What is a Psychiatric Evaluation?
What is a Psychiatric Evaluation?
A psychiatric evaluation is a diagnostic tool employed by a psychiatrist. It may be used to diagnose problems with memory, thought processes, and behaviors. Diagnoses can include depression, schizophrenia, anxiety, bipolar disorder, and addiction.
A psychiatric evaluation aims to:1
Include the patient while making decisions about an initial treatment plan
Rule out other physical conditions that might be causing the symptoms
Identify long-term problems that might emerge in the future
Make changes in the treatment if needed, for those who have had a psychiatric evaluation in the past
Confirm the diagnosis of a mental disorder that requires treatment by a psychiatrist
How Long Does It Take to Do a Psychiatric Evaluation?
The duration of a psychiatric evaluation varies from one person to another. The amount of information needed helps to determine the amount of time the assessment takes. Typically, a psychiatric evaluation lasts for 30 to 90 minutes. At J. Flowers Health Institute, evaluations take approximately 2 hours to ensure a comprehensive and accurate evaluation.
Where to Get a Psychiatric Evaluation?
People can get psychiatric evaluations in different settings. These include:
Inpatient units (following hospitalization)
Outpatient facilities, such as office-based practices or intensive outpatient programs
Residential treatment facilities
Home care services
Long-term care facilities
What are the Types of Psychiatric Evaluation?
According to the American Psychiatric Association (APA), the types of psychiatric evaluation are:1
General Psychiatric Evaluation
This aims to determine if a person has a mental illness that needs specialized care by a psychiatrist. A psychiatrist obtains the necessary information by asking specific questions which may be answered orally or in writing.
Moreover, the psychiatrist can review the person’s medical history and order lab tests. Notably, the evaluation may also involve meetings with the person’s family members.
An emergency psychiatric evaluation is performed when an individual:
Is agitated and uncooperative
Shows violent or self-injurious behaviors
Poses a threat to self or other people
Is markedly confused or hallucinating
A majority of people who receive emergency evaluations have recent trauma or drug use. Examples include people who have used cocaine which resulted in stimulant-induced hallucinations.
In the emergency department, a non-psychiatric physician first evaluates the case. If the physician rules out medical causes, they may consult a psychiatrist.
This helps with diagnosis in people who may have problems with behavior or thinking.
Someone who thinks they have a mental disorder may request a clinical consultation. Some people may not be able to seek help due to their illness. A clinical consultation may be performed at the request of family members or doctor. However, the psychiatrist has to inform the person about the evaluation.
The Growing Need for Psychiatric Evaluation in the United States
Psychiatric evaluation is a valuable tool in identifying mental disorders. It can help with better diagnosis and also aid proper treatment.
Sadly, mental illnesses are more common than many people think. Below are some recent stats about the growing mental health diagnoses in the United States.
According to the Centers for Disease Control and Prevention (CDC),2
20% of children have a current or past diagnosis of a debilitating mental disorder.
In any given year, mental illness affects 1 in 5 Americans.
Over half of Americans will have some types of mental disorder during their lifetimes.
Severe mental disorders affect about 4% of Americans (1 in 25). Examples of these disorders include schizophrenia, bipolar disorder, and major depression.
The top three mental disorders among adults in the United States are:
Anxiety disorders, which affect 48 million people
Major depression, which affects 17.7 million people
Posttraumatic stress disorder (PTSD), which affects 9 million people1
Untreated depression is one of the major causes of suicide. About 1 in 5 people with untreated depression attempt suicide during their lifetimes.6
Suicide ranks tenth in the list of leading causes of death in the United States. In 2017, suicide was responsible for 47,000 deaths. Most notably, among people aged 10 to 34 years, suicide was the second most common cause of death.7
Mental Health Diagnoses Do Not Receive Enough Treatment
A huge gap exists between the prevalence of mental disorders and the availability of treatment.
Over 15 million children and adolescents need specialized psychiatric treatment. The number of psychiatrists practicing child and adolescent psychiatry is only 8,300. This is about 1 for every 1,800 children and adolescents.8 Notably, the gap will likely widen in the future.
What is a Psychiatrist?
A psychiatrist is a medical doctor who has completed a four-year residency training in psychiatry. During the first year of training, they work with people with a variety of mental disorders such as depression, anxiety, and addiction. Usually, first-year residency training takes place in a hospital setting.
In the next three years, they learn various methods of diagnosing and treating mental illnesses. These include the use of talk therapy and drugs to treat mental illness. They also learn about new treatments, such as electroconvulsive therapy (ECT).
ECT helps some people with severe or resistant depression. ECT passes small currents into the patient’s brain. The changes in the electrical activity of the brain, which can relieve some of the symptoms of depression.
According to the APA, about 45,000 psychiatrists are currently working in the United States.11
What is a Board-Certified Psychiatrist?
After completing their four years of training, many psychiatrists appear in a voluntary examination conducted by the American Board of Psychiatry and Neurology. They become board-certified psychiatrists after they pass the test.
A psychiatrist may choose to enroll in specialized training to become a specialist in:
Child and adolescent psychiatry
Psychosomatic (mind and body) medicine
Psychiatrist vs. Psychologist: What are the Differences?
Psychiatrists are medical doctors who have received specialized training in psychiatry. They diagnose and treat mental illnesses such as depression and anxiety. A psychiatrist can prescribe medications to treat a mental disorder. They can also use other treatment methods, such as talk therapy and ECT. The main difference between the two professions is that psychologists cannot prescribe medications, whereas a psychiatrist can.
A psychologist is a health professional with an advanced degree. They may have one of the following degrees:
- A doctor of psychology (PsyD degree)
- A doctor of philosophy (Ph.D. degree) in clinical psychology, counseling, or school psychology
What Does a Psychiatrist Do?
A psychiatrist plays a central role in the diagnosis and treatment of mental disorders such as:
Mood disorders including depression and bipolar disorder
Schizophrenia, which is a type of psychotic disorder
Post-traumatic stress disorder (PTSD)
A psychiatrist can order or conduct various tests to make an accurate diagnosis. They can correlate the lab results with findings from the patient’s medical history. This helps them understand how an individual’s history or genetics contribute to the risk of mental illness.
A psychiatrist treats mental illness with medications that improve brain function, just as another sort of doctor might treat high blood pressure with pressure-lowering drugs. Psychiatrists often combine medications with talk therapy.
Psychiatrists do not treat conditions that may occur due to structural damages in the brain, such as brain cancers, epilepsy, and the effects of a stroke. Neurologists treat these conditions.
That said, a person with any of these disorders might have psychiatric symptoms. In such cases, a psychiatrist may work as a part of the team to design the best treatment plan.
How Does a Psychiatrist Perform an Evaluation?
A qualified psychiatrist performs an evaluation. The psychiatrist must be certified by one of the following professional organizations:
- The American Board of Psychiatry and Neurology, or
- The American Board of Osteopathic Neurology and Psychiatry.
A psychiatric evaluation has several steps. In the first step, the examiner introduces themself to the patient. This is done to make the patient feel comfortable.
First, the psychiatrist will ask for the reason behind the visit. The patient’s answer will help provide the psychiatrist with “identifying information.” Then, the psychiatrist will ask about symptoms, personal history, and family history.
The patient will also answer questions about their recent or past traumatic experience and any problems with drug or alcohol use. Next, the examiner will inquire about marital history and financial status.
The questions can include: 12
Have you experienced anxiety, unreasonable fear, or restlessness in the last six months?
Do you have problems falling or staying asleep?
Have you had a panic attack recently?
Do you have problems falling or staying asleep?
Have you been a victim or a witness of a traumatic event?
Do you have nightmares or flashbacks of the event?
Have you ever been treated for a mental illness? If so, what medications did you take? What other treatments did you receive?
Do you deliberately avoid situations that might cause panic?
Do you hear or see things that others do not?
Is anyone trying to hurt you?
When did you first start drinking or using drugs?
Do you drink alcohol or use drugs?
Has anyone in your family committed suicide, used drugs, or had a mental disorder?
Are you married?
How is your relationship with your spouse and other family members?
Have you ever attempted suicide? If so, how many times? What were the reasons?
What is your highest level of education?
Have you ever been arrested?
Do you believe in God or follow any particular religion?
Are you sexually active?
Do you use any method of contraception?
Have you ever been hospitalized for a serious condition, such as a head injury or major surgery?
Do you have a current or past history of seizures?
While you are answering the questions, the examiner will be observing:13
- Attitude (whether or not they are actively participating in the conversation)
- General appearance
- Hygiene and grooming
- Mood and emotional expression
- Speech (tone, volume, choice of words)
- Thinking and perception
- Awareness (if they are aware of their mental status)
It's important to answer the questions accurately and truthfully. This will help the psychiatrist make an accurate diagnosis. Some mental illnesses are hard to diagnose. In such cases, additional tests may be needed.
Interview Involving a Family Member
People with loved ones being psychiatrically evaluated may ask questions. Below are some questions that are commonly asked:
What is the problem with my loved one?
Are they normal?
Is my behavior responsible for the current situation?
Should they be hospitalized?
Is the condition curable?
What are the treatment options?
What can I do to make them feel better?
What is the cost of the treatment?
Sometimes psychiatric symptoms may be caused by a physical disorder. For example, a deficiency of thyroid hormones may cause depressive symptoms.14 A physical examination helps identify physical causes for mental illness.
During the examination, patients should make sure to tell their doctors about the medications they take.
The examiner may order blood and urine tests. These tests help determine the levels of hormones, vitamins, and electrolytes in the body. The tests also check if alcohol or drugs have been used recently.
If the doctor suspects a neurological problem, a brain scan may be needed. Examples of a brain scan include:
- Magnetic resonance imaging (MRI)
- Electroencephalogram (EEG)
- Computed tomography (CT) scan
Psychiatric Evaluation vs. Psychological Evaluation
A certified psychiatrist usually performs a psychiatric evaluation. In an emergency, it may be carried out by a mental health clinician. A psychiatric assessment is more specific. It focuses on mental illnesses, such as depression, anxiety, and psychotic disorders.
A clinical psychologist performs a psychological evaluation. The psychologist must have a doctoral degree (Ph.D., Psy.D., or Ed.D.). Moreover, they must have obtained a license for independent practice. A psychological evaluation looks at attitude, emotions, thoughts, and behavior.
People who suspect they may have mental illnesses usually go for a psychological evaluation first. If this does not lead to a diagnosis, they may consider a psychiatric evaluation.
Preparing for a Psychiatric Evaluation
Before visiting a psychiatrist, patients should prepare a list of things to ask, including:
Is it normal to feel the way I do?
Do I have a mental health disorder?
How much does the treatment cost?
How long will the treatment last?
What are my treatment options?
What factors can trigger my illness?
What can I do to feel good again?
Will my children have a similar illness in the future?
Moreover, it's helpful to answer the following questions in writing and bring them to the evaluation:
- What are my symptoms? How long do they last?
- What do I do to control the symptoms?
- How do I feel, think, and behave?
- Did the symptoms appear after a major life event, such as the death of a loved one?
It is best to start writing the answers at least one week before the appointment. A patient may take a friend or family member with them.
Patients who take any medications or supplements should make sure to inform their doctors. Some drugs (prescription or OTC) can change the way people think and behave.
What Can a Psychiatric Evaluation Tell a Patient?
A psychiatric evaluation not only helps to diagnose a mental disorder but also guides treatment planning. After the assessment has ended, most people ask about their diagnosis. Many doctors will name a specific diagnosis.
Nonetheless, some may prefer to inform the patient about the diagnosis using general terms. This is more likely if the evaluation showed a severe mental disorder, such as psychosis. A doctor usually conveys an unfavorable diagnosis after 5 to 10 visits.
Once a person knows the name of their problem, they will inquire about prognosis. Prognosis means predicting the outcomes of disease.
Most mental disorders need ongoing treatment, much like other chronic illnesses. Treatments typically only help relieve the symptoms. Thus, the doctor will honestly tell the patient the outcomes and measures to control their symptoms. Notably, they will reassure patients and ask them to stick to the treatment plan.