I. Introduction and Correctional Psychiatry
i. With any patient you want to gather the following:
1. a history
5. an opinion
ii. Forensic psychiatry focuses on personality disorders
b. Correctional Facilities
i. 50% of inmates suffer from anti-social personality disorder
ii. Jails and prisons are required to treat serious mental illness
iii. Civil units treat well enough to restore to return to family
II. How Psychiatry relates to Lawyers:
a. As attorneys, in reviewing the medical record:
i. If the doctor is treating the patient, ask, has the doctor developed clear and measurable means of following the patient’s symptoms and symptom progress?
1. is the patient getting better, staying the same, getting worse?
2. If there was a discontinuation of treatment, ask how did this happen:
a. Did the physician or patient decide?
3. Was there remission of symptoms?
4. Were there incomplete trials or failed trials
5. Were the patient and the physician engaged in treatment
III. Psychiatric Evaluation and the Mental Status Examination
a. A psychiatric evaluation is not complete without understanding the effects of past interpersonal and family relationships on present functioning.
b. The Psychiatric Evaluation
i. Identifying information
ii. Chief complaint
iii. History of present illness
1. Details of problem
a. Has it changed over time?
b. What makes it better/worse?
c. Are there other symptoms associated with it?
2. If possible, get information from family/friends but need permission
iv. Past Psychiatric History
1. Past psychiatric history
a. Types of hospitalization
v. Past medical history
vi. Social and Developmental History
1. Childhood development
3. Social relationships
4. Current functioning
vii. Family History
1. Provides psychiatric history of family
a. Any disorders that run in the family
b. Have there been any suicides or homicides?
c. Next, the Physical Examination/Mental Status Examination is performed
i. Mental status changes over time; is assessed at one point in time but can be different at another time
ii. Mental status examination consists of:
1. Appearance, attitude and behavior
a. Description of dress, posture, facial expression
a. Tone of voice, ability/inability to articulate speech
3. Mood and Affect
a. ( this is subject and from the patient’s point of view) Irritable, euphoric, worried, happy
b. Affect is what the examiner observes i.e. tearful, angry, fearful, hostile
4. Thought content and thought process
a. Topics the patient discusses, preoccupations, ambitions, repetitive themes
b. Logical associations? Loose associations?(decreased logical relationship), tangentiality? Incoherence?
a. Illusions? Hallucinations,
6. Suicide and Homicide
7. Cognitive Function
a. Alert, le
ii. Often accompanied with depression and paranoia
iii. Will often use Multi-Mental State test to determine
iv. Treatment may include anti-depressant
i. Not a disease but a syndrome
ii. Delirium is something that happens to someone’s brain when something is wrong
iii. Acute onset(within hours,days)
1. Causes persons level of consciousness to fluctuate
iv. Accompanied with:
2. Inability to articulate
3. Inability to perceive what is going on around them, to the point of hallucinations
v. Typically a person will have an abnormal body temperature, have a disease or infection; a medical problem that is the causation of the onset of delirium
1. Person is usually very sick when suffering from delirium
V. Mood Disorders
a. Episodes are the building blocks of disorders
b. The episode that is occurring now only tells you about the current state; you need their history to determine entirely what is wrong
c. Treatment of depression does make patient a different person
i. Instead, gives patient the ability to deal with problems if willing to