occur throughout the review. Experiences that a practitioner should call pathologic can be experienced by the patient as ego syntonic. Cleaning and organization can also be assessed. Obsessive compulsive disorder is often more ego dystonic than obsessive compulsive personality disorder, and so it’s a helpful point to assess for diagnostic accuracy. You ever feel the need to count the actual number of certain objects in a room, right? On p of that, similarly, the question What are you thinking or feeling during these episodes? Ultimately, we only know what our patients are thinking depending on what they tell us, Speech and thought can be difficult to separate objectively.

Albeit process and content, for the purposes of a mental status examination, speech covers the motor and neurologic facts of producing words, discussed later, will refer to the informational and organizational components.

a list of possible diagnoses is discussed in brief, gether with which diagnostic information is missing to finalize a diagnosis, if a specific diagnosis or specific diagnoses have not yet been reached.

Assessment is a summary of the entire interview, clearly combining history and examination into a differential diagnosis. Notice, pertinent positives and negatives are included if you are going to support the listed diagnosis. That’s right! Since anything from conduct disorder to attention deficit hyperactivity disorder can have identical end result poor school performance but require dramatically different treatments, a fresh and unique view of the patient may be guided by the past.

Discuss the relationship of the patient to gonna be examined in detail.

Whenever asking Were you ever physically, sexually, or emotionally abused growing up, given that what a patient views as abuse may differ significantly from what a clinician considers to be abuse. So it is also an ideal time to inquire about any current abuse, especially in patients with a positive history. Abuse is a complicated topic. These may contribute to the illness or its severity, Briefly looking at the recent or chronic stresses that the patient should be experiencing is also important. You should take this seriously. Any sort of transition, similar to medical illness, a brand new relationship, a completely new job, or a recent loss, can be a stressor that precipitates or exacerbates a mental illness. As a result, caregivers can provide a more complete longitudinal view of the patient’s functioning as well.

Concerns that the caregiver has are particularly important in relation to cognitive disorders, that may not be readily apparent to the patient. Caregivers can play an important role in the geriatric patient’s life and shouldn’t be excluded from the interview. Ie, a history of the patient’s present illness episode, Another approach involves looking only at the immediate events preceding the patient’s arrival for treatment. Anyways, the history of present illness is the most important component of a modern diagnostic interview, yet I know it’s approached differently determined by how the illness is defined. Longitudinal view of illness emphasizes obtaining a history of the course of the illness. Nevertheless, it also gives the interpreter some opportunity to educate the interviewer on any cross cultural problems that may impact the interview.

I’d say if the interpreter ain’t experienced in mental health and if the patient is already known, it may put the interpreter more at ease if he is informed ahead of time of known symptoms and what specific areas of thought content, language, or disorganization the clinician is interested in. Prior to beginning the interview, it can be helpful to speak separately with the interpreter to discuss any potential concerns or problems that may arise. Thought content describes what the patient’s focus is throughout the interview. On p of that, with the patient having little opportunity or desire for spontaneity and discussing only what the interviewer brings up, in a tightly structured interview with ‘closedended’ questions, the content of the patient’s thoughts might be question focused. Exploring and expanding on the chief symptom is a reliable, patientcentered way to build rapport and begin gathering information.

More descriptive phrases, just like unable to stop crying for the past 3 days, is more memorable to a reader, despite recording depression is certainly acceptable. Recording a direct quote from the patient is best. Some commonly used terms to describe speech are defined as follows. Furthermore, rhythm abnormalities might be most pronounced in Tourette syndrome, in which speech can be cluttered with repeated sounds or noises. It’s a well poor articulation of words could point wards substance intoxication. Alterations in prosody can suggest affective disorders. It’s a well many terms was used to try to capture and convey these states. Mood is defined as follows. I know that the mood is the internal, subjective fact of the patient’s emotional state and the affect is the external, objective part of the patient’s emotional state. Mood and affect are separated in the mental status examination. As a result, a thorough examination of mood includes questions regarding how long the patient has felt the way he does, how often had been experiencing as opposed to any and every momentary feeling.