A psychiatric evaluation, or an interview conducted by a psychiatrist, includes a history of current and past psychiatric problems, a medical history, and a mental status exam which evaluates things such as concentration and clarity of thought. The focus of the interview will vary according to the circumstances. Most psychiatric evaluations are voluntary and occur when a person in distress seeks psychiatric help, though sometimes concerned relatives, the police or EMTs bring the patient to the hospital for a psychiatric evaluation.
Psychiatric Evaluations in the Emergency Room
The psychiatric evaluation in the emergency room focuses on assessing the urgency of the problem, the degree of danger the patient poses to himself or to others, and the proper setting for treatment. The evaluation includes an assessment of the patient's ability to care for himself. In addition, the psychiatrist evaluates the possibility of underlying medical causes for the psychiatric problem. Lab tests and brain imaging may be ordered. The main question guiding the interview in this setting is whether the patient can go home with a referral to outpatient treatment, or whether he requires admission. If admission is necessary, the question becomes what setting is appropriate: if the patient is dangerous, jail might be the best setting; elderly or medically ill patients may need to be hospitalized in a unit that combines medical and psychiatric treatment.
Inpatient Psychiatric Evaluation
Once admitted to a psychiatric unit, the psychiatrist completes a more detailed history. He inquires about the patient's current problems, current life situation and current treatment. He also explores the patient's history--medical, psychiatric and social. He reviews the patient's medications, and the risks and benefits associated with them. The goal of this assessment is to determine the precipitating cause for admission, to start or change treatment as necessary and to start establishing aftercare plans. The first psychiatric interview in the inpatient unit is conducted with the goal of discharge in mind; one of the main questions is whether the patient is safe to leave the hospital.
Outpatient Psychiatric Evaluation
The nature of an outpatient psychiatric evaluation depends on the setting. In community mental health centers, an evaluation typically lasts one hour. The interview focuses on assigning a diagnosis to the patient according to the criteria set by the "Diagnostic and Statistical Manual of Mental Disorders," or the "DSM." The psychiatrist will then decide on a course of treatment. In private practice, some psychiatrists follow the same model. Others perform an assessment over several sessions, an assessment that is not sharply delineated from treatment itself. The goal here is to get to know the patient at a deeper level, to understand such things as her personality structure and the influence of early life events on her current psychological state.
Disability Evaluation
Some patients are sent to a psychiatrist by the social security disability office. The purpose of the visit here is not to establish a physician-patient relationship and start a course of treatment, but to give a one-time objective expert assessment of the person's mental condition. The interview is conducted along the standard format. The examining psychiatrist doesn't determine whether the patient will receive disability and doesn't voice an opinion on the matter. She presents the interview results to the social security administration and has no further contact with the person seeking disability.
References
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Pedro Ruiz (eds.); 2009
- "The Psychiatric Interview: A Practical Guide (Practical Guides in Psychiatry)"; Daniel J. Carlat; 2004
- "Psychodynamic Psychiatry in Clinical Practice"; Glen Gabbard; 2005
