Transcript Psychiatric Appointment Form Powerpoint

Providing Context at
Psychiatric Appointments
What Psychiatric Prescribers Need To Know
When Assessing and Treating Individuals
With Developmental Disabilities
What Is In A Snapshot?
Psychiatric appointments occur out of
context.
Psychiatric appointments are brief and in
the moment.
Sometimes people ‘aim to please’ when
meeting with professionals.
Without context, what is directly observed
during a psychiatric appointment can be
challenging to evaluate.
Cognitive Delays & Provision
of Verbal Context
 Abstractions such as time frames, reasons why,
and relative seriousness of events might be
distorted.
 Memory gaps and inability to fully describe a
situation might impact what is shared.
 A patient might not understand questions in a
diagnostic interview.
 Lack of trust with a clinician or saying “Yes” as a
strategy to please might distort what is shared.
Deep Listening
Though psychiatric prescribers necessarily
depend on others to provide context, it is
important that patients with developmental
disabilities are accorded respect and are the
central treatment focus.
Supports to Persons With
Developmental Disabilities
Family supports.
Medicaid Personal Care and COPES
supports.
Adult Family Home supports.
Group Homes and Boarding Home
supports.
Supported Living supports.
Community Protection supports.
Treatment Modalities
 Be sure that physical pain, neurological conditions,
and other physiological issues are being treated.
 Ask if there is a Functional Assessment, Positive
Behavior Support Plan, and a Cross-Systems Crisis
Plan for patients with very challenging symptoms.
 Address the adequacy of residential, educational, and
vocational supports.
 Is the patient using counseling therapies?
 Access Speech Therapy, OT and PT when helpful.
 Psychiatric treatment is not a stand alone solution.
How Systems Skew Psychiatric
Assessments and Treatments
In frustration, support providers may over-
state symptoms to effect a strong response.
Unrealistic expectations are sometimes
placed on psychiatric prescribers.
There is a tendency to look for the most
powerful pill.
There is the idea that using medicine is the
easiest (cheapest?) way to fix problems.
Changes in Community Mental
Health Services
 More money is being spent on pharmaceuticals
and less money is being spent on mental health
case management per client.
 Mental health caseloads have essentially doubled
in Washington State in the past fifteen years.
 Collaboration and consultation between mental
health case managers and prescribers for each
client has substantially decreased.
Requesting Contextual
Information at Appointments
 Psychiatric prescribers depend on families and
agency staff to provide supports to individuals
with developmental disabilities at psychiatric
appointments.
 Patients are better served if families and/or
support providers understand psychiatric
treatments.
 Good care requires good sharing of information –
both ways.
Psychiatric Appointment
Information Sheet - GOALS
 Minimize unnecessary psychotropic medication use.
 Limit the number, dose and toxicity of necessary
psychotropic medications as possible.
 Obtain as accurate and detailed information as possible to
make medication decisions.
 Identify treatable psychiatric conditions.
 Identify environmental, social and medical causes of
concerning behaviors.
 Determine efficacy of existing psychotropic therapy.
 Identify any side effects
Demographic Information
Patient Name
Psychiatric Prescriber
Appt. Date
Person(s) Completing Form
Relationship to Patient
Who else provided input?
Guardian (if any)
Guardian phone #
Date of last visit
General Information
Who is providing information?
How well do they know the patient?
Are there differing opinions or an agenda?
What is the patient’s weight and why is it
important?
Basic Medical Information
Recent Weight & Date when weighed
Date of last Blood Draw
Pharmacy Name and Phone Number
Name(s) of other involved medical specialists (general
practitioner, neurologist, gastroenterologist, dentist, etc.)
Medications and Diagnosis
List all current psychiatric meds, dosages, &
times administered.
List all current non-psychiatric meds, dosages,
& times administered.
Current DSM Diagnosis (if any):
Axis I:
Axis II:
Axis III:
Reasons For The Appointment
Please address the following issue(s):
Describe other efforts to address symptoms
of concern:
How is the client doing in general
Great
OK
Doing Poorly
Since the last appt. is the client doing:
Better
Same
Worse
Information From Patient’s
Support System
How is the patient doing now?
Has anything changed since the last
appointment?
Stress Related To Life Events
Loss of job
Significant change in
support staff
Victim of crime or
assault
Change in family
circumstance
Increased stress at home
Exposed/witness to violence
Move to a new
residence
Law enforcement contact
Death in family
Medical tests/MD visits/ER
visits
Loss of preferred
activity
Death or loss of a friend
Change in physical health
Other -
Physiological Symptoms
Constipation
Dizziness/fainting
Nausea/Vomiting
Slurred speech
Diarrhea
Rapid or slow pulse
Rectal
bleeding/discomfort
Stumbling/unsteady gait
Abdominal pain
Weight gain/loss
Urinary
difficulties/excess
Edema/swelling
Chest pains
Tingling/numbness
Stiffness
Tremor/shaking/ticks
Seizures
Fatigue
Headache
Physical weakness
Injury requiring medical
response
Physiological Symptoms - II
Unusual facial/ mouth/eye
movement
Unusual movements of
extremities
Drooling
Dry mouth
Increased thirst
Unusual tastes/smells
Appetite change
Choking on food
Dental pain
Change in skin color
Rash/Itching
Breast discharge
Sexual function difficulties
Menstrual changes
Excessive sleepiness
Loud snoring
Breathing abnormalities
Wheezing or cough
Sweating or chills
Hearing/vision changes
Hair loss/unusual growth
Other -
What Physiological Symptoms
Can Tell Us
 Is the patient experiencing a medical condition as
a potential cause of behavioral concerns?
 Is a psychotropic medication causing a
physiological symptom?
 Is a psychotropic medication causing a medical
condition?
 What physiological symptoms are associated
most commonly with what psychotropic
medications
Behavioral Symptoms
Assaultive Behavior
Peculiar rituals
Anger outburst(s)
Listless, low energy
Sleep/awake change
Criminal activity
SIB causing self-harm
Has dangerous friends
Poor attention to hygiene
Increased irritability
Restlessness or anxiety
Pacing/repetitive
Nightmares
Obsessively organized
Suicidal behavior
Indiscriminate sexual
activity
Reported hallucinations
Intrusive/pressured
Elopement or Wandering
Excessive
neediness/dependent
Crying/tearfulness
Behavioral Symptoms II
Substance Abuse
Isolative, withdrawn
Medication refusal(s)
Low response, flat affect
Changes in food/drink intake
Repeated police/ER contacts
↓ interest in activities
Making false accusations
Property destruction
Work/recreation activity
refusals
Talking about death/dying
Hoarding/stealing/collecting
Possible delusions/paranoia
Labile, rapid change in mood
Dramatic reduction in need for
sleep
Poor phone use (making 911
calls)
Pressured/rapid speech
Disorganized/tangential
speech
Stripping/exposing self in
public
Change in sexual activity
Other -
What Behavioral Symptoms
Can Tell Us
 Behavioral symptoms as side effects of medication.
 Behavioral symptoms associated with various psychotropic




medications.
Behavioral symptoms associated with various psychiatric
diagnoses.
When is it appropriate to treat behavioral symptoms with
psychotropic medication?
Which behavioral symptoms are most likely to respond to
psychotropic medication and which are not?
Why are changes in circumstance important to consider in
making decisions about psychotropic medications?
Team Building
 Accurate psychiatric assessment and treatment of
individuals with developmental disabilities is best done
with a team approach.
 Detailed information sharing improves the quality of care.
 For a number of reasons there are powerful pressures on
the mental health system to pursue efficiencies,
decreasing time resources for adequate assessment and
monitoring of psychiatric services.
 Formalizing ways to share information across systems
may be a helpful structure for collaborations.