PsychConsult6

The patient is a [text memo="age" size="2"]-year-old,[checkbox value=" white| African-American| Hispanic| Asian|"] [checkbox value="female|male|transgender female|transgender male|gender non-binary individual"] [select name="variable_9" value="with no past psychiatric history,|with history of |"]
[checkbox value="depression|MDD|situational depression|anxiety|GAD|panic attacks|mood disorder|bipolar disorder|somatic symptoms|somatic symptom disorder|ADHD|PTSD|dementia|dementia with behavioral disturbances|OCD|psychosis|substance abuse|personality disorder|maladaptive personality traits|recurrent suicidal ideation|suicide attempt|schizoaffective disorder, bipolar type|schizoaffective disorder|schizophrenia|psychosis|unknown mental health diagnosis|severe persistent mental illness|psychiatric hospitalization|noncompliance with psychiatric medications/treatment"][textarea memo=" " rows="5"]

Patient [select value="initially presented to emergency department|initially presented to outside emergency department|was transferred here from outside facility"][select value=" alone| with family| with significant other| via EMS | already sedated and intubated| by police||"] [select value=" |complaining of |for complaints of | due to report of | for higher level of care due to "][text memo="PRESENTING PROBLEM" size="20"].  [select name="variable_13" value="Per ED records,|Per outside records, |Per chart,|At time of admission,|Upon transfer and admission here,||"][select value="the patient reported |family reported |friend reported|EMS reported |staff at the facility reported|it was reported |outside records indicated |police reported|the patient was"][textarea memo="history of presenting complaints" rows="3"]  [select name="variable_13" value="In ED, work-up showed|At outside hospital,| Initial work-up showed|| "][textarea name="variable_1" default=""]  [select name="variable_14" value="No UDS results noted. |UDS at outside hospital reportedly|UDS was"] [checkbox name="variable_1" value="+amphetam/metham|+barbituates|+benzos|+cocaine|+opiates|+phencyclidine|+THC|+methadone screen"].  [select name="Druglevel1" value="||Acetominophen level less than 10.0 mcg/mL . |Acetominophen level high at X mcg/mL .|Salicylate level less than 10.0 mg/dl .|Salicylate level elevated at X mg/dl .|Lithium level therapeutic at X .|Lithium level low at X, not trough.|Lithium level low at X .|Lithium level high at X.|Depakote level high at X.|Depakote level low at X, not trough.|Depakote level low at X ."]  [select name="Druglevel2" value="||Acetominophen level less than 10.0 mcg/mL . |Acetominophen level high at X mcg/mL .|Salicylate level less than 10.0 mg/dl .|Salicylate level elevated at X mg/dl .|Lithium level therapeutic at X .|Lithium level low at X, not trough.|Lithium level low at X .|Lithium level high at X.|Depakote level high at X.|Depakote level low at X, not trough.|Depakote level low at X ."]  [select name="Druglevel3" value="||Acetominophen level less than 10.0 mcg/mL . |Acetominophen level high at X mcg/mL .|Salicylate level less than 10.0 mg/dl .|Salicylate level elevated at X mg/dl .|Lithium level therapeutic at X .|Lithium level low at X, not trough.|Lithium level low at X .|Lithium level high at X.|Depakote level high at X.|Depakote level low at X, not trough.|Depakote level low at X ."]  [select name="Druglevel4" value="||Acetominophen level less than 10.0 mcg/mL . |Acetominophen level high at X mcg/mL .|Salicylate level less than 10.0 mg/dl .|Salicylate level elevated at X mg/dl .|Lithium level therapeutic at X .|Lithium level low at X, not trough.|Lithium level low at X .|Lithium level high at X.|Depakote level high at X.|Depakote level low at X, not trough.|Depakote level low at X ."] 

Psychiatry consultation requested for[select value=" evaluation and management of | due to reports of |"][text memo="presenting problem" size="20"].  Patient seen for psychiatric consultation [select name="variable_18" value="in hospital room on medical floor.|in ICU.|"] [select name="variable_20" value="Patient is poor informant due to symptomatic presentation.|Patient is poor informant due to current somnolence.|Patient is poor informant due to cognitive impairments.|Patient is considered reliable historian."][select name="variable_17" value="Sitter is at bedside and steps out for interview.|Sitter is at bedside.|"] [select name="variable_15" value="No family/friends present.|Spouse is at bedside |Family is at bedside|Friend is at bedside|Caregiver is at bedside"][select name="variable_16" value="|and provides collateral history.|and provides majority of history.|but steps out for interview at patient request.|but steps out for interview."]

[select value="Per report from patient,|Per family report,|Per review of chart,|Per report from care giver, |Reportedly,|Apparently,"][select value=" the patient was in usual state of mental health until|the patient had no history of mental health concerns until |the patient has been having problems with|"][textarea memo="Mental health history" rows="5"]. [checkbox name="depression" memo="depression" value=""][checkbox name="anxiety" memo="anxiety" value=""][checkbox name="sleep" memo="sleep" value=""][checkbox name="mood" memo="mood" value=""][checkbox name="ptsd" memo="ptsd" value=""][checkbox name="adhd" memo="adhd" value=""][checkbox name="autism" memo="autism" value=""][conditional field="depression" condition="(depression).is('')"] [var name="Patient"]'s depression is characterized as [checkbox value="little interest or pleasure in doing things|hopelessness|helplessness|sleeping too much|difficulty getting to sleep|difficulty staying asleep|feeling tired or having little energy|poor appetite|overeating|feelings of inadequacy|irritability|poor concentration|psychomotor retardation|psychomotor agitation|suicidal ideation"]. [select value="Depressive symptoms are present most of the day, nearly every day|Depressive symptoms are mostly present |"][text size="20"][select value=", are exacerbated by |"][text size="20][select value=", are improved by |"][text size="20]. [select value="Depressive symptoms impact|"][select value=" social/work functioning by | "][textarea rows="1"].[textarea memo="Additional Depression information" rows="5"][/conditional][conditional field="anxiety" condition="(anxiety).is('')"] The patient's anxiety generally presents as [checkbox value="feeling nervous or on edge|worry|difficulty relaxing|feeling restless|difficulty getting to sleep|difficulty staying asleep|irritability|poor appetite|overeating"][text size="20]. [select value="Anxiety is present |"][select value="in the context of multiple different situations/events such as |primarily in social situations such as | "][textarea rows="1"]. [select value="Anxiety usually last for approximately |Anxiety is present most of the time on most days"][text size="20"][select value=", is brought on by |"][text size="20][select value=", is relieved by |"][text size="20]. [textarea memo="Additional Anxiety information" rows="5"][/conditional][conditional field="mood" condition="(mood).is('')"][select value=" Mood instability has been an issue since |"][text size="20"]. [select value="Disordered mood can present as |"][checkbox value="euphoria|excessive energy|excessive self-confidence|insomnia|irritability|agitation|racing thoughts|impulsive behavior|risk taking behavior|paranoia|delusions of grandeur|auditory hallucinations|visual hallucinations|depression|apathy|hopelessness|helplessness|suicidal thoughts|no motivation|hypersomnia"]. [select value="Mood lability is exacerbated by |There are no identified precipitating factors to mood lability|"][textarea rows="1"]. [textarea memo="additional information of mood lability" rows="4"][/conditional][conditional field="autism" condition="(autism).is('')"]
[select value="Per patient,|Per family,|Per record,|"][text size="20"][select value=" they have been | patient has been |"][select value="diagnosed|undiagnosed|"][text size="20"][select value=" autism spectrum disorder "][textarea memo="details of diagnosis/symptom timeframe" rows="4"]. [var name="name"]'s symptoms present as persistent difficulty, in multiple contexts, with social communication and interaction including: [checkbox value="abnormal or failed back and forth conversation|failure to initiate or respond to social interactions|reduced sharing of interests/emotions|limited emotional affect|limited/incongruent nonverbal communication|difficulty with developing/maintaining/understanding relationships|difficulty sharing imaginative play|limited or absent interest in peers"]. They have demonstrated restricted/repetitive patterns of behavior, interests, or activities including: [checkbox value="repetitive motor movements|repetitive speech|infexible adherence to routines|ritualized patterns of verbal or nonverbal behavior|significant difficulty with transitions|rigid thinking patterns|highly restricted and fixated interests|hyper-reactivity to sensory input|hyporeactivity to some sensory input"]. Presentation is [select value="without|with"] intellectual impairment, and [select value="without|with"] language impairment. [textarea rows="4"][/conditional][conditional field="adhd" condition="(adhd).is('')"]
[var name="name"] has a pattern of [checkbox name=addtype value="inattention and hyperactivity/impulsivity|inattention|hyperactivity/impulsivity"] that interferes with functioning. [/conditional][conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('inattention')"] Inattention manifests as [checkbox memo="At least 6 for ADHD" value="poor attention to details or careless mistakes in work or activities|difficulty sustaining attention|not seeming to listen when spoken to directly|not following through on instructions or failing to finish tasks|having difficulty organizing tasks and activities|avoiding tasks that require sustained mental effort|frequently losing things necessary for tasks|often easily distracted by extraneous stimuli|forgetfulness in daily activities"].[/conditional] [conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('hyperactivity/impulsivity')"] [var name="name"]'s hyperactivity/impulsivity presents as [checkbox memo="six or more for ADHD" value="frequent fidgeting or squirming|often leaving seat when remaining seated is expected|frequently restless|difficulty engaging in leisure activities quietly|often seeming to be on the go or difficult to keep up with|excessive talking|blurting out answers before a question has been completed|difficulty waiting for their turn|interrupting or intruding on others"][/conditional][conditional field="adhd" condition="(adhd).is('')"]
These symptoms have been present since [text memo="before 12yo" size="20"], and are recognized in multiple settings including [text memo="2 or more" size="20"]. [textarea rows="3"][/conditional]
[conditional field="sleep" condition="(sleep).is('')"]Sleep is reported to be generally [select name="sleepq" value="poor |fair |good.|erratic |inconsistent |excessive|"][select value="with difficulty initiating sleep and staying asleep due to |with difficulty initiating sleep due to |with difficulty maintaining sleep due to |"][textarea rows="2"]. They estimate getting approximately [text size="4"] hours of [select value="broken |solid |"]sleep per night. [select value="Disturbed sleep has been an issue for |Disturbed sleep is a new issue within the last |"][textarea rows="1"]. [select value="There has been no workup for Sleep Apnea|There was a past workup for sleep apnea which indicated |"][textarea rows="1"]. [select value="Current attempts at improving sleep include |The patient is currently attempting no interventions to improve sleep|Current quality of sleep is dependent on |"][textarea rows="2"]. [select value="Past unsuccessful attempts at improving sleep include |There have been no past attempts at improving sleep|"][textarea rows="2"].[/conditional][conditional field="sleep" condition="(sleep).isNot('')"]Sleep is reported to be generally good. [/conditional][conditional field="depression" condition="(depression).isNot('')"]Patient denies any marked issues with depression. [/conditional][conditional field="anxiety" condition="(anxiety).isNot('')"]Patient denies any significant issues with anxiety. [/conditional][conditional field="mood" condition="(mood).isNot('')"]Patient denies a history of mania, excessive mood lability, grandiosity, or uncharacteristic risk taking behavior. [/conditional]

[select value="Current psychiatric medications include: |Patient is unable to recall current psychiatric medications|Unable to cover current psychiatric medications with patient due to symptomatic presentation|"][textarea rows="4"]. [select value="Patient denies current outpatient psychiatric follow-up|Patient currently receiving outpatient psychiatric services through|Patient currently followed for outpatient psychiatric medication with|"][textarea rows="1"]. [select value="Patient denies currently receiving individual counseling/therapy|Patient currently engaging in individual counseling with |"][textarea rows="1"]. [select value="Patient denies current suicidal ideation or thoughts of self harm|Patient reports currently experiencing |Patient denies current suicidal ideation but endorses thoughts of"][textarea rows="1"]. [checkbox value="With good eye contact and without hesitation, patient is able to contract for safety.|Patient is not able to contract for safety."][textarea rows="1"] [select value="Patient denies having access to guns|Patient reports guns at home|Patient reports having access to guns"][textarea rows="1"]. 

REVIEW OF SYSTEMS
 [comment memo="Use freetext to explain {+}s if needed"]
[checkbox memo="Constitutional" name="Constitutional" value=""][conditional field="Constitutional" condition="(Constitutional).is('')"]Constitutional: [checkbox name="Constitutional1" value="fever"][/conditional][conditional field="Constitutional1" condition="(Constitutional1).is('fever')"][select value="(-)|{+}"], [/conditional][conditional field="Constitutional" condition="(Constitutional).is('')"][checkbox name="Constitutional2" value="chills"][/conditional][conditional field="Constitutional2" condition="(Constitutional2).is('chills')"][select value="(-)|{+}"], [/conditional][conditional field="Constitutional" condition="(Constitutional).is('')"][checkbox name="Constitutional3" value="malaise"][/conditional][conditional field="Constitutional3" condition="(Constitutional3).is('malaise')"][select value="(-)|{+}"], [/conditional][conditional field="Constitutional" condition="(Constitutional).is('')"][checkbox name="Constitutional4" value="unexplained wt gain/loss"][/conditional][conditional field="Constitutional4" condition="(Constitutional4).is('unexplained wt gain/loss')"][select value="(-)|{+}"][/conditional][conditional field="Constitutional" condition="(Constitutional).is('')"][checkbox name="Constitutional5" memo="freetext" memo_size="small" value=""][/conditional][conditional field="Constitutional5" condition="(Constitutional5).is('')"]
--[textarea memo="explanation of abnormals if needed" memo_size="small" memo_color="orange" rows="2"][/conditional][conditional field="Constitutional" condition="(Constitutional).is('')"]
[/conditional][checkbox memo="Musculoskeletal" name="Musculoskeletal" value=""][conditional field="Musculoskeletal" condition="(Musculoskeletal).is('')"]Musculoskeletal:[checkbox name="Musculoskeletal1" value=" muscle pain"][/conditional][conditional field="Musculoskeletal1" condition="(Musculoskeletal1).is(' muscle pain')"][select value="(-)|{+}"], [/conditional][conditional field="Musculoskeletal" condition="(Musculoskeletal).is('')"][checkbox name="Musculoskeletal2" value=" back pain"][/conditional][conditional field="Musculoskeletal2" condition="(Musculoskeletal2).is(' back pain')"][select value="(-)|{+}"], [/conditional][conditional field="Musculoskeletal" condition="(Musculoskeletal).is('')"][checkbox name="Musculoskeletal3" value="joint pain/swelling"][/conditional][conditional field="Musculoskeletal3" condition="(Musculoskeletal3).is('joint pain/swelling')"][select value="(-)|{+}"] [/conditional][conditional field="Musculoskeletal" condition="(Musculoskeletal).is('')"][checkbox name="Musculoskeletal4" memo="freetext" memo_size="small" value=""][/conditional][conditional field="Musculoskeletal4" condition="(Musculoskeletal4).is('')"]
--[textarea memo="explanation of abnormals if needed" memo_size="small" memo_color="orange" rows="2"][/conditional][conditional field="Musculoskeletal" condition="(Musculoskeletal).is('')"]


Psychiatric: