Assessment, psychiatric planning

Clearly document your risk assessment and plan in the ED and psychiatric notes, handing over to ED, paediatrics and the incoming psychiatrist. 

Additional information besides the DSM-IV-TR diagnosis is required before a comprehensive treatment plan can be developed. The American Psychiatric Association Practice Guidelines for Psychiatric Evaluation of Adults offers a more comprehensive approach to patient assessment. It includes a full discussion of the domains needed for a thorough clinical evaluation, including chief complaint history of present illness past psychiatric history general medical history social, family, and occupational history physical and mental status examinations and diagnostic tests. It further describes issues of privacy, evaluations in the elderly, and techniques for working with multidisciplinary teams. ... 

Psychiatric rating scales should not be confused with psychological tests such as neuropsychological and intellectual assessments, and are best used as only one part of a comprehensive diagnostic plan. Tables 60-3, 60-4, and 60-5 describe commonly used patient-rated and clinician-rated scales for a variety of disease states. " In clinical research, a combination of clinician- and self-rated rating scales and diagnostic tests provides the most accurate measurement of drug efficacy and treatment outcome. 

Patient assessment is the basis from which a pharmaceutical care plan evolves. Problem identification and therapeutic monitoring cannot occnr nntU a thorongh assessment is complete. The initial assessment is also the basis for evalnating response to therapy throughout the course of treatment. Psychiatric assessment requires sensitivity and good listening skills on the part of the clinician because it is based primarily on a subjective interview and not objective tests. With careful data collection, clinicians can make substantial contributions to care that improve patient outcomes. 

Because target symptoms of psychiatric disorders may respond differently in demented patients, a detailed list of symptoms to be treated should be documented in the pharmacotherapy plan to aid in monitoring. These could include, for example, striking at spouse because patient believes spouse is an impostor, verbal threats and refusal to allow clothes to be changed, and so on, as opposed to documenting vague symptoms such as aggression or delusions. To make an accurate assessment of depression, multiple symptoms (e.g., sleep, appetite, and activity and interest levels) need to be assessed in addition to the patient s stated mood. 

Allow time for introductions. Don t plough through a full psychiatric assessment the meeting should focus on positive care planning. 

---