initial psychiatric evaluation questions

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Normative values are not always available, and it is even more uncommon to have normative values available based on factors such as educational level, age, race, ethnicity, culture, or comorbid conditions that can influence ratings. This approach would allow for maximum flexibility in how clinicians document findings of their assessments. These materials and sponsorship may have influenced patients’ reported compliance with treatment. psychiatric evaluation to the unique circumstances of the patient and in determining which questions are most im- portant to ask as part of an initial assessment. Depending on the clinical setting, the patient’s cooperation and ability to respond, the time available for the evaluation, and the type of treatment planned, some information may be more or less relevant to obtain as part of the initial assessment. Timing: Patients were assessed at baseline and again at 5 weeks. Also, there were no differences between patients who continued the trial and those who dropped out, in terms of age, gender, duration of illness, or PANSS score at discharge. Thus, changes may be needed in clinician training and in the resources devoted to shared decision making to promote the implementation of these recommendations. Statement 1. Examples may include spiritual beliefs that are not part of an organized religion or cultural or religious rituals, including food preferences. Many individuals receiving psychiatric treatment are taking multiple medications, and this magnifies the likelihood of drug-drug interactions (Haueis et al. 2010) but are equally relevant to paper-based formats. Between or prior to visits, mobile technology may also be adaptable to obtaining quantitative measurements (Palmier-Claus et al. Setting: The University of Medicine and Dentistry of New Jersey–University Behavioral HealthCare (a statewide mental health care delivery system at the university). 2010; Tully et al. As described under “Expert Opinion Survey: Results,” expert psychiatrists typically practice in accordance with this recommendation. If a patient becomes anxious or annoyed by being asked about substance use, this could interfere with the therapeutic relationship between the patient and the clinician. This level of confidence is informed by available evidence, which includes evidence from clinical trials as well as expert opinion and patient values and preferences. Clinician-rated patient compliance also did not differ between the groups. Statement 2. Applicability: This study measured rehospitalization rates as a proxy for overall clinical outcome. To determine whether the patient has an ongoing relationship with a primary care health professional requires gathering additional information besides a simple recording of the clinician’s name. It also recommends documentation of an overall estimation of suicide risk, which is a matter of clinical judgment that is informed by all data collected about an individual patient during the evaluation. Selection bias: High Risk: Not all patients who were asked agreed to be part of the study, and those who chose to participate may have had different drinking patterns from those who refused. Tourette Syndrome 2006; Saha et al. Percentage of experts who “strongly agreed” or “agreed” that an individual clinician’s decision making about a patient’s psychiatric diagnosis and treatment plan is improved when the clinician typically (i.e., almost always) documents the following in the patient’s medical record: Estimation of risk of aggressive behavior (including homicide), including factors influencing risk, Estimation of suicide risk, including factors influencing risk, Rationale for treatment selection, including discussion of the specific factors that influenced the treatment choice, Rationale for clinical tests (e.g., laboratory studies, imaging, ECG, EEG) as part of the initial evaluation. Dr. David Dranetz is an experienced Psychiatrist serving the College Station community. The clinician could discuss the likely diagnostic possibilities or explain why symptomatic treatment is still indicated, even in the absence of a clear diagnosis. As another aspect of patient preference, it is helpful to ask whether or not the patient wishes to have family members or others (e.g., case managers, close friends) involved in discussions or decisions about aspects of care including treatment. These searches yielded 32,895 articles in MEDLINE, 7,052 articles in PsycINFO, and 5,986 articles in the Cochrane database. Selection bias: Moderate Risk: Patients were selected consecutively, rather than randomly, so it is possible that the patients included in the study are not a representative sample. Statement 3. Confounding factors (including likely direction of effect): Depending on the investigators’ a priori hypotheses, the lack of blinding could influence the judgments about contributors to psychiatric symptoms and the clinical significance of laboratory abnormalities. Directness: Indirect: Many studies directly measured adherence and patient satisfaction after an intervention in which patients were educated or included in a decision-making intervention. Time-based terms such as “current,” “recent,” or “past” are often used in clinical contexts without a clear meaning. The most intensive treatment (PMT + CP + KC) produced a clinically relevant reduction in rehospitalization, with a 24% rate of rehospitalization compared with a rate of 50% in the control group, although the statistical significance of this effect was nominal. Data Field Person Demographic Information Person’s Name Record the first name, last name, and middle initial of the person. Also, subjects were assessed outside of a standard psychiatric evaluation, which may limit the applicability of the study findings to the identification and diagnosis of substance use disorders as part of the initial psychiatric evaluation. No differences were found between strategies on later dropping out and weight change (in anorexia nervosa patients) during inpatient treatment. 2008). 2012; Singh et al. APA suggests (2C) that the initial psychiatric evaluation of a patient include assessment of the patient’s personal/cultural beliefs and cultural explanations of psychiatric illness. Detection bias: Low Risk: There was no attrition, and multiple approaches were used to determine whether patients had died during the study period (including by suicide) and/or had made a suicide attempt. Outcomes: Attendance at the meetings varied from 20% to 94%, with a mean of 73%. 2011), is available on request from the VA National Center for PTSD at http://www.ptsd.va.gov/professional/assessment/te-measures/ths.asp. Capacity for decision making The ability of an individual, when faced with a specific clinical or treatment-related decision, “to communicate a choice, to understand the relevant information, to appreciate the medical consequences of the situation, and to reason about treatment choices” (Applebaum 2007, p. 1835). KC was delivered over 20 sessions. 2006 (see above). The assessment produces a risk score from 0 to 12. APA recommends (1C) that the initial psychiatric evaluation of a patient include review of the patient’s mood, level of anxiety, thought content and process, and perception and cognition. 2002) can be used to document signs and symptoms and guide treatment. 2011c; Li et al. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, is formulation of an appropriate treatment plan improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of his or her language needs (i.e., basic language ability and need for an interpreter)? 2010) or adhering to other forms of treatment. Reporting bias: Low Risk: The battery of tests was prespecified. However, there may be opportunities to pair measures derived from this guideline with follow-up measures derived from other guidelines. When there is insufficient information to support a recommendation or a suggestion, a statement may be made that further research about the intervention is needed. Furthermore, these preferences can be difficult to judge (Kon 2012) and may be culturally mediated (Charles et al. Selection bias: Moderate Risk: Since randomization was done using a cluster approach in which all patients at a given site were randomly assigned to the same treatment arm, site-specific factors may have produced differences in the intervention and control groups. Especially in developed countries, patients are used to and expect digital, computerized information exchange, including for health-related monitoring and communication. The new strategy involved all patients starting with an admission interview, followed by a tour of the unit and an explanation of the program. Study design: Nonblinded observational study with a comparison “control” group to assess the representativeness of the sample as compared with the clinic population and individuals treated in CMHCs statewide. 2011, 2014; Thomas et al. In the group with schizophrenia or bipolar disorder, 31 (91%) of the at-risk drinkers reported a past problem with alcohol, and 20 (59%) reported a current problem. A second individual (L.F.) screened the 32,895 references from the 2011 search after duplicate articles from the different searches were eliminated. A psychologist or geriatrician independently performed cognitive testing for establishing a reference consensus diagnosis using DSM-IV or ICD-10 criteria. Other organizations have promoted similar educational and collaborative approaches to care, often using the term “shared decision-making.” For example, the U.S. Preventative Services Task Force has described how shared decision making may be incorporated into the delivery of preventative care (Sheridan et al. The treatment groups contained psychoeducational medication training (PMT) alone (n = 32) or in combination with cognitive psychotherapy (CP) (n = 34) and (n = 33)/or (n = 35) key-person counseling (KC). 2011; Veerbeek et al. Also, the study appears to indicate that patients were offered voluntary admission to a research unit, and it is unclear if patients may have had a legal incentive to do this, given the warrant they were brought in under. 2012; Redelmeier et al. Patients in the intervention group reported significantly greater sense of involvement in medical decisions after the initial planning talk, but this difference was not found at discharge. Get started with this our psychiatric evaluation form sample for a head start or create your own blank psychiatric evaluation form. 2005) as comparator data. No studies have addressed the benefits of documenting suicide risk in the medical record. 2013) or decision aids (Knops et al. Study design: Nonrandomized, nonblinded intervention study. In studies of psychotherapy, systematic rating scales have been used to provide “outcome-informed treatment” in which patients provide feedback on levels of distress as well as on facets of the therapeutic alliance and perceived benefits of treatment (Boswell et al. Data were obtained using an interactive voice response system on the phone. Psychiatrists and other mental health professionals may speak more than one language and may be able to communicate in the patient’s preferred language. If suicidal or aggressive symptoms or behaviors are reported, these will also require further questioning to assess the patient’s level of risk, as described in “Guideline III: Assessment of Suicide Risk” and “Guideline IV: Assessment of Risk for Aggressive Behaviors.” Inquiry about specific symptoms may also be suggested by observations of the patient’s behavior during the interview. ^�w��'�!�K幌��y�M�>���������� � j:- endstream endobj 56 0 obj 199 endobj 20 0 obj << /Type /Page /Parent 15 0 R /Resources 21 0 R /Contents [ 30 0 R 32 0 R 34 0 R 36 0 R 38 0 R 42 0 R 44 0 R 46 0 R ] /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 >> endobj 21 0 obj << /ProcSet [ /PDF /Text ] /Font << /TT2 26 0 R /TT4 24 0 R /TT5 22 0 R /TT7 40 0 R >> /ExtGState << /GS1 51 0 R >> /ColorSpace << /Cs6 27 0 R >> >> endobj 22 0 obj << /Type /Font /Subtype /Type0 /BaseFont /FBPOOB+MS-Mincho /Encoding /Identity-H /DescendantFonts [ 49 0 R ] /ToUnicode 23 0 R >> endobj 23 0 obj << /Filter /FlateDecode /Length 215 >> stream Detection bias: High Risk: Several of the outcome measures were obtained through patient interview, such as addiction severity, AIDS risk behavior, days of cocaine use, and so forth. Dr. Watkins is employed as a researcher at the RAND Corporation and is a psychiatrist in private practice. Other quantitative measures ask the patient to consider both symptom frequency and severity, which can also make the findings difficult to interpret. However, the materials were developed by a pharmaceutical company and may be dissimilar to education provided by a physician or other mental health professional. This difference of opinion is considered minor. Attrition bias: Low Risk: Attrition was not discussed in the study, implying that all 60 patients initially chosen to be a part of the study also participated in the follow-up. Dr. Lomax is employed as a professor at Baylor College of Medicine. More detailed inquiry can then occur as the therapeutic relationship develops, the patient’s sociocultural context changes, or other findings suggest the need for in-depth knowledge of the patient’s culturally related beliefs. APA recommends (1C) that the initial psychiatric evaluation of a patient include review of the patient’s mood, level of anxiety, thought content and process, and perception and cognition. Every item must be completed. 2 Psychiatric Evaluation Form free download. NQF Measure 110, “Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use,” assesses the percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use (http://www.qualityforum.org/QPS/0110). The typical practices of other psychiatrists are unknown, but anecdotal observations suggest possible variability. Exceptions to the denominator of performance measures derived from this guideline might include patients who are unable to participate in the evaluation due to current mental status. A systematic review of the literature, Depression outcomes in psychiatric clinical practice: using a self-rated measure of depression severity, Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication, The descriptive epidemiology of commonly occurring mental disorders in the United States, Recognition of co-occurring medical conditions among patients with serious mental illness, Quality of care for cardiovascular disease-related conditions in patients with and without mental disorders, Limited English proficiency as a barrier to mental health service use: a study of Latino and Asian immigrants with psychiatric disorders, The Wessex Recent In-Patient Suicide Study, 1. Dr. Swartz has also received consulting and educational fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Pfizer. This could produce confounding effects in either direction. t�(БV@S�q"#K0�y�k��@�? In some circumstances, information from laboratory testing may be available that provides clues to substance use. 2012a, 2012b). Patients may also be taking nonprescribed medications such as nutritional supplements or herbal products (Freeman et al. The psychiatric evaluation may occur in a variety of settings, including inpatient or outpatient psychiatric settings and other medical settings. Increasing numbers of young adults reside with their parents (Vespa et al. Brief screening instruments improved the identification of risky drinking at this psychiatry clinic. S��_W��nY��_د�{�-��^�+(��_B��x/�P�?���>A������T�z���Y�=}�6�bE�G��>���YT�fR��vs�ŨH)��¤�J*z���n���K�}�G�U�X��. Depending on the setting and type of treatment, transference issues could arise and interfere with effective treatment if the psychiatrist conducts the physical examination himself or herself. A parent/guardian measure exists for children ages 6–17 years. 2008). This may limit the generalizability of its findings to the United States, to individuals with other psychiatric diagnoses, and to individuals using other substances. Applicability: Patients were chosen from rural clinics in Germany, and all had a diagnosis of schizophrenia. A similar measure might assess the percentage of patient visits and admissions where interpreter preference is screened and recorded. Nevertheless, there is no evidence that assessment of any of these factors can predict suicide in an individual (Assessment and Management of Risk for Suicide Working Group 2013; Brown et al. To what extent do you agree that the identification and diagnosis of substance use disorders is improved when the initial psychiatric evaluation of any patient typically (i.e., almost always) includes assessment of the following? Few statistically significant differences in either treatment outcomes or duration of medication compliance were found between the treatment groups, and significant differences found were of fairly small magnitude. Potential harms of assessment have not been a focus of study but are likely to be minimal. When the clinician is speaking with patients about their current life circumstances and the reasons they are presenting for evaluation, it can be useful to consider whether unrecognized alcohol or substance use may be contributing to their symptoms or associated with stressors such as recent medical problems, relationship conflicts, traumatic exposures, or school/occupational, financial or legal difficulties. As described under “Expert Opinion Survey Results,” expert psychiatrists typically practice in accordance with these recommendations. 2010; Sinclair et al. Only patients who agreed to this randomization were included, and this may have affected the results of the study. Detection bias: Moderate Risk: Compliance was measured by a series of three questions to the patient and also a pill count. Some patients received psychotropic medications between evaluations; the study investigators analyzed these patients separately and did not find any differences from the study population as a whole. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are clinical decision making and treatment outcomes improved when quantitative measures of the following are typically (i.e., almost always) obtained on at least one occasion after the initial psychiatric evaluation, compared to nonquantitative clinician assessment? Percentage of experts who “strongly agreed” or “agreed” that an individual clinician’s decision making about a patient’s psychiatric diagnosis and treatment plan is improved when the clinician typically (i.e., almost always) documents in the patient’s medical record an estimation of suicide risk, including factors influencing risk: 93.2%. Patients seeking treatment for cocaine dependence received either 12 weeks of weekly individual therapy (IND) or an intensive 3-hour, three-times-per-week treatment program (INT). However, because standardized, validated instruments were used, this risk is low. 2013), suggesting the need to explore with patients the ways in which family members can help them meet their identified treatment goals (Dixon et al. Quasi-experimental design; retrospective chart review; 2002–2004; admission strategy involved a 5-day introductory period prior to entering treatment. There were 324 psychiatric units in the area that were screened on eligibility criteria (i.e., majority of patients have an acute psychiatric disorder, patients are admitted directly onto the unit, patients usually stay less than 3 months, patients are 18–65 years old, and the unit admits all potential patients and is not specialized for the treatment of specific disorders). “Quantitative measures” are defined as clinician- or patient-administered tests or scales that provide a numerical rating of features such as symptom severity, level of functioning, or quality of life and have been shown to be valid and reliable. Because psychoeducation was included in all treatment groups, this intervention may help with lowering relapse. Patients not receiving the educational materials initially exhibited a more positive response to treatment (week 4), but this difference did not persist at later follow-ups and was associated with significantly higher relapse rates. Furthermore, information in medical records may be lacking or incomplete. For patients who present with a psychiatric symptom, sign, or syndrome in any setting, are diagnostic accuracy and treatment safety improved when the initial psychiatric evaluation typically (i.e., almost always) includes assessment of the following aspects of the patient’s general medical history? A detailed systematic review on screening for suicide risk in primary care settings also has not identified any serious harms (O’Connor et al. Outcomes: Proportion of individuals who were found to have a previously unrecognized and undiagnosed medical illness that was felt to be specifically causing or exacerbating their psychiatric symptoms. Systematic use of measures may require changes in workflow to distribute scales and additional time to review the results with the patient. Order of name is at Statements 4 and 5 are not appropriate for quality measurement because the balance of benefits and harms of the suggested assessments is uncertain. These recommendations should not be viewed as representing a comprehensive set of questions relating to assessment of medical health, nor should they be seen as an endorsement of a checklist approach to evaluation. Personal/cultural beliefs Beliefs related to the patient’s personal/cultural characteristics and identity, including but not limited to his or her beliefs about age, ethnicity, gender, race, religion, and sexuality. Depending on the setting, general health status, and other clinical characteristics of the patient, clinicians may judge other parts of the evaluation as having a greater priority in planning initial treatment. A meta-analysis, Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions, Evaluation of drug interactions in a large sample of psychiatric inpatients: a data interface for mass analysis with clinical decision support software, Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review, Functional status and all-cause mortality in serious mental illness, A comparative quality assessment of evidence-based clinical guidelines in endocrinology, The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire, Prospective evaluation of emergency department medical clearance, Brief screening instruments for risky drinking in the outpatient psychiatry clinic, Mortality of Finnish acute psychiatric hospital patients, Psychoeducational training for schizophrenic patients: background, procedure and empirical findings, Collaboration with drug treatment by schizophrenic patients with and without psychoeducational training: results of a 1-year follow-up, Impact of childhood life events and trauma on the course of depressive and anxiety disorders, Sex differences in mortality of admitted patients with personality disorders in North Norway—a prospective register study, Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: Results of the National Epidemiologic Survey on Alcohol and Related Conditions, Treatment preferences affect the therapeutic alliance: implications for randomized controlled trials, Noncancer pain conditions and risk of suicide, Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care, The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk, Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force, Do professional interpreters improve clinical care for patients with limited English proficiency?

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