Presentation on theme: "Psychiatric Assessment"— Presentation transcript:
1Psychiatric Assessment Winter Conference2014Psychiatric AssessmentNurse Practitioners of Idaho
2Getting started Wisdom from Samuel Shem Setting the tone with what you can control:Cultivating a style of active listening that’s warm, empathetic, courteous, conversational and comprehensiveInitiate the interview with brief introduction to orient them to the purpose or clarify their understanding of why they are talking with you
3Listen ListenEncourage, with as few questions as possible, the person to give an uninterrupted story as to why they are in your office, in mental health treatment, or whatever the situation may be.Much of the mental status exam can be completed during this part of the interview.
4History of Present Illness DSM-5 Self-Rated Level 1 Cross Cutting MeasuresWhat are your current symptoms?When did they start?What is their severity?How have they affected your self-care, relationships, work, etc.?What precipitated them or has made them worse?Has there been any treatment?When was the last time you felt well?
5Questions to build Therapeutic Alliance What do you think has caused this (problem)?Has something happened in your life that may have triggered it or made it worse?How does this (problem) affect your every day life (ability to work, relationships, ability for self-care)?How kind of treatment has helped you the most, in the past?What is your biggest worry about this problem?Adapted from “The Pocket Guide to the DSM-5 Diagnostic Exam”, Abraham M. Nussbaum, M.D.
6Past Psychiatric History Any past episodes of symptoms?At what age did they start?Were there any precipitating or traumatic events at the time?Did you undergo treatment with counseling or medication?If so were these helpful? Obtain as much detail as possible about past treatment, efficacy, and any side effects or adverse reactionsAny hospitalizations for mental health reasons?Any attempts to injure yourself (or others)?
7Past Psychiatric History Have you ever done something during one of these episodes that got you in trouble with your spouse or work, or even got you arrested“Sometimes people try to make themselves feel better or less worse by using alcohol or drugs - have your ever tried that?”If yes, then what drugs or alcohol did you use? How much and how often, and when was the last time?
8Psychiatric Review of Systems MoodPsychosesAnxietyObsessions & compulsionsTraumaDissociationSomatic concernsEating & feedingSleepingSubstances & other addictions
9Assessment continued PMI ROS Allergies Family History(Mental health, Substance abuse, Suicide attempts)Developmental historySocial history
10Social History Where did you grow up? How long did you live with your family?Any trauma history?How far did you go to school?Detailed work historyWhat is the longest time you have ever worked at one job?Detailed relationship historyHave you ever served in the military?Have you ever been arrested?
11Mental Status Exam Thought process Thought content AppearanceBehaviorSpeechMoodAffectAttitudeThought processThought contentCognition and intellectual resourcesInsight, judgment, impulse controlMMSE
13Psychiatric Crisis Interview Assess for high risk clinical issues:psychosissuicideanxietyEnvironment should be as safe, calm and quiet as can be arranged
14Psychiatric Crisis Interview Be attentive to physical comfort/discomfort of your patientWork on therapeutic allianceTry to slow things down, if possible, for better problem-solvingInvolve other clinicians as needed