Clinical Evaluation and Treatment Planning: A Multimodal Approach
Every psychiatric evaluation must be specific to the context in which it occurs. The evaluation of a patient in the psychiatric emergency room is different from the evaluation of a graduate student applying for psychoanalysis, a member of a couple who seeks consultation for marital distress, or an indicted prisoner who is being evaluated for competence to stand trial. In each case, the evaluation and treatment plan are tailored to the situation.
We present an outline of a comprehensive ap-proach to psychiatric evaluation. The complete psychiatric evalu-ation consists of the psychiatric interview; physical examination
including neurological assessment; laboratory testing; and, as appropriate, neuropsychological testing, structured interviews and brain imaging. The results of the evaluation are then used to assess risk, reach tentative and, if possible, defi nitive diagnoses, and complete initial and comprehensive treatment plans. Clearly, the length, detail and order of the evaluation need to be modified when it is conducted in different settings. The clinician needs to assess the goals of the interview, the patient’s tolerance for questioning, and the time available. Table 19.1 shows the variation of the psychiatric evaluation with the type of setting.