APA Updates Guidelines on Psychiatric Evaluation in Adults
Am Fam Physician. 2016 Jul 1;94(1):62-64.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
The initial psychiatric evaluation should include a review of the patient's mood, anxiety level, thought content and process, perception, and cognition, and history of trauma and psychiatric history.
In the setting of current suicidal ideas, identify the intended course of action, access to suicide methods, motivations for suicide and reasons for living, quality of the therapeutic alliance, and history of suicidal behaviors of biologic relatives.
Quantitative measures of symptoms, level of functioning, and quality of life should be obtained to improve clinical decision making and treatment outcomes.
From the AFP Editors
The American Psychiatric Association (APA) recently released the third edition of its guidelines on psychiatric evaluation of adults. The nine-part guideline has been updated based on new evidence identified since the previous edition was released in 2006. Although the strength of the evidence supporting the recommendations in the updated guidelines is low, there is consensus that their benefits clearly outweigh the harms. In cases where the balance of benefits and harms is difficult to judge, or the benefits or harms are unclear, the APA made suggestions for care instead of recommendations. For more information about these guidelines, including tips for implementation, see the full report from the APA.
Guideline 1: Review Symptoms, Trauma History, and Treatment History
The APA recommends that the initial psychiatric evaluation include a review of the patient's mood, anxiety level, thought content and process, perception, and cognition. The clinician should review the patient's trauma history and his or her psychiatric history, including psychiatric diagnoses, treatments (type, duration, and medication dosages), adherence and response to treatments, and history of psychiatric hospitalization and emergency department visits for psychiatric issues. The goal of this guideline is to improve the quality of the clinician-patient relationship, the accuracy of psychiatric diagnoses, and the appropriateness of treatment selection. Knowledge of prior psychiatric diagnoses can inform the current diagnosis because a patient may be presenting with a continuation of a previously diagnosed disorder, or may now have a different disorder that commonly co-occurs with the first. Past treatments are relevant because lack of effectiveness may suggest a need to reconsider the accuracy of the diagnosis. Symptoms that emerge during treatment (e.g., hypomania or mania in a patient with depression) may also require reassessment of the diagnosis.
Guideline 2: Evaluate Substance Use
To identify patients with substance use disorder and to facilitate treatment planning, the APA recommends that clinicians assess the patient's use of tobacco, alcohol, and other substances (e.g., marijuana, cocaine, heroin, hallucinogens), as well as misuse of prescribed or over-the-counter medications or supplements. Ensuring that initial psychiatric evaluations include assessment of substance use may improve the differential diagnosis because substance use disorders, other psychiatric disorders, and other medical conditions may share similar presenting symptoms, such as anxiety, depression, mania, and psychosis.
Guideline 3: Assess Risk of Suicide
The APA recommends that clinicians evaluate the patient's current suicidal ideas, plans, and intent, including active or passive thoughts of suicide or death; prior suicidal ideas, plans, and attempts, including attempts that were aborted
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions