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The psychiatric interview is the main tool used by Dr. Fischer to gain knowledge of the patient. It is the essential vehicle for assessing a patient for the presence of the signs and symptoms of psychiatric problems. The primary objective of the psychiatric evaluation is to establish a diagnosis. This diagnosis can help provide a prognosis and serve as the basis for developing an effective treatment strategy as well as helping to assess treatment outcome. The psychiatric interview can also help determine the degree of functionality or disability present in the patient at the time of the interview.
A psychiatric assessment is a complex, detailed, in-depth process. In the psychiatric interview, the necessary information is gathered to assess the patient’s psychiatric condition. During the evaluation, the psychiatrist gathers information and seeks to discover the enduring and distinctive pattern of perceiving, feeling, thinking, and behaving of the patient. The patient’s particular way of organizing information and their methods of coping with the world become evident during the process. The effectiveness of the patient’s interpersonal and occupational functioning is elucidated.
To determine the degree of functionality or disability present in the patient, the severity of the psychosocial stressors currently and previously acting on the individual are noted, evaluated, and quantified. Psychosocial stressors play a role in initiating, precipitating, and /or exacerbating mental disorder. These stressors are significant risk factors for mental illness because they make substantial adaptive demands on the individual that may tax or exceed the individual’s adaptive resources. If this occurs it may result in the impairment of the stability of the individual’s psychological functions. Because of this the individual’s psychological vulnerability and strengths are assessed. When an individual’s coping resources are overwhelmed, psychiatric symptoms develop. Psychological resilience refers to the individual’s strengths and the positive behavioral adaptation and response exhibited when the individual encounters a significant stress. It refers to the individual's capacity to withstand severe stressors without manifesting psychiatric dysfunction. Resilience includes the ability to find positive meaning in seemingly adverse situations and to bounce back to homeostasis.
Psychological resilience and vulnerability are influenced by genetic factors, family environment, trauma experienced, medical factors and education to name a few. Depending on the degree of psychological resilience or vulnerability possessed by an individual and the demands of the psychosocial stressors acting on the individual, that person may demonstrate several outcomes. The individual’s adaptive resources may barely be taxed and the individual may return to their baseline level of functioning or the individual may actually develop and grow from being able to deal with the stressful experience and learn from it. If, on the other hand, the individual’s coping resources are overwhelmed, the stability of the individual’s psychological functioning can be impaired and psychiatric symptoms may develop.
During the psychiatric evaluation Dr. Fischer reviews the following fundamental areas of dysfunction:
- Disturbances in affect or emotion.
- Disturbances in cognition or thinking.
- Disturbances in attention.
- Disturbances in behavior.
- Disturbances in work.
- Disturbances in interpersonal relations.
- Disturbances in self-esteem or identity.
- Inhibitions in intimacy.
Disturbances in affect include the predominant biochemical disorders such as panic attacks, depression, and bipolar disorder. Disturbances in thinking include problems with concentration, organization, obsessional thoughts and compulsions, paranoia and impairment in reality testing. Disturbances in attention and problems maintaining focus include attention deficit disorder. Disturbances in behavior include compulsiveness, impulsiveness and addictive behavior. These first four areas are usually an indication for the use of medication in treatment. Disturbances in self-esteem, interpersonal relations and intimacy are generally best addressed through psychotherapy.
After the evaluation is complete, the patient and Dr. Fischer review the findings and the various options available for treatment. Based on the results of the evaluation it may be evident that psychotherapy is indicated without the need for medication, or that medication is indicated and would be helpful in correcting a chemical imbalance or that a combination of medication in conjunction with psychotherapy is indicated. The goal of the discussion is for the patient and Dr. Fischer to reach a mutually agreeable decision concerning the optimum practical treatment plan for the patient.