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]
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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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