Assessment

In complex cases a period of inpatient observation or explorative treatment may be necessary. As full a history as possible of the current illness should be obtained from the patient together with corroborative histories from the relatives and carers. The standardized format of psychiatric history should be supplemented by a detailed developmental history, a description of current social functioning, environmental circumstances, level of mental retardation, associated somatic disorders and physical disabilities, and the aetiology of the mental retardation. Enquiries should be focused on behavioural changes such as sleep disturbance, loss of appetite, weight loss, lack of interest, bizarre behaviour, restlessness, anxiety, withdrawal, and any other deviations from customary behaviour. Precipitating factors such as stressful events and possible predispositions to reacting in a particular way in a particular situation should be explored. Full details of previous psychiatric illnesses suffered by the patient and the family history of mental illness should be obtained. Because of the general paucity of subjective complaints by the mentally retarded, the examiner must rely more on objective data regarding the patient's appearance, manner of communication, facial expression, evidence of hallucinations, posture, etc. If called for, direct observations should be made in as wide a range of settings as is necessary. To these ends, a video recording of the patient in his or her natural surroundings may provide important information about the interactional pattern of the patient and his or her surroundings. The psychiatric examination is usually supplemented by somatic, neurological, neurophysiological, biochemical, and psychological examinations.

How To Win Your War Against Anxiety Disorders

How To Win Your War Against Anxiety Disorders

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