Assessment psychiatric symptoms

Unless the TBI has caused severe cognitive impairment (i.e., dementia), most patients after TBI can provide an accurate and insightful description of their physical and cognitive impairment. However, they often have less insight into the nature and severity of many of the common psychiatric symptoms that follow TBI. For this reason, the initial assessment should also include an interview with the patient s family members and friends, if they are available. Interviews with other health care providers (e.g., doctors, nurses, physical and occupation therapists) can also be extremely helpful. 

Patients who present with psychiatric symptoms need a careful medical assessment for many reasons. ... 

A comprehensive assessment includes a description of psychiatric symptoms, physical findings, frequency and severity of binge/purge episodes, laxative and ipecac use, exercise patterns, and laboratory and ECG abnormalities. Interpersonal and relationship problems should also be evaluated. Some findings indicating a more chronic course of illness, such as salivary gland inflammation or erosion of dental enamel, may take months to reverse or may never normalize, hence these are not sensitive indicators of early treatment... 

Clinicians should use standardized psychiatric rating scales to rate response objectively. The four-item Positive Symptom Rating Scale and the Brief Negative Symptom Assessment are scales that are brief enough to be useful in the outpatient setting. 

Sandoz Clinical Assessment-Geriatric. The Sandoz Clinical Assessment-Geriatric (SCAG) test measures 18 individual symptoms plus a global rating using a seven-point scale similar to those used in the Brief Psychiatric Rating Scale. It measures the present period or that within the last week, requires about 10 to 15 minutes to complete, and does not contain subtests. 

Houtsmuller EJ, Henningfleld JE, Stitzer ML (2003) Subjective effects of the nicotine lozenge assessment of abuse liability. Psychopharmacology 167 20-27 Hughes JR, Hatsukami D (1986) Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatr... 

The assessment of dysthymic disorder is identical to that nndertaken for MDD. Causative factors such as medical illnesses, depression-indncing medications, or abused substances must be ruled out. Mild depressive symptoms in the context of other psychiatric disorders must also be ruled out. 

Insomnia Due to Another Psychiatric Illness. Insomnia is often a symptom of mood and anxiety disorders. Depression is classically associated with early-morning awakening of the melancholic type, whereas so-called atypical depression leads to hypersomnia. Anxiety commonly leads to problems falling asleep. These patterns are not invariable. One should therefore always perform a thorough assessment for anxiety or depression in patients complaining of insomnia. 

Pediatric PTSD is a psychiatric disorder that is prone to both under- and overdiagnosis, especially when assessments are superficially or inexpertly conducted. For example, a traumatic exposure history in combination with current externalizing behavioral symptoms does not necessarily imply a diagnosis of PTSD. Conversely, children who present with an externalizing behavioral disorder in conjunction with anxiety symptoms and aggression are often not fully evaluated for PTSD. 

For these reasons, the interview of a medically ill pediatric patient is generally briefer than that of a physically healthy child. Because the illness biases psychiatric assessment, the consultant must rely heavily on premorbid history and other informants such as the parents, nurses, and primary care physician in assessing the meaning of current symptoms. Diagnostic criteria as supplied by DSM-FV should also be used. 

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