Initial psychiatric assessment: A practical guide to the ...
[Pages:4]Initial psychiatric assessment: A practical guide to the clinical interview
1. ID
Name: ________________________________________________ Sex: __________________________________________________ DOB: ____________________________ Age: ________________
Marital status:__________________________________________ Occupation: ___________________________________________ Financial situation: ______________________________________
2. HPI ONSET, DURATION, COURSE (Why present now/precipitants/stressors? When it started? How long it lasts/frequency? What is it like? Impact on life)
For episodic illnesses describe first episode: 1. Onset: 2. Precipitants: 3. Duration: 4. Rx response:
DEPRESSION ("Sigecaps") Low mood for >2 weeks Sleep Interest Guilt/worthlessness Energy Concentration Appetite/weight Psychomotor slowing Suicide:
Hopelessness/Plan/Access
MANIA ("Giddiness") Grandiose Increased activity
goal-directed/high risk Decreased judgment Distractible Irritability Need less sleep Elevated mood Speedy talking Speedy thoughts
PSYCHOSIS Hallucinations/illusions Delusions Self-reference:
people watching you talking about you messages from media Thought blocking/insertion Disorganization: speech/behavior
PANIC ATTACKS Trembling Palpitations Nausea/chills Choking/chest pain Sweating Fear:
dying/going crazy Anticipatory anxiety Avoidance Agoraphobia
GENERALIZED ANXIETY Excess worry Restless/edgy Easily fatigued Muscle tension
sleep concentration
OBSESSIVE-COMPULSIVE DISORDER Intrusive/persistent thoughts Recognized as excessive/irrational Repetitive behaviors:
Washing/cleaning Counting/checking Organizing/praying
PTSD Experienced/witness event Persistent re-experiencing Dreams/flashbacks Avoidance behavior Hyper-arousal:
vigilance/ startle
SOCIAL PHOBIA Performance situations:
Fear of embarrassment Fear of humiliation Criticism
SPECIFIC PHOBIAS Heights/crowds/animals
BORDERLINE PESONALITY Fear abandonment/rejection Unstable relationships Chronic emptiness
self esteem Intense anger/outbursts Self-damaging behavior Labile mood and impulsivity
ANTISOCIAL PERSONALITY Forensic history:
arrests/imprisonment Aggressiveness/violence Lack of empathy/remorse Lack of concern for safety:
self or others Childhood conduct disorder
BODY DYSMORPHIC DISORDER Excess concern with appearance
or certain part of body Avoidance behavior
EATING DISORDERS Binging/purging/restriction/amenorrhea Perception of body image or weight
3. PSYCHIATRIC HX Previous psychiatric Hx/Counseling/Suicide attempts/Violence: Previous diagnoses: Medications/Tx:
4. FAM PSYCHIATRIC HX Psychiatric Dx/Visits/Counseling/Suicide attempts:
Substance use:
Suicide: 5. MEDICAL HX Previous illnesses & treatment: Surgeries/hospitalizations: Head injury (+/- LOC) and workup/imaging: Medications: Alcohol use: Substance use: (caffeine, nicotine, over-counter/illicit med/drugs)
6. SYSTEMS REVIEW CNS: H & N: CVS: RESP: GI: GU: MSK: DERM:
7. PERSONAL HX Place of birth: As a child: (family structure, parents' occupations, relationship with parents, siblings, friends, abuse) As a teen: (friends, relationships, school, activities, sex, trouble, relationship with parents) As an adult: (work, finances, education, relationships, family, goals for future, trends in functioning)
8. MSE Appearance: Behavior: Speech: Emotion: Affect and mood Perception: Thought process: Thought content: Concentration: Memory: Insight: Judgment: Suicide:
9. FOLSTEIN MMSE
Orientation:
/10
Time: year
season
month
date
day
Place: floor
building
city
province
country
Immediate recall:
/3
Attention:
/5
Delay recall:
/3
Naming:
/2
Repetition:
/1
3-stage command:
/3
Reading:
/1
Copying:
/1
Writing:
/1
Total:
/30
10. IMPRESSION/FORMULATION BIOPSYCHOSOCIAL
11. MULTIAXIAL DIAGNOSIS Axis I: Psychiatric disorder: Axis II: Personality: Axis III: Medical conditions: Axis IV: Social factors: 12. PLAN Investigations:
Treatment: Biological: Psychological:
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- initial psychiatric evaluation
- improved psychiatric evaluation form sf dph
- example of a psychosocial assessment ceufast
- initial psychiatric assessment a practical guide to the
- application for involuntary emergency examination and
- initial evaluation template magellan provider
- level of care utilization system for psychiatric and
- dhcs 1801 application for up to 72 hour assessment
- psychiatric intake form cairn center
- mental health plan assessment form
Related searches
- beginners guide to the stock market
- a girlfriends guide to divorce
- the complete guide to act grammar rules
- psychiatric assessment questions pdf
- initial psychiatric assessment pdf
- initial health assessment icd 10
- initial psychiatric assessment template pdf
- initial psychiatric evaluation template
- guide to the constitution
- guide to the stock market
- nursing psychiatric assessment template
- jessica fisher lindsay davis thesis a thesis presented to the faculty of the de