A psychiatric assessment is a medical examination that takes place predominantly in the form of an interview or clinical conversation, which may be more or less structured. Information will be requested regarding the person’s general state of health, including any examinations that have been carried out and any documentation that the person considers relevant to present to the doctor.
Part of the clinical examination concerns the way the interview itself takes place: how the person speaks, expresses themselves, presents themselves, behaves, the order in which they provide information, and what they emphasize.
The interview, therefore, is not merely a narrative in terms of its content, but also contains a series of elements that can be gathered from the interview itself.
Third parties may also be present during the assessment if the patient requests this, or agrees to it at the request of these people (relatives, friends, partners). However, in some cases the doctor may consider it appropriate for the interview to take place entirely or partially one-to-one with the patient, so as to allow them to express themselves more freely. In such cases, third parties may provide the doctor separately with whatever information they consider important.
A psychiatric assessment is not a courtroom proceeding. The doctor does not make moral judgments or pass judgment on the merits of a situation involving the patient and other people. Hearing different points of view is often useful because third parties may notice certain elements better than the patient, while the patient may notice and report other elements more accurately. Finally, there are other elements that the doctor is better able to identify, which is why observing the patient directly is crucial, at least during an initial assessment or in particular circumstances.
The assessment is also an opportunity to prescribe and explain medication, encourage the patient to reflect on certain matters, or comment on events that have occurred. The exchange of information, or the psychotherapeutic interaction, between doctor and patient can take place in different ways: sometimes beginning with an “emotional release,” sometimes with a narrative, or perhaps as a more focused interview based on specific symptoms.
One of the purposes of the assessment is to formulate a diagnosis. This may be limited to the syndrome (the set of symptoms, considered in terms of how they are expected to develop or evolve as groups of symptoms, not necessarily all moving in the same direction); to the illness understood as the person’s current state (based on how it is expected to evolve); or to the overall clinical picture (based on how it is expected to evolve beyond the current phase).
A diagnosis is not always possible after a first session, particularly a definitive diagnosis that provides an overall view and reduces apparently different symptoms to a principal underlying pattern, with different phases and different symptoms depending on the moment, but with a predictable course in relation to certain core symptoms and the response to treatment.
The choice of treatment can likewise be made immediately, although not always in a way that is specific to a particular illness. Furthermore, not all illnesses have specific treatments, and not all known syndromes can actually be defined as illnesses. In other words, the course over time cannot necessarily be predicted for every syndrome, because several different outcomes may be possible.
For some people, talking about personal experiences or feelings can be embarrassing. Others may fear that their thoughts will be judged as strange, funny, bizarre, or inappropriate to talk about. It should be kept in mind that a psychiatrist has probably already encountered similar situations and that, despite the uniqueness of individual personal stories, the types of feelings and thoughts found in psychiatric disorders—from anxiety to psychosis—tend to be similar.
The psychiatrist is therefore not there to be surprised or to judge the patient as an ordinary observer might, but rather to formulate a diagnosis and gain a better understanding of the situation.
Diagnoses should never be regarded as insults, labels, or judgments that “brand” or diminish a person. Instead, they are channels through which it is possible to intervene in the particular circumstances of an individual using standardized tools. These tools provide a way of reaching the core of a disorder in a predictable manner and treating it in the desired direction.
Treatment decisions are made by the psychiatrist and proposed to the patient. If there are more or less equivalent alternatives, the patient may choose according to the factors they prefer or dislike. Otherwise, the available alternatives may be explained, but one of them will be identified as the recommended option.
The patient’s suggestions will be heard, but they will not necessarily be taken into account when determining and recommending the appropriate treatment. This has nothing to do with a judgment about the patient’s intelligence or with being more or less “open” to cooperation.
Many of the ideas patients have about treatment arise from what their psychological or psychiatric condition leads them to judge as better, worse, urgent, frightening, and so on. Often these are choices or attempts that have already been tried and failed, yet the patient may nevertheless feel compelled to suggest or repeat them if left to decide entirely for themselves.
In a psychiatric assessment, however, the doctor’s role is precisely to work around these obstacles and recommend what may sometimes seem too hasty, too simple, wrong, or unlikely to the patient.
On the other hand, there are patients whose expectations are too absolute and urgent, who invest heavily in the idea of getting better immediately (within days or weeks), without taking into account what the disorder itself predicts—for example, gradual improvement, improvement occurring symptom by symptom, or an initial period of waiting before significant changes become apparent.
Treatment aims to produce a state of well-being comparable to that of the average person who does not seek medical attention because of symptoms.
This means that it is certainly reasonable to aim for complete improvement, while it is unrealistic to expect treatment for an illness to solve every aspect of a person’s life, including those that have nothing to do with the limitations imposed by the symptoms.