This chapter is focused on the needs of the clinician in a service for general adult psychiatry, who has to carry out the initial assessment of the patient and family working either in the context of a multidisciplinary team or independently. Within this quite wide remit, the discussion is limited to general principles that guide the practice of all types of psychiatry. The chapter does not include the special procedures and techniques also needed for assessment of children and adolescents, the elderly, persons with mental retardation, persons with forensic problems, and persons requiring assessment for suitability for special types of psychotherapy.
It is assumed that the reader has already had significant experience of clinical psychiatry and has completed the first stages of a postgraduate psychiatric training programme. Therefore details of the basic methods recommended in commonly used textbooks or manuals of instruction for obtaining and recording information on essentials such as the history, personal development, mental state, and behaviour of the patient are not included in this chapter. (1,2 and3)
Three topics have been given special attention. These are assessment by means of a multidisciplinary team, the trio of concepts diseases, illness, and sickness, and the development of structured interviewing and rating schedules. The first two have a special connection that justifies emphasis in view of the recent increase in multidisciplinary styles of assessment. For instance, when different members of the team appear to be in disagreement about what should be done, it is usually a good idea to ask the question: 'What is being discussed—is it the patient's possible physical disease, the patient's personal experience of symptoms and distress, or the interference of these with social activities?'. It will then often become apparent that the issues in question are legitimate differences in emphasis and priority of interest, rather than disagreements. The third topic is given prominence in order to illustrate some aspects of the background of the large number of such schedules (called 'instruments' for convenience) that are now available. They are usually given the shortest possible mention in research reports, but since most advances in clinical methods and service developments come from studies in which an assessment instrument has been used, clinicians should know something about them.
The aim of the initial clinical assessment is to allow the clinician and team to arrive at a comprehensive plan for treatment and management, that has both short-term and longer-term components. The achievement of this will be discussed under the following headings.
• Concepts underlying the procedures of assessment
• Contextual influences on assessment procedures
• Assessment as a multidisciplinary activity
• Instruments for assessment
• The condensation and recording of information
• Making a prognosis
• Writing reports
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