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Cognitive Therapy Orange County

Cognitive Therapy Orange County

Corey Rose

inside orange county cognitive therapy services

Psychiatric Evaluations

A psychiatric evaluation is a systematic assessment used by psychiatrists to identify the causes, symptoms, and course of a psychiatric illness. A psychiatric evaluation can be an initial assessment or a reevaluation of an ongoing problem. An initial psychiatric evaluation aims to formulate a diagnosis and devise a treatment plan based on the diagnosis.  If the evaluation is a reassessment of a patient, it will focus on revising the plan of treatment according to the new insights obtained from the evaluation. 

Diagnoses can include a wide range of mental health conditions, including but not limited to depression, anxiety, bipolar disorder, schizophrenia, and addiction. 

What is Included in a Psychiatric Evaluation?

In general, any psychiatric evaluation consists of an interview section and an examination part.

A. Psychiatry Interview

Psychiatric evaluation varies on a per patient basis. At Orange County, our trained specialists consider interviewing the patient as the core component of a psychiatric evaluation. 

The components typically covered during a psychiatric interview before making a clinical diagnosis and recommendation include:

1. Chief Complaint

You will be first inquired about the reason for the evaluation. For this, your psychiatrist will usually ask an open-ended question. For instance, “what brought you here today?”

The psychiatrist will also try to figure out the reason for evaluation from other involved parties (e.g., family, other healthcare providers) for seeking evaluation at this specific time.

2. History of Present Illness

This entails obtaining answers to the following questions:

  • When, how, and where the problem started?
  • What’s the nature of the problem?
  • What is the severity level of the patient’s symptoms? 
  • What are the major triggers (for instance, stressful life events)?
  • What factors alleviate the symptoms?
  • Have you received any prior treatment for this episode?

For this section, you may also be given a patient health questionnaire to fill in prior to the start of the interview. Your psychiatrist will go through the questionnaire while interviewing you.

3. Past Psychiatric History 

If the evaluation is a reassessment, then your psychiatrist will need to know about:

  • The past outpatient visits
    • Where and how often have you been seen?
  • List of psychiatric medications tried in the past, including:
    • Why did you use them, for how long, and at what dose?
    • How was your response to them? 
    • How was your medication compliance?
    • Did you experience any side effects? If yes, what were those?
    • If stopped, what was the reason for stopping them?
  • Past inpatient psychiatric hospitalizations
    • Most recent: when, where, why?
    • Remote: when, where, why?
  • Suicidal history
    • Have you ever tried to harm yourself? When and how? 
    • Have you ever had any suicidal thoughts? When and why?
    • How many episodes in life?
    • Have you been having any suicidal thoughts lately? 
  • History of violence
    • Have you ever been violent in your life? If yes, when, and why?
    • Have you been feeling violent lately?
  • History of any Psychotherapy
    • What type and when? 
    • For how long?
    • Was it effective?

    4. Substance Abuse (and Alcohol) History

    • Do you smoke or use any other drugs? If yes, what licit and illicit substances have you used and in what quantity?
    • Have you ever had a drinking problem?
    • In what dose (including the heaviest dose), for how long, with what pattern, and route of use? 
    • What were the consequences (functional, social, occupational, or legal) of use? 
    • Did you develop any tolerance or withdrawal symptoms to substance use? 
    • Was substance use associated with psychiatric symptoms? 
    • Can family members provide evidence regarding the patient’s substance use and its consequences?

    5. General Medical History

    • Any history of significant medical illnesses, hospitalizations, or surgeries?

    6. Family History

    • Is there any history of psychiatric illness in the family?
    • Is there any history of substance abuse in close relatives?
    • Is there any history of suicide in the family?
    • Is there any history of violent behavior?

    7. Psychiatric Review of Systems

    This section involves screening the patients for major psychiatric disorders. Your doctor will ask you a series of questions to rapidly screen you for:

    • Depression
    • Anxiety disorders (including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder)
    • Bipolar disorder
    • Personality disorders
    • Substance abuse disorders
    • Eating disorders 
    • Psychotic symptoms, for instance:
    • If you have been seeing or hearing things that don’t have an explainable source?
    • Do you often feel suspicious of people around you or have difficulty trusting others?
    • Have you ever felt that an individual, group, or organization, is going to harm you despite the absence of any concrete evidence?
    • Cognitive disorders (like dementia)
    • Post-traumatic stress disorder

    8. Developmental and Social History

    This section covers questions about your:

    • Childhood 
    • How was your childhood?
    • Any history of sexual, physical, or emotional abuse?
    • Exposure to any other traumatic experiences?
    • Education
    • What is your highest level of education?
    • How was your performance as a student? 
    • Do you have any history of suspensions? If yes, why?
    • Parental relationship
    • Divorce, separation, death, domestic violence 
    • Occupation
    • Job history
    • Work relationships
    • Disability (SSI/SSD)
    • Your own marital relationship and children

    9. Sexual History

    • Are you sexually active? 
    • When was the last time that you were sexually active?
    • Have you been using contraception?
    • Any chance of being pregnant? 

    B. Mental Status Examination

    Mental Status Examination (MSE) is the psychological counterpart of a physical exam that evaluates a patient’s mental state and behaviors. During an MSE, we observe the patient (known as objective assessment) as well as ask questions (termed as subjective assessment).

    MSE can be regarded as a continuation of the interview and a part of the comprehensive physical examination.

    The MSE is composed of the following components: 

    Appearance and behavior

    This is the first step of an MSE. The doctor first observes: 

    • The physical appearance (apparent vs. documented age)
    • How well are you groomed (tidy/disheveled/provocative): Unkempt appearance may suggest depression or psychosis. A provocative dressing may suggest bipolar or personality disorder.
    • Posture (upright/slouchy): A person with depression will often slouch; droopy shoulders may reflect that the person is down.
    • Eye contact: Poor eye contact may suggest depression or psychosis
    • Attitude (cooperative or not) 

    Mood and Affect

    • The clinician will observe your emotions expressed both verbally and non-verbally during an interview, referred to as ‘affect.’ 
    • Patients will also be asked to describe in their own words about how they feel, referred to as ‘mood’ (e.g., happy, sad, angry, tired, frustrated, scared).

    Thoughts

    Your thoughts will be assessed in terms of:

    • Process: Are your thought processes coherent and logical? 
    • Content: Are there recurrent or persistent ideas in the patient’s thought processes? Are you having any thoughts of harming self or others? 
    • Perception: Are you experiencing perceptual disturbances, e.g., 
    • Hallucinations (hearing voices or seeing things that do not exist)
    • Disordered thinking or delusions (false beliefs that someone is going to harm the patient or that people are talking against the patient)
    • Illusions (misperceiving real stimuli)
    • Phobias (irrational fears)

    Speech   

    Speech is assessed in terms of:

    • Rate: normal, rapid, slow, or pressured
    • Volume: loud, normal, soft, or whispered 
    • Amount: logorrheic (excessive talkativeness as in bipolar disorder), responsive, or reserved
    • Articulation and fluency: articulated, perplexed, accentuated, stuttered, mumbled, clear, or slurred 
    • Latency: increased, decreased, or no latency 

    Insight and judgment

    Insight: Do the patients understand that they are sick and need treatment?

    Sensorium and cognition

    This includes assessing:

    • Orientation
    • Oriented to person, place, time, and situation
    • Registration and recall 
    • These elements can be tested by having the patient learn four unrelated items or concepts, and then asking the patient to recall the information after 3 to 5 minutes of doing another, unrelated mental task.
    • Attention and concentration 
    • These are assessed by asking the patient to spell a word forward and backward and subtract serial sevens from 100.
    • Abstract reasoning 
    • This is tested by asking the patient to explain the meaning of some proverbs and comparing two items (such as comparing an apple to an orange).
    • Language functions 
    • These are assessed by asking the patient to name, read, and write.
    • Visuospatial ability 
    • This function is assessed by asking the patient to copy a figure and draw an object.
    • Executive functions
    • High level functions are assessed by asking you to make a list, e.g., mention as many animals [or fruits or vegetables] as you can in one minute.
    • General intellectual level
    • This function is evaluated by asking general knowledge questions, such as identifying the previous five presidents. We also take into account the patient’s education level and socioeconomic status.

    How Long Does It Take to Do a Psychiatric Evaluation?

    The duration of a psychiatric evaluation varies from one person to another. The degree of information needed can predict the duration of an assessment. Typically, a psychiatric evaluation lasts for 30 to 90 minutes. At Orange County, evaluations take approximately 2 hours to ensure a comprehensive and accurate evaluation.

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