The Psychiatric Evaluation

You’ve arranged an appointment with a shrink, you’re not sure why, and your mind is astir with anxiety over the visit.  You’ve never seen a psychiatrist before.  The questions keep you awake at night.  Can they read minds?  Will they judge you right away?  Will seeing someone even make a difference?

The short answers:

• No, providers can’t read minds.
• No, the professional isn’t there to judge you.  They’re there to help you.  If the provider comes across as judgmental, find somebody else.
• Yes, seeing a provider can absolutely improve the quality of your life.  Remember, if you keep doing what you’re doing now (struggling with your issues on your own), it’s unlikely anything will change.

The long answer:

Your first meeting is called a psychiatric evaluation, and here’s what to expect.

What does the psychiatric evaluation involve?  A provider needs to gather quite a bit of information. This is to get to know you, as well as to establish a diagnosis and figure out what treatment to offer.  To do this, they ask dozens of questions and perform what’s called a “mental status exam.”

What types of questions are asked, and what are the right answers?  There will be many types of questions and, no, there aren’t any right or wrong answers.  Just answer as honestly as you can.  The more the provider knows, the more likely they’ll be able to help you.  Sample questions include:

• “Why are you here today?”
• “What is your life like now?”
• “What is stressing you?”
• “Have you ever had problems with drugs or alcohol?”
• “Do you every hear voices no one else hears?”
• “Do you ever feel paranoid, like someone or something is trying to kill you?”
• “Are you having thoughts of hurting yourself or others?”

There might also be questions about your childhood, education, occupation, legal history, marital status, and level of support you have in your life.  Remember, the interviewer can’t read your mind; if there’s something you need to tell them, anything they forget to ask, by all means say it out loud.

What is a mental status exam?  The mental status exam is the objective part of the mental health provider’s evaluation.  In simple words, it’s what they observe.  Have you ever been people-watching?  What do you notice?  Their behavior, the way they move and talk, and the expressions on their face?  Do you notice whether they’re happy or distraught?  That’s what a provider does.  They might ask some strange questions to better understand your thinking.

• “What does it mean when I say, “Rome wasn’t built in a day?”  Asking about the meaning of a proverb tests ability to abstract.
• “How do you spell the word _____ backwards?” This tests concentration.
• “I’m going to say three words. When I’m finished saying them, I need you to say them back to me.”  This checks immediate recall, a type of memory.
• “I’d like you to copy this [complicated] design please.”  Copying a complicated design measures organization.

Why does the provider want to know so much?  Opening up to a stranger is difficult, and we recommend you share information at your own pace and comfort level.  That said, psychiatric clinicians do ask very intimate questions.  They recognize that people are complicated, that each person is unique, and they shouldn’t offer treatment unless they know what is really going on.

Take a look at this example of a psychiatric evaluation.  It’s uses a lot of “doctor” speak and includes more detail than discussed in this article (diagnosis, formulation, etc), but might still be of interest.