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What is a Psychiatric Evaluation

hello I'm dr. Timothy theis I'm a

psychiatrist and planning to talk to you

today about what's involved in a

psychiatric evaluation persons come to

see me with issues that may complicate

their medical condition such as anxiety

elevated mood depression disturbances in

attention and sleep and various other

problems in a psychiatric interview I

begin by asking an individual to tell me

about what it is they're concerned about

and and then we explore together the

nature of their symptoms when they began

what the intensity has been the

circumstances in which those symptoms

occur and others who may have observed

those symptoms and how they've affected

the individual how they've affected also

the persons around them how that person

interacts with significant others and

with such as family or friends and how

those symptoms that may impact sleep how

they may impact their sense of physical

well-being pain their emotional

well-being their ability to function in

school or in work or socially and after

exploring the duration the timing and

the various aspects of those symptoms

then we'll discuss what a likely

etiology or or explore what the reasons

for those symptoms what other factors

might be involved as far as a person's

physical health or different patterns of

behavior after learning about those

presenting symptoms and what's involved

in that for an individual I tend to

inquire

about what a person's past psychiatric

history has been what other counselors

or psychologists or individuals have

they seen sometimes I'm the first

individual they've seen but often a

person has seen someone else if not at

least their primary care physician and

have attempted to address the issues of

concern with that individual upon

understanding that past history and

what's been done to try to address those

symptoms that also gives us important

clues about how we might then look at

and understand those those problems and

then address them perhaps in a different

way or maybe use some of the things that

have been successful in the past and add

to those things to help improve a

person's condition next it's important

to learn about family psychiatric

history often there are relatives who

have suffered similar conditions or

related conditions and learning about

what a person's relatives have

encountered what has been successful in

helping those relatives as well as

things that have not worked at all for

those relatives it can often give us

clues as to what may be helpful for the

individual themselves and then to learn

about the medical history of the family

pertinent things that that might be

important as we consider various

treatment options and might indeed

complicate and have an overlay as to

causing psychiatric symptoms maria's

different medical conditions then I

inquire about the medical history of an

individual and learn about the specifics

of different things that they've

encountered prior physical symptoms as

well as perhaps surgeries when their

last physical exams allowed

had been done with the results of those

various tests and surgeries have been

and understand how those issues may be

impacting the individual and then I'll

inquire about nutrition and a person's

habits what do they take vitamins or

medications are they consuming caffeine

or tobacco alcohol street drugs how

those things might impact or be related

to the concerns that a person has raised

and then will consider prior medication

treatments often that's that's very

important to understand the details of

what a person has tried before what

their experience of medications has been

many times persons have tried various

herbal therapies as well or tried

vitamins and things that generally may

be helpful for a person also have the

risk of causing an important side

effects and we want to understand how

those things may give us clues as to

what kinds of treatments are most likely

to be beneficial for that individual

next I'll acquire about developmental

history what were things like for the

individuals mother while they were

pregnant for that with that person what

were things like with the labor and

delivery the early development where

their normal developmental milestones

did they sit up and walk and talk as

they should how was their learning

through school are there specific

learning disabilities that might be

impacting their circumstances and then

I'll inquire about the nature of

relationships with family members and

significant others particularly as it

one

as growing up and how that may give us

clues as to perhaps symptoms started

earlier than a person thought about

previously or there were other factors

in the nature of those relationships

that may be important and understanding

a given individual especially issues

related to trauma or abuse things that

can have a profound impact on a person

and their life experiences and how they

they view their world and then

understanding a person from their social

context who they live with the nature of

the relationships they have with other

individuals what they have pursued

educationally and vocationally the kinds

of things they enjoy the ways in which

they like to use their free time are

there legal issues that that may be

involved in stressing them at present

has there been military service and the

unique and challenging issues that that

they may have encountered in that kind

of activity as well as some are there

what is a person's worldview what it

what kind of spiritual interest do they

have what is the cultural context in

which their symptoms have been

experienced and how does that influence

their seeking treatment their

willingness to accept various different

types of treatment or how they might

prefer to approach treatment and then

finally I'll I'll ask a set of questions

that often seem a bit unusual to an

individual its its acquiring about and

and trying to explore their what I call

their mental status what is the nature

of their thought processes are they

thinking in relatively concrete terms

or able to abstract well and think

fairly fluidly have their symptoms

impacted how they process information

and describe the various different

circumstances and print providing that

history they've provided and then

finally we may close with providing

treatment or symptom focused physical

exam and often as matters that involve

psychiatric treatment will want to know

for instance what is a person's weight

is that influenced by treatment or is it

influenced by the symptoms they have

many times with psychiatric illness a

person may either lose their appetite or

have increased appetite or find

themselves gaining or losing weight and

so we want to put that into context with

things as long as well as things such as

blood pressure and pulse and

understanding them the capacity of their

respiratory status and cardiovascular

health and other pertinent things that

that might be involved in understanding

the symptoms they present with and

finally after doing that assessment why

we'll consider together whether it's a

prudent or indicated to do additional

diagnostic testing or perhaps order some

laboratory tests to see if there are

chemical imbalances that might be

influencing the symptoms at hand and

discuss what the patterns and the

history that the person has just

provided what they indicate about what's

likely happening how they might fit in

with the psychiatric issues that I'm

familiar with and whether they're our

our our non medication on pharmaceutical

related issues

it might be changed what kind of habits

might be changed that might improve a

person's condition looking at things

like sleep and improving sleep exercise

nutritional issues that may be

beneficial in diminishing their symptoms

and hopefully thereby limiting their

need for medication

I'll make recommendations about

psychotherapy and how that might help

improve or whether or not that's

indicated for the condition at hand and

then finally discuss whether or not the

the side effects the risks the benefits

that that psycho pharmaceutical

intervention of medication intervention

whether that's worth considering given

the intensity of the symptoms and how

disabling they might be for a given

individual as well as the likelihood

that those symptoms might continue and

the disability and trouble that might

cause for the individual going forward

thank you enjoy calm