Initial Step in Mental Health Assessment
The initial psychiatric evaluation of a patient should begin with establishing the reason for presentation, followed by a systematic psychiatric review of symptoms to identify psychiatric signs, symptoms, and disorders. 1
Key Components of Initial Assessment
1. Reason for Presentation
- Identify why the patient is seeking evaluation
- Document chief complaint and presenting symptoms
- Understand the patient's background, relationships, and life circumstances 1
2. Psychiatric Review of Symptoms
The American Psychiatric Association recommends a systematic evaluation of:
- Anxiety symptoms and panic attacks
- Sleep abnormalities
- Impulsivity
- Mood, level of anxiety, thought content and process, perception and cognition 1
3. Mental Status Examination
This critical component should assess:
- General appearance and nutritional status
- Speech, including fluency and articulation
- Coordination and gait
- Involuntary movements or abnormalities of motor tone
- Mood and affect
- Thought content and process
- Perception and cognition 1, 2
4. Risk Assessment
Always include assessment of:
- Current suicidal ideas, plans, and attempts
- If present, evaluate:
- Patient's intended course of action if symptoms worsen
- Access to suicide methods
- Motivations for suicide
- Reasons for living
- Current aggressive or psychotic ideas 1
Important Additional Elements
After the initial assessment, proceed with:
- Psychiatric history (past diagnoses, treatments, hospitalizations)
- Substance use history
- Medical history
- Family history
- Personal and social history 1
Clinical Approach
The psychiatric evaluation should be tailored to the patient's circumstances while ensuring all essential elements are covered. The American Psychiatric Association guidelines recognize that:
- Not all recommended areas of inquiry may be completed in a single visit
- Clinical judgment is crucial in determining which questions are most important for a specific patient
- The evaluation may require several meetings with the patient, family, or others 1
Common Pitfalls to Avoid
- Overlooking medical causes of psychiatric symptoms
- Relying solely on screening tools without clinical judgment
- Neglecting cultural factors in symptom presentation
- Making assumptions about lack of capacity based on diagnosis alone 2
By following this structured approach to the initial mental health assessment, clinicians can effectively identify psychiatric symptoms, assess risk, and develop appropriate treatment plans that address the patient's unique needs.