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What Is a Complete Psychiatric Evaluation?

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For anyone that is new to therapy and exploring different options, there are a few steps that will happen. One of the initial steps will be a complete psychiatric evaluation. Now this phrase carries with it a lot of intimidation and may sound like a serious event, but in fact, it’s a fairly simple and common part of the therapy process. 

In the same way that an x-ray is used to help identify a broken bone, a psychological evaluation is used to help identify behavioral and emotional issues. It is simply a tool to help identify an issue so that a path of treatment can be determined. 

What Are Psychiatric Evaluations? 

A psychological evaluation is a mental health assessment used by a professional — such as a family doctor, psychologist, or psychiatrist — to test patients on whether they are experiencing mental health-related issues. 

Children, adolescents, and adults are all available to be tested, although the tests will naturally vary depending on age. The goal is to be able to identify and diagnose emotional, behavioral, or developmental disorders in relation to the physical, genetic, environmental, social, emotional, educational, and cognitive thinking behaviors displayed by a patient. There are typically multiple different components that make up a psychiatric evaluation, such as answering questions verbally, performing physical tests, and completing questionnaires. 

Why Would Someone Need a Psychiatric Evaluation?

It can be very difficult for someone to notice that they may potentially have a mental illness. Most of the time, it’s the family members, spouses, teachers, or friends that are the first to notice their loved one may have issues. 

As a result of the individual’s feelings, thoughts, and behaviors, they may often act disruptively, rebellious or depressed. These actions will soon begin to cause a strain in their relationships or negatively impact their work, school, sleep, eating, emotional expressions, coping abilities, attentiveness, and responsiveness. It’s generally around these times that the person or persons who have noticed these issues will speak with the individual about undergoing therapy or a psychiatric evaluation. 

What Are the Goals of a Psychiatric Evaluation?

A psychiatric evaluation itself is not a form of therapy and will ultimately not help heal any potential issues by itself. The goal of a psychiatric evaluation is to identify potential issues or patterns that could be harmful. 

Just like an x-ray doesn’t repair a broken bone, a mental health evaluation won’t repair negative behaviors. However, a psychiatric evaluation is an extremely critical step toward repairing and improving mental health and absolutely should not be skipped. 

Here are the goals of a psychiatric evaluation:

  1. Figure out whether a mental disorder or other condition that would require professional mental help is present in the patient.
  2. Collect data that would be required to support a clinical diagnosis of a mental disorder or condition.
  3. Confer with the patient in order to develop a potential treatment plan.
  4. Identify possible long-term issues that could emerge and should be addressed in the proposed treatment plan. 

What Does a Psychiatric Evaluation Look Like?

A psychiatric evaluation will have many components and will typically take between 30 and 90 minutes to complete depending on the reason for the evaluation. There will generally be several sections, including questionnaires, checklists, surveys, interviews, and observations ranging in scope and depth. 

Here are some of the different sections to expect for a psychological evaluation:

Mental Status 

This aspect of the test is generally the largest and contains the most components. Using observations and questions, a psychiatrist will evaluate the patient’s current mental function by focusing on their appearance, speech, thinking and perception, emotional expression, and cognitive functions. 

  • Appearance. Unspoken clues for underlying mental conditions can be found in the general appearance of a person. Is the individual functionally capable of caring for themself or are they undernourished, disheveled, dressed inappropriately for the weather, or have significant body odor?
    Is the person unable or unwilling to comply with social norms? Are they wearing socially inappropriate clothing on purpose? Have they engaged in substance abuse or self-harm? Do they smell like alcohol or have scars, indicating drug abuse or self-inflicted injuries?
  • Speech: This assessment will be made by noting the spontaneity, syntax, rate, and volume of an individual’s speech patterns. While someone with depression will tend to speak slower and softer, a patient with mania may speak rapidly and loudly. Individuals with difficulty speaking or a loss of ability to understand words may be suffering from a head injury, stroke, brain tumor, or multiple sclerosis.
  • Emotional expression. By asking a patient to describe their feelings, a patient’s tone, posture, hand gestures, and facial expressions will be noted. The mood (emotional state reported by the patient) and affect (patient’s expression of the emotional state) should be observed and assessed by the interviewer. Something looked for is the appropriateness of effect to the content of the speech. Is the person smiling while discussing a tragic event? Do they look pained when talking about happy events?
  • Thinking and perception. This will be assessed by noticing the content of what’s being communicated and also the method used. Abnormal content may appear as delusions, ideas of reference, or obsessions. The assessment will focus on whether these ideas are linked and goal-oriented and whether transitions from one thought to the next are logical. Psychotic and manic patients tend to have disorganized thoughts and abrupt flights of ideas. 
  • Cognitive functions: These pertain to a number of functions based on the patient’s behavior. Abnormalities most often occur with delirium or dementia but may be a result of intoxication or withdrawal. The behaviors used to identify these issues include: 
  • Attentive, alertness, and concentration
  • Orientation to person, place, and time
  • Immediate, short term, and long term memory
  • Abstract reasoning
  • Insight
  • Judgment

Physical Exam

In some cases, a patient may be suffering from a physical illness that will cause symptoms that appear like a mental illness. A physical examination can better help medical professionals determine whether a physical disorder (such as thyroid-related disorders) or a neurological issue is the culprit. In addition to having direct effects, many physical conditions or injuries can cause enormous stress and require coping mechanisms to withstand the condition’s issues. Often people with severe physical conditions will experience adjustment disorders, and individuals with underlying mental disorders may become more unstable as a result. 

Lab Tests 

Evaluations may come with blood work, urine tests, or brain scans in order to rule out potential physical evaluations and provide more information for the psychiatrist. Brain scans and imaging studies can help identify potential physical issues in brain structures that could result in the symptoms of a mental illness. Questions about drug and alcohol use and perhaps a toxicology report may be required to confirm the issues do not stem from side effects related to the ingestion of chemicals. 

Mental Health History

There will be questions related to how long symptoms have been experienced, the personal and family history of mental illness, and any previous psychiatric treatments received. There are some mental illnesses that are hereditary and passed down genetically, so family history can be very important to help identify a potential illness.

Personal History 

A part of the process will include answering questions about lifestyle and personal history. Information and details about occupation, marital or relationship status, military service, and childhood will need to be provided. This information can help determine the largest sources of stress in a person’s life and help identify previous trauma that could influence the symptoms being experienced. 

The Takeaway

There are many factors and components that make up a complete psychiatric evaluation, but each is just as important as the last. Discovering the root of a problem is the most important step in treating it.

When you experience physical symptoms related to sickness, you go to a doctor to have blood work done. In the same manner, when you have mental and emotional issues, you can go to a therapist to have a psychiatric evaluation done. 

For mental health, the “blood work” would be a complete psychiatric evaluation from a qualified mental health professional. It’s very difficult to solve a problem unless you know exactly what it is and why it exists in the first place. These evaluations are designed to identify the root of the issue and create paths toward resolution. 

Treating the symptoms of a mental illness without a full psychiatric evaluation may even end up causing harm in the long run. By discovering the root cause of the issue, the symptoms a more targeted plan of action can be hatched and implemented so that you will soon be on the road to recovery! 

Sources

  1. Routine Psychiatric Assessment – Psychiatric Disorders (merckmanuals.com)
  2. Comprehensive psychiatric evaluation (hopkinsmedicine.org) 
  3. Psychiatric Evaluation of Adults Second Edition (psychiatryonline.org) 

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