Psychiatric assessment, diagnosis and formulation....⬇️          

 

 

Humans are complicated beings, fraught with all sorts of "problems in living". At any given time, some people's problems in living are more complicated than others. Such problems are attributable to a complex web of biological vulnerability, external stress, adversity, trauma, substance abuse and abstract influences such as bad luck, fate, spirituality and culture. In addition, there are a variety of “unknown unknowns” which we cannot account or plan for.

An initial assessment can usually be completed within an hour (see what to expect) but for specialist assessments or where a person's problems are very complicated, I may need two separate one hour sessions to undertake a comprehensive assessment. 

The primary purpose of psychiatric assessment is to obtain an understanding or hypothesis as to why a particular patient may have problems with living (with a view to doing something about it). The assessment aims to determine :

  • Why you are experiencing psychological symptoms at this point in time

  • Why you developed your problems with living or symptoms in the first place

  • Why things have taken this particular course during your life thus far

  • What (if any) is the most appropriate way to describe your problems with living in the form of a psychiatric diagnosis

  • Why things are not getting better (or changing)

  • A "roadmap" for change (in those motivated to do so)

One could argue that this sort of opinion could be obtained from a good friend, family or even a stranger. To some extent this is true, but others will often be unable to apply objectivity, medical expertise and experience in psychological medicine when providing their opinion. I will also provide suggestions for tailored treatment where appropriate.

Assessment and the resulting opinion can occasionally be interpreted as character assassination. This is understandable given that the assessment is focussed on how you relate to yourself, others and your environment. Psychiatric diagnosis can only be made when a person is struggling in these areas, hence the idea of dysfunction can be difficult to accept.

Diagnosis is based on both the subjective information that the patient supplies along with my objective assessment of biological, psychological and social factors across the lifespan. I am always amenable to discussing and possibly amending my opinion and encourage patients to obtain a second opinion if they feel that my assessment/opinion is unsatisfactory in any way.

I have written more about some of the pitfalls of psychiatric diagnosis here.

With your permission I will speak to a person whom you feel is a good source of collateral information as well as your GP, physician or surgeon when necessary.

I will provide an objective diagnostic opinion as well as a detailed formulation to your referring doctor. I will spend time explaining this to you as well as providing copies of written reports within 7 working days if you request these. With your permission, I will also provide feedback to the referring GP (or physician) by telephone if this is deemed urgent.