Psychiatric Assessment

Kieren P.M. Obed Jr.,MD The patient also may be both relieved and reassured that
Davao Medical School Foundation the physician is interested in him or her “as a
person” and may use the opportunity to express
BIOPSYCHOSOCIAL APPROACH worries and emotional and psychological distress.
Currently advocated as the best paradigm of psychiatric
assessment. PSYCHIATRIC INTERVIEWING
This approach suggest that equal emphasis be given to the
evaluation of the psychological, social, and biological The psychiatric interview is an interaction between patient and
factors impacting on the patient’s clinical presentation. physician designed to assess psychiatric status or to
VALUES OF A DIAGNOSIS provide treatment of an emotional or behavioral problem.

The main reason for a psychiatric evaluation is the identification

of mental and emotional disorders.
To do this actively, clinicians must develop a basic
understanding of what constitutes “abnormal” behavior.

History, Physical Examination, and Laboratory Assessment in

the Psychiatric Evaluation

Psychiatric Evaluation in a Psychiatric Setting:

The principal features of the psychiatric evaluation are the
psychiatric history and the mental status examination.
These establish the presence of a psychiatric syndrome.

A medical history, PE, and Laboratory Assessment also are

included in psychiatric evaluations, although little
emphasis is placed on their role during medical training
when patients are assumed to have “primarily psychiatric
problems.”

Because 30 to 50% of psychiatric inpatients and

outpatients have medical disease concurrent with
their psychiatric symptoms (LaBruzza, 1981), 5 to
30% of which either actually cause or exacerbate the
psychiatric problem, it is inappropriate for
psychiatrics or medical students to neglect the
medical part of the evaluation in patients with
psychiatric symptoms.

It is therefore essential to include the physical examination as

an integral part of the psychiatric evaluation in all first-
time inpatients and outpatients being appraised for a
psychiatric disease.

Psychiatric Evaluation in the Medical Setting

Medical students are usually taught psychiatric evaluation in

psychiatric settings.
In most medical centers, little or no instruction is given for initiating
psychiatric questions in patients seen in primarily medical
settings, despite the fact that 80% of patients with
psychiatric conditions are seen by primary care specialist
(Regier et al., 1978).

Medical students frequently are indoctrinated with the idea that

“nonpsychiatric patients shouldn’t be asked embarrassing
psychiatric questions.”
The end result of this advice is that, in their future practices,
psychiatric problems in many if not most of their primary care
patients are overlooked.

To embark on a series of psychological questions usually is

unexpected and may be viewed initially by the patient as
an invasion of privacy unless the reasons for the
questions are explained or the patient can be led to see
a possible connection to the presenting complaint or
general condition.