All patients presenting for psychiatric care should receivea comprehensive
descriptive psychopathological evaluation.This should include a broad
symptomatological assessment specifyingthe time frames of the findings, as
well as a mental stateexamination at the time of the patient interview (Table
4.1).
Standardised definitions of terms should be used in describingthe elements
of psychopathology. Standardised glossaries shouldbe consulted, such as the
World Health Organization's Lexiconof Psychiatric and Mental Health
Terms and Schedules for ClinicalAssessment in
Neuropsychiatry.
A comprehensive evaluation should document symptoms elicitedor observed
during the interview, those present in the recentpast and relevant to the
current illness, as well as thosepresent during the more distant past and
relevant to the pastpsychiatric history.
The assessment of signs and symptoms requires careful observationof the
patient during the interview, listening to the patient'snarrative during the
presentation of a chief complaint andhistory, and specific questioning in
suspected problem areas.Evidence of signs and symptoms may also come from
ancillaryinformation sources, such as records of prior treatment andthe
reports of relatives, friends, representatives of socialagencies, and other
professionals.
The clinical significance of symptoms should be determined bya
consideration of their severity. Severity is reflected inthe intensity,
frequency and duration of symptoms, their tendencyto cause subjective
distress, and their impact on the patient'sfunctioning. Symptom severity
should be documented. Violentand suicidal ideation and behaviours should be
thoroughly assessedand documented.
The evaluation of symptoms should be guided by hypotheses abouttheir
diagnostic or syndromic significance. Observations andlines of questioning
should be based on the identificationof major psychiatric syndromes and the
ruling out of specificdisorders in differential diagnosis.
Variations in the presentation of psychopathology accordingto a patient's
age, gender and sociocultural background shouldbe considered in the conduct
of the examination and in theinterpretation of collected information
for example,depression tends to present predominantly with somatic symptoms
in traditional societies. The significance of any behaviouror mental
activity, as indicative of psychopathology or asculturally sanctioned should
be carefully considered.
Attention should be paid to diagnostic criteria, such as thoseof the
standard international classifications, to guide theevaluation of symptoms
and mental state and to appraise theirsyndromic significance. However, the
possibility of culturaland regional variations and of atypical presentations
shouldbe considered.
Delgado, H. (1993)Curso de
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I. (1999)Lecciones de Psicologia Medica [Lessons
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Mind: An Introduction to Descriptive Psychopathology (2nd edn).
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(1997) Psychopathology across the life cycle. In
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