Psychiatric Assessment Winter Conference 2014 Psychiatric Assessment Nurse Practitioners of Idaho

Getting 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 comprehensive Initiate the interview with brief introduction to orient them to the purpose or clarify their understanding of why they are talking with you

Listen Listen Encourage, 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. http://www.nevdgp.org.au/files/programsupport/mentalhealth/Mental%20State%20Exam%20-%20form.pdf

History of Present Illness DSM-5 Self-Rated Level 1 Cross Cutting Measures What 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?

Questions 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.

Past 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 reactions Any hospitalizations for mental health reasons? Any attempts to injure yourself (or others)?

Past 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?

Psychiatric Review of Systems Mood Psychoses Anxiety Obsessions & compulsions Trauma Dissociation Somatic concerns Eating & feeding Sleeping Substances & other addictions

Assessment continued PMI ROS Allergies Family History(Mental health, Substance abuse, Suicide attempts) Developmental history Social history

Social 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 history What is the longest time you have ever worked at one job? Detailed relationship history Have you ever served in the military? Have you ever been arrested?

Mental Status Exam Thought process Thought content Appearance Behavior Speech Mood Affect Attitude Thought process Thought content Cognition and intellectual resources Insight, judgment, impulse control MMSE

MMSE MMSE http://www.healthandwelfare.idaho.gov/Portals/0/Medical/MedicaidCHIP/MiniMental.pdf

Psychiatric Crisis Interview Assess for high risk clinical issues: psychosis suicide anxiety Environment should be as safe, calm and quiet as can be arranged

Psychiatric Crisis Interview Be attentive to physical comfort/discomfort of your patient Work on therapeutic alliance Try to slow things down, if possible, for better problem-solving Involve other clinicians as needed

Q & A

Thank YOU!