Psychiatric assessment, symptoms and signs

Abstract

The aim is to provide a structure and some practical advice for clinicians who conduct diagnostic interviews in psychiatry and related fields. The psychiatric assessment is usually conduced over about one hour. A conclusion may not be reached at single sitting, but the process is essentially a series of cross-sectional events. In this book, some examples are given which arose in the course of assessment/treatment of patients (sometimes years). When psychopathology is possibly present, a psychiatric assessment is conducted, and based on any findings, a diagnosis and a management plan is formulated. An appropriate diagnosis and management plan is the first step and foundation on which future management is built. In addition, the initial psychiatric assessment has therapeutic potential. At this point the patient will be at her/his most distressed, vulnerable, and even suspicious. A respectful but confident manner displayed by the diagnostic interviewer may have immediate and long-term influences on the ability of the patient to participate positively in management. The initial psychiatric assessment is limited insofar as it is a single, cross-sectional sample, like a histological slide. Accordingly, we extend our knowledge of the case by obtaining information from others (family, other clinical staff), taking a thorough personal and personality history, and reassessment of the patient. There is only one first interview between a patient and a particular clinician. That interview changes things. At future interviews the patient will not be as apprehensive, the signs and symptoms will not be as crisp and the clinician will not be as open to the range of possibilities. Psychiatry is complex and evolving. An early task is to know what is and what is not a psychiatric problem.