Laura T. is a 27-year-old female who has been referred for psychiatric evaluation
Review of systems will help the PMHNP determine whether there are any physical reasons for the patient’s symptoms. Prioritization of the history assists in determining which areas to focus on during this part of the assessment. Incorporation of an open-ended question enables the PMHNP to gather important information about attention or changes in behavior or cognition.
Hi, Laura. It’s nice to meet you. I know that you probably feel a bit anxious. You’re here because your family thinks that there may be an explanation for your recent strange odor experiences, so it’s natural to be anxious to get some answers. Before we get started, I’d like to introduce myself and let you know a little bit about how we’ll approach this process. My name is Dr. Cameron and I’m a Pre-Health Psychiatric Nurse Practitioner with training in Psychiatry and Community Mental Health. I will assess you based on current medical history, with the use of diagnostic tools and techniques such as the ones we will discuss in our session today. This assessment process should allow us both to identify potential causes for recent events in your life and will help us determine next steps for treatment if needed.
The assessment will cover a review of systems, medical history, and recent life events. Your PMHNP may also evaluate your mood and provide counseling. Certain laboratory tests (including a complete blood count) and other diagnostic procedures (such as an electrocardiogram or EKG) may be ordered to help diagnose physical problems that are contributing to the hallucinations.
The primary goal of this intervention is to provide information–in a caring manner–to help the client realize that she is not imagining things such as foul odors. She may not realize what it means to have an hallucination and that she can do something about it.
During a psychiatric evaluation, it is important to describe and gather a full history in order to make an accurate diagnosis. Additionally, my knowledge of the presenting symptoms will help me move efficiently through the assessment process. I always begin by asking about personal and family history. I then review psychosocial factors to get an idea of what the person’s daily life may be like. After that, I move on to symptom analysis, which includes a thorough description of each symptom and its timing, onset, frequency, duration, intensity, abruptness or gradations of change, quality (eg, sharp pain vs dull ache), associated effects on functioning and impact on the patient’s life.
It’s a priority in your psychiatric assessment to be compassionate. This will make it easier for the patient to open up about their concerns and state of mind. Having a concern about schizophrenia automatically puts you on alert for mania or psychosis.
Reviewing the patient’s history to rule out all potential psychiatric diagnosis
The priority of assessment includes:
It is important to rule out breath and body odor by asking about recent food intake, bowel habits, or medications. Other contributing factors can include poor dental hygiene, periodontal disease, sinus infections, medical conditions (asthma), or smoking. However, these are not likely causes if there has been no recent change in her living circumstances or environmental factors.
Indication of attitude toward the client (e.g., hostile, cooperative).
Laura T. is a 27-year-old female who has been referred for psychiatric evaluation. She has no significant psychiatric or medical history and denies any history of substance abuse, but she is here because she is persistently having olfactory hallucinations. For the last 3 months, she has been having this progressive sense of smelling particularly foul odors—feces, rotting food, trash— with no obvious cause. She made the appointment because she had an uncle who had schizophrenia and he used to have hallucinations too, although he was mostly hearing voices. The PMHNP knows that a priority of assessment includes a: