Psychiatric assessment
The principles of the psychiatric assessment should not just apply to
patients with known psychiatric disease. It should be incorporated
whenever someone with abnormal speech or behaviour presents.
The psychiatric assessment helps to:
- Screen for underlying mental illness
- Discriminate between organic and functional causes of abnormal behaviour
e.g. delirium versus psychosis
- Predict the risk of the patient to self or public
Important points
- The developmental history and pre-morbid personality reveals if there
are any underlying intellectual or psychological issues contributing to a
person's condition e.g. academic performance, familial and intimate
relationships, friendships, job history
- The mental-state examination provides a 'snapshot' of the person's state
of mind at the time the patient was assessed. It doesn't necessarily
offer diagnostic or prognostic information as it can change over time
(psychotic symptoms and mood can fluctuate). However, it provides
useful comparative data to see if a patient is stable, improving or
deteriorating
- Familiarise yourself with the psychiatric terminology and jargon, it
will make explaining a patient's condition far easier (use Kaplan and
Sadock's glossary).
Problem list
- The DSM Axis system is the commonly accepted format. It
formularise the bio-psycho-social factors involved and provides the degree
of functioning.
- Briefly:
- Axis I - Major psychiatric conditions (including developmental
disorders)
- Axis II - Personality disorders (acquired patterns of behaviour
developed over childhood and adolescence)
- Axis III - Concurrent medical or physical conditions
- Axis IV - Concurrent social or external factors
- Axis V - Global Assessment of Functioning (establishes the impact of the
patient's mental condition on daily life - scored out of 100)