Psychiatric Assessment

1. Psychiatric Assessment Occupation Based Practice II: Mental Health

2. History Identifying information Chief complaint Hx of present illness Past psy hx Family psy and med hx Medical hx

3. Mental Status Exam Appearance Behavior Speech Emotion Thought process & content Perception Attention Orientation Memory Judgment Intelligence Insight

4. MSE Objective report of patient’s current mental functioning as observed Present concrete illustrations to justify every conclusion “The client moved slowly, cried throughout the interview, and never laughed. Client stated he felt sad most of the time.”

5. Appearance Client presented well-groomed and casually dressed in scrubs. Child presented in unwashed, torn clothing and with dirty, unkempt hair.

6. Motor Behavior Gait, gestures, stereotyped movements, impulse control Catatonic, psychomotor retardation Agitated (pacing, fidgeting, constantly getting up from chair) Tardive dyskinesia Biting nails, playing with hair, rocking Heather Extrapyramidal : Involuntary movements, Tremors and rigidity, Body restlessness, Muscle contractions, Mask like face, Involuntary movement of the eye called oculogyric crisis.Drooling, Shuffling gait, Increased heart rateHeather Extrapyramidal : Involuntary movements, Tremors and rigidity, Body restlessness, Muscle contractions, Mask like face, Involuntary movement of the eye called oculogyric crisis.Drooling, Shuffling gait, Increased heart rate

7. Speech Volume, rate, coherence but not content Loud, rapid, pressured, slowed, soft, hesitant, slurred, dysarthria, monotonous latent (delay in responding and initiating) Incoherent, inaudible Poverty of speech

8. Emotion Mood: experienced feeling, client tells you Elevated, euphoric, expansive Anxious, apprehensive, sad, depressed, irritable Affect: observable expression Broad (normal range), flat, blunt, constricted, labile, inappropriate

9. Thought Process Word usage- neologisms, word approximations Continuity of thought- association among ideas (clanging, echolalia, perseveration, flight of ideas, tangential, looseness of associations) “I’ve slept in trees before. Sleeping in trees is uncomfortable. Family trees are the worst.”

10. Thought Content Delusions, overvalued ideas, illogical thinking, magical thinking Poverty of content* What does religion mean to you? “All that church stuff. Amazing Grace. Amazing Grace. It is personal, very personal. I understand what you mean, you who live in God’s grace.” Incoherence- incomprehensible content * Also seen in political speeches

11. Content or Behavior? Obsessions- persistent, unwanted thoughts- thought content Compulsions- ritualistic behaviors usually arising out of obsessions, or anxiety The two are usually reported together

12. Perception Abnormal sensations- tactile, auditory, visual, olfactory, gustatory Hallucinations may be due to mental or physical illness or meds SI deficits: distorted time sense, hyper/hypo sensitive, dyspraxias, abnormal gait or posture

13. Your Turn: Gerald Appearance Behavior Speech Emotion Thought process & content Perception

14. Orientation Awareness of: Time Place Person

15. Memory LTM (remote) or STM (recent v. immediate) Repeat this: book, umbrella, elephant In 5 mins I’ll ask again. Can’t recall at least 2 ? organic deficit Types: Procedural, Declarative, Semantic, Episodic, Prospective Confabulation: not intentional bluffing

16. Judgment What would you do if you found a stamped, addressed envelope lying on the street? What would you do if you were the first to notice a fire in a theater? What would you do if you noticed a 3 year old playing alone at the end of a pier?

17. So, what were those three items?

18. Intelligence/Information Simple math Abstract- How are a table, chair and desk the same? All furniture All made of wood They’re not the same You can write with them Proverbs

19. Insight Awareness of the problem and its cause Complete denial Dim and fleeting admission Aware, but others are causing it Intellectual recognition of the problem and internal cause Acceptance of the illness

20. DSM IV TR As OTs, focus on symptoms, not dg Axis I Clinical Psy disorders (developmental) Axis II Personality disorders (intellectual) Axis III General medical conditions Axis IV Other problems (financial, social, legal, work) Axis V GAF