Initial Psychiatric Evaluation

### Initial Psychiatric Evaluation

1. Reason for Seeking Help

What prompted you to seek psychiatric help today?
[textarea memo="Additional information" rows="2"]
(This question focuses on the immediate reason for the visit.)
Can you describe the specific issues or symptoms that led you to seek help?
[textarea memo="Additional information" rows="3"]
(This question delves into the specifics of the issues or symptoms.)
2. Medication History

What medications are you currently taking for your psychiatric conditions?
[textarea memo="Additional information" rows="2"]
How long have you been on these medications?
[textarea memo="Additional information" rows="2"]
Have you taken psychiatric medications in the past? If so, which ones and for how long?
[textarea memo="Additional information" rows="3"]
How effective were these medications for you? Did you experience any side effects?
[textarea memo="Additional information" rows="3"]
Who prescribed your current medications (outpatient psychiatrist, inpatient facility, hospital)?
[textarea memo="Additional information" rows="2"]
Were there any medications prescribed but never taken? If so, why?
[textarea memo="Additional information" rows="2"]
3. Previous Psychiatric Care

Have you seen a psychiatrist before? If yes, who was the psychiatrist?
[textarea memo="Additional information" rows="2"]
When was your last appointment with them?
[textarea memo="Additional information" rows="2"]
Why did you stop seeing your previous psychiatrist?
[textarea memo="Additional information" rows="2"]
4. Diagnosis History

Have you ever been given a psychiatric diagnosis? If so, what were they?
[textarea memo="Additional information" rows="2"]
Have any of your diagnoses changed or been updated over time?
[textarea memo="Additional information" rows="2"]
5. Substance Use

Do you currently use or have you used recreational drugs or alcohol? If so, what substances and how often?
[textarea memo="Additional information" rows="3"]
What was the reason for using these substances (e.g., coping mechanism, social use)?
[textarea memo="Additional information" rows="3"]
Have you ever sought treatment for substance use or addiction?
[textarea memo="Additional information" rows="2"]
6. Current Symptoms and Functioning

How have these symptoms impacted your daily life, work, or relationships?
[textarea memo="Additional information" rows="3"]
Are there specific triggers or patterns you’ve noticed with your symptoms?
[textarea memo="Additional information" rows="3"]
7. Past Treatments and Responses

What treatments or therapies have you tried before (e.g., psychotherapy, behavioral therapy)?
[textarea memo="Additional information" rows="3"]
How did you respond to these treatments?
[textarea memo="Additional information" rows="3"]
10. Lifestyle and Environment

Can you describe your living situation? Are there any factors that might influence your mental health (e.g., housing stability, financial stress)?
[textarea memo="Additional information" rows="3"]
What is your daily routine like? How do you manage stress and self-care?
[textarea memo="Additional information" rows="3"]
11. Goals and Expectations

What are your goals for treatment? What would you like to achieve through psychiatric care?
[textarea memo="Additional information" rows="2"]
Are there any specific concerns or expectations you have about your treatment?
[textarea memo="Additional information" rows="2"]

Based on the initial questions    asked and screening records, we have identified some areas that may require more focused exploration. To better understand and address your current condition, I will now ask you a few specific questions related to the symptoms and issues you’ve mentioned. The one we are considering today includes:     [textarea memo="Additional information" rows="3"]

[checkbox name="ADHD_inattention" memo="ADHD Inattention" value=""][checkbox name="ADHD_hyperactivity" memo="ADHD Hyperactivity" value=""][checkbox name="ADHD_combined" memo="ADHD Combined" value=""][checkbox name="depression" memo="Depression" value=""][checkbox name="anxiety" memo="Anxiety" value=""][checkbox name="bipolar_mania" memo="Bipolar Disorder (Mania)" value=""][checkbox name="bipolar_depression" memo="Bipolar Disorder (Depression)" value=""][checkbox name="PTSD" memo="PTSD" value=""][checkbox name="OCD" memo="OCD" value=""][checkbox name="panic_disorder" memo="Panic Disorder" value=""][checkbox name="social_anxiety" memo="Social Anxiety" value=""][checkbox name="ODD" memo="Oppositional Defiant Disorder" value=""][checkbox name="DMDD" memo="Disruptive Mood Dysregulation Disorder" value=""][checkbox name="conduct_disorder" memo="Conduct Disorder" value=""][checkbox name="schizophrenia" memo="Schizophrenia" value=""]

[conditional field="ADHD_inattention" condition="(ADHD_inattention).is('')"]
### ADHD (Inattention Type)    
ADHD Inattention Type symptoms reported include:
[checkbox value="careless mistakes|difficulty sustaining attention|not listening|failure to follow through|difficulty organizing tasks|avoiding tasks|forgetfulness|easily distracted|losing things necessary for tasks|difficulty with details|poor organizational skills|making repeated errors"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="ADHD_hyperactivity" condition="(ADHD_hyperactivity).is('')"]
### ADHD (Hyperactivity Type)    
ADHD Hyperactivity Type symptoms reported include:
[checkbox value="fidgeting|leaving seat|running or climbing excessively|unable to play quietly|talking excessively|interrupting others|difficulty waiting for turn|impulsivity|disruptive behavior|difficulty remaining seated|excessive movement|restlessness"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="ADHD_combined" condition="(ADHD_combined).is('')"]
### ADHD (Combined Type)    
ADHD Combined Type symptoms reported include:
[checkbox value="inattention|hyperactivity|impulsivity|difficulty sustaining attention|careless mistakes|difficulty organizing tasks|restlessness|fidgeting|talking excessively|difficulty remaining seated|interrupting others|difficulty waiting for turn|avoidance of tasks|forgetfulness|easily distracted|losing things necessary for tasks"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="depression" condition="(depression).is('')"]
### Depression    
Depression symptoms reported include:
[checkbox value="depressed mood|loss of interest|weight change|sleep disturbance|psychomotor agitation|fatigue|feelings of worthlessness|difficulty concentrating|recurrent thoughts of death|suicidal ideation|hopelessness"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="anxiety" condition="(anxiety).is('')"]
### Anxiety    
Anxiety symptoms reported include:
[checkbox value="excessive worry|restlessness|easily fatigued|difficulty concentrating|irritability|muscle tension|sleep disturbance|startle response|avoidance behaviors|panic attacks|feeling overwhelmed"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="bipolar_mania" condition="(bipolar_mania).is('')"]
### Bipolar Disorder (Mania)    
Bipolar Mania symptoms reported include:
[checkbox value="elevated mood|grandiosity|reduced need for sleep|talkativeness|racing thoughts|distractibility|increased goal-directed activity|excessive involvement in activities with high potential for painful consequences|impulsivity|irritability|hyperactivity|excessive energy"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="bipolar_depression" condition="(bipolar_depression).is('')"]
### Bipolar Disorder (Depression)    
Bipolar Depression symptoms reported include:
[checkbox value="depressed mood|loss of interest|weight change|sleep disturbance|psychomotor agitation|fatigue|feelings of worthlessness|difficulty concentrating|recurrent thoughts of death|suicidal ideation|hopelessness|sadness|low energy|feelings of guilt"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="PTSD" condition="(PTSD).is('')"]
### PTSD    
PTSD symptoms reported include:
[checkbox value="intrusive memories|flashbacks|nightmares|avoidance of reminders|negative changes in mood|detachment from others|increased arousal|hypervigilance|startle response|difficulty sleeping|irritability|difficulty concentrating"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="OCD" condition="(OCD).is('')"]
### OCD    
OCD symptoms reported include:
[checkbox value="obsessions|compulsions|intrusive thoughts|repetitive behaviors|rituals|difficulty controlling thoughts or behaviors|significant distress or impairment|avoidance behaviors|time-consuming rituals"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="panic_disorder" condition="(panic_disorder).is('')"]
### Panic Disorder    
Panic Disorder symptoms reported include:
[checkbox value="recurrent panic attacks|palpitations|sweating|trembling|shortness of breath|feeling of choking|chest pain|nausea|dizziness|chills|fear of losing control|fear of dying|numbness|tingling"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="social_anxiety" condition="(social_anxiety).is('')"]
### Social Anxiety    
Social Anxiety symptoms reported include:
[checkbox value="intense fear of social situations|worry about being embarrassed or judged|avoidance of social interactions|physical symptoms of anxiety in social situations|fear of being scrutinized|difficulty making eye contact|excessive self-consciousness|trembling|sweating"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="ODD" condition="(ODD).is('')"]
### Oppositional Defiant Disorder (ODD)    
ODD symptoms reported include:
[checkbox value="angry mood|argumentative behavior|defiant behavior|spiteful behavior|vindictiveness|actively refusing to comply with requests|deliberately annoying others|blaming others for mistakes"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="DMDD" condition="(DMDD).is('')"]
### Disruptive Mood Dysregulation Disorder (DMDD)    
DMDD symptoms reported include:
[checkbox value="severe temper outbursts|frequent irritability|angry mood|difficulty regulating emotions|verbal or physical aggression|difficulty maintaining friendships|outbursts out of proportion to situation|chronic irritability"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="conduct_disorder" condition="(conduct_disorder).is('')"]
### Conduct Disorder    
Conduct Disorder symptoms reported include:
[checkbox value="aggression toward people or animals|destruction of property|deceitfulness|theft|serious violation of rules|bullying|physical fights|using weapons|breaking laws|truancy|running away from home"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="schizophrenia" condition="(schizophrenia).is('')"]
### Schizophrenia    
Schizophrenia symptoms reported include:
[checkbox value="delusions|hallucinations|disorganized speech|grossly disorganized behavior|catatonia|negative symptoms|social withdrawal|reduced emotional expression|difficulty with daily functioning|cognitive impairments"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]
### Initial Psychiatric Evaluation

1. Reason for Seeking Help

What prompted you to seek psychiatric help today?
Additional information
(This question focuses on the immediate reason for the visit.)
Can you describe the specific issues or symptoms that led you to seek help?
Additional information
(This question delves into the specifics of the issues or symptoms.)
2. Medication History

What medications are you currently taking for your psychiatric conditions?
Additional information
How long have you been on these medications?
Additional information
Have you taken psychiatric medications in the past? If so, which ones and for how long?
Additional information
How effective were these medications for you? Did you experience any side effects?
Additional information
Who prescribed your current medications (outpatient psychiatrist, inpatient facility, hospital)?
Additional information
Were there any medications prescribed but never taken? If so, why?
Additional information
3. Previous Psychiatric Care

Have you seen a psychiatrist before? If yes, who was the psychiatrist?
Additional information
When was your last appointment with them?
Additional information
Why did you stop seeing your previous psychiatrist?
Additional information
4. Diagnosis History

Have you ever been given a psychiatric diagnosis? If so, what were they?
Additional information
Have any of your diagnoses changed or been updated over time?
Additional information
5. Substance Use

Do you currently use or have you used recreational drugs or alcohol? If so, what substances and how often?
Additional information
What was the reason for using these substances (e.g., coping mechanism, social use)?
Additional information
Have you ever sought treatment for substance use or addiction?
Additional information
6. Current Symptoms and Functioning

How have these symptoms impacted your daily life, work, or relationships?
Additional information
Are there specific triggers or patterns you’ve noticed with your symptoms?
Additional information
7. Past Treatments and Responses

What treatments or therapies have you tried before (e.g., psychotherapy, behavioral therapy)?
Additional information
How did you respond to these treatments?
Additional information
10. Lifestyle and Environment

Can you describe your living situation? Are there any factors that might influence your mental health (e.g., housing stability, financial stress)?
Additional information
What is your daily routine like? How do you manage stress and self-care?
Additional information
11. Goals and Expectations

What are your goals for treatment? What would you like to achieve through psychiatric care?
Additional information
Are there any specific concerns or expectations you have about your treatment?
Additional information

Based on the initial questions asked and screening records, we have identified some areas that may require more focused exploration. To better understand and address your current condition, I will now ask you a few specific questions related to the symptoms and issues you’ve mentioned. The one we are considering today includes:
Additional information

ADHD Inattention ADHD Hyperactivity ADHD Combined Depression Anxiety Bipolar Disorder (Mania) Bipolar Disorder (Depression) PTSD OCD Panic Disorder Social Anxiety Oppositional Defiant Disorder Disruptive Mood Dysregulation Disorder Conduct Disorder Schizophrenia






























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Sandbox Metrics: Structured Data Index 0.43, 85 form elements, 393 boilerplate words, 40 text areas, 30 checkboxes, 15 conditionals, 224 total clicks
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