Introductions

CC

Introductions

How are you doing?

Can you tell us what happened to bring you here?
When you (had these thoughts/took those pills) what was going on? (SI/MDD/ANXIETY)
How long have you been feeling this way?
Do you remember when you first started feeling this way?
Sometimes these feelings are always there and sometimes they come and go.
Which is it for you?

Is there anything that makes these feelings worse/better?

Is this the first time or have you tried before to hurt yourself?
What led to this?
When you took pills whom did you tell?

DId anything stress you out or upset you prior to?

Family Dynamics
Who do you live with?
Anyone else live in the home with you and your (mom/dad/grandmother/foster parent)?
How many siblings do you have?
Any half/siblings?
Where do they live?
Where does your (mom/dad) live?
Do you like living with your (xxxx, xxxx)?
Do you get along with ( xxxx, xxxx in house)?
How old were you when your parents divorced?
Who has custody of you?
Do you get to visit (xxxx)?
How often?
Is DCFS involved with your family?

School
Where do you go to school?
What grade?
Do you like school?
Do you have friends at school?
Do you have friends outside of school?
Do you have any teachers you like and trust?
How are your school grades?
Any issues with school?
Any problems with schoolwork (classwork, homework)?
Any discipline issues at school? (detention/suspension/expulsion)?

Where you ever held back a grade?

Any special classes or extra help ever provided to you at school?
Speech therapy? Tutors?
Ever been bullied at school/online/or at home?

Past History (Psych)

Have you ever been hospitalized before (mental issues)?
Do you currently see a Psychiatrist? Have you ever?
Do you currently see a Therapist/counselor? Have you ever?
Are you still seeing them? How often do you see them? How long have you been seeing them?
How did you leave treatment?
Do you find it helpful to see Psychiatrist/Therapist?

Did they put you on any medications?

Which medications?
• depression
• anxiety
• panic
• ADHD
Do the medications help?
Do you take your medications? Why not?

How is you sleep?

When do you go to sleep?
How long are you able to sleep?
Any issues getting back to sleep?

Have you ever tried to hurt yourself before? Cutting/punching

Have you ever tried to hurt anyone else before?
Have you ever thought about suicide? How often?
Have you ever tried to commit suicide?
Do you have access to guns or weapons?

Have you ever been the victim of abuse?

Physical abuse? (someone hit you)
Sexual Abuse?
Psychological abuse?
Left alone when little (Neglect)?

Was the abuse reported? To police to DCFS? What was the result?

Family History
Have any of you parents, grandparents, aunts, uncles, brother, or sister:
• nervousness
• depression
• alcohol or drug abuse
• suicide attempts
• hospitalizations
• heart issues, heart attacks, death from heart attack

Social History
Are you dating?
Do you identify as female, male, non-gender (sexual identification)?
Does this identification cause you any stress?
Have your family and friends accepted your choice in sexual identification?
Are you attracted to boys, girls, or both (sexual orientation)?

What do you like to do for fun?

Do you still enjoy some things? What?

Do you drink ETOH?

Do you smoke or vape?
Do you use recreational drugs?
Is there substance use at school?
Is there substance use in the home?

Psychiatric ROS
MOOD DISORDERS
Depression (SIGECAPS) MDD – 2 weeks 4/7 + depressed mood or loss pleasure +change PDD – 2
years
“Are you depressed, down, or sad?” most of day, nearly every day?
• Interest deficit (anhedonia)
“Do you have anything that brings you happiness” diminished interest/pleasure in almost all most day
“Any recent weight loss/gain?” 5% in month
• Appetite disorder (increased or decreased)
• Sleep disorder (increased or decreased)
• Guilt (worthlessness, hopelessness, regret)
• Energy deficits (fatigue or loss of energy)
• Concentration deficit (inability to think, concentrate, or make decisions”
• Psychomotor agitation/slowing
“When was last time you remember not being depressed”
• Suicidality (recurrent thoughts of death, SI wo plan, SA, SI w plan)

Mania (DIGFAST) (at least 1 week most day every day; 3 or more; hypo 4 days
“Have you ever had several days when felt so happy energized didn’t need to sleep”
“Ever been told you are talking too fast”
• Distractibility/Impulsivity
• Indiscretion (excess involvement w pleasurable activities, recklessness)
• Grandiosity (conquer the world, special powers, more religious than normal)
• Flight of Ideas (tons of great ideas, racing thoughts)
• Activity increase/excess energy
• Sleep decreased need
• Talkativeness (hard to stop talking, talked very fast)

Depressive

Mixed
• Irritability
• Liability

PSYCHOTIC DISORDERS
“Ever had experiences like dreaming but you were awake?”
“Ever had a strange odd experience you couldn’t explain”
“Do you see or hear things other people can’t?”
“Does anything weird ever happen, like you are being followed or watched?”
“Ever feel like the TV or radio is talking just to you or has hidden messages just for you?”

Schizophrenia (2 or more significant portion time during 1 month period for 6 months) (phreniform 1month
< 6mo)
• Delusions
• Hallucinations
• Speech/Thought disorganization
• Behavior disorganization
• Negative symptoms (diminished emotional expression or avolition)

SUBSTANCE USE DISORDERS

• Tolerance
Need for markedly increased amounts (over this past year) of alcohol to achieve intoxication or desired
effect?

• Withdrawal syndrome
“Ever have cravings or strong desire to use alcohol?”
“Ever have symptoms of alcohol withdrawal?

• Loss of control
“Ever use more than you intend?”
“Ever wish or try to cut down or control or stop?”
Use has resulted in a failure to fulfill major role obligations work or home?
Continued use despite having recurrent interpersonal problems caused or exacerbated by the effects?
Important social, occupational, or recreational activities are given up or reduced because of alcohol use?
Recurrent use in situations in which it is physically hazardous?
Use is continued despite knowledge of having a persistent or recurrent physical or psychological problem
that is likely to have been caused or exacerbated by substance?

ANXIETY DISORDERS
“Do you Worry a lot?”
“Have you always been a worrier or is this something new?”
“When did you worrying start?”
“Ever had a panic attack”
“Uncomfortable in social situations?”
“Any special fears?”

Generalized Anxiety Disorder (excessive worry more days than not for 6months)
• Muscle Tension
• Fatigue
• Concentration problems
• Restlessness, feeling on edge
• Irritability
• Sleep problems

Panic disorder (Recurent panic attacks 4 symptoms followed by 1 or more months worry about more
attacks or maladaptive change to avoid)

“How long until peak”

• Palpitations, Chest pain, Nausea
• SOB, Choking sensation, Dizziness, Paresthesia, Chills/Hot Flashes
• Fear of dying, Fear of going crazy, Shaking, Sweating
• Derealization or depersonalization

Agoraphobia
• fear of being in a place where you cannot get away or escape
• avoiding such Places

Social Anxiety

Specific Phobia

Obsessive-Compulsive
• obsessions
• compulsions
• irrational beliefs
Posttraumatic Stress (RANA)
• Reexperiencing trauma: flashbacks, or nightmares
• Avoidance of stimuli associated w trauma
• Negative alterations in cognitions and mood
• Alertness increased: insomnia, irritability,
hypervigilance, startle response, reckless behavior,
poor concentration

EATING DISORDERS
Bulimia Nervosa
• binging
• out-of-control when eating
• concern with body image
• purging
Anorexia Nervosa
• weight significantly low
• fear of being fat
• body image distortion
• excessive exercise

ATTENTION DEFICIT HYPERACTIVE DISORDER (MOAT)

“Do you have problems focusing or paying attention?”
“Do you daydream? when worried or stressed?”
“Do you have problems listening?”
“Are you frequently forgetful?”
“Do you have difficulty sitting still or waiting your turn to talk?”
“Do you tend to interrupt people when talking?”
“Do you have difficulty waiting in lines?”
• Movement excess (hyperactive)
• Organization problems
• Attention problems
• Talking impulsively

BEHAVIOR DISORDER
Oppositional Defiant Disorder
Talk back to parents, teachers, other adults?
Do you push people’s buttons?
Do you hold a grudge?
When you get into trouble is it ever your fault?

Conduct Disorder
Every run away from home or school?
Ever get into fights at school?
Ever steal?
Ever set things on fire?
Ever get arrested?

Mood Depression: Patient endorses depression or sadness

Mood Depression: Patient denies low self-esteem
Mood Depression: Patient denies decreased need for sleep
Mood Depression: Patient endorses poor quality sleep
Mood Depression: Patient denies fluctuating changes in appetite
Mood Depression: Patient endorses low energy
Mood Depression: patient endorses difficulty concentrating
Mood Depression: patient denies psychomotor agitation or slowing
Mood Depression: patient denies suicidal ideation or homicidal ideation
Mood Mania: Patient endorses impulsivity
Mood Mania: Patient denies grandiosity
Mood Mania: Patient denies recklessness
Mood Mania: Patient denies excessive energy
Mood Mania: Patient denies decreased need for sleep
Mood Mania: Patient denies spending beyond means
Mood Mania: Patient denies talkativeness
Mood Mania: Patient denies racing thoughts
Mood Mania: hypersexuality did not assess
Anxiety Generalized: Patient denies excessive anxiety and worry.
Anxiety Generalized: Patient denies difficulty controlling worry.
Anxiety Generalized: Patient endorses anxiety and worry are associated with fatigue, irritability, muscle
tension, sleep disturbances
Anxiety Generalized: Patient endorses anxiety and worry cause significant distress
Anxiety Panic: Patient denies panic or panic attacks
Anxiety Obsessive-compulsive: Patient denies compulsive behaviors
Anxiety Obsessive-compulsive: Parents denies obsessive thinking
Anxiety Obsessive-compulsive: Patient denies irrational beliefs
Anxiety Post Traumatic stress: did not assess
Anxiety Social: did not assess
Anxiety Simple Phobias: did not assess
Psychosis: Patient denies visual/auditory hallucinations
Psychosis: Patient denies paranoia
Psychosis: Patient denies delusions
Psychosis: Patient denies bizarre perceptions
ADHD: Patient denies having more energy
ADHD: Patient endorses difficulty concentrating
Eating Disorders: Patient endorses fluctuating appetite
Eating Disorders: Patient denies weight loss
Sleep Disorders: Patient denies increased need for sleep
Sleep Disorders: Patient denies fatigue
Sleep Disorders: Patient denies insomnia
Sleep Disorders: Patient denies difficulty falling asleep
Sleep Disorders: Patient endorses poor quality sleep
Alcohol Use Disorder: Patient endorses taking in larger amount of alcohol than she intends
Alcohol Use Disorder: Patient denies desire or attempts to cut down or control alcohol use
Alcohol Use Disorder: Patient denies cravings or strong desire to use alcohol
Alcohol Use Disorder: Patient endorses use has resulted in a failure to fulfill major role obligations work or
home
Alcohol Use Disorder: Patient endorses continued use despite having recurrent interpersonal problems caused
or exacerbated by the effects of alcohol.
Alcohol Use Disorder: Patient denies Important social, occupational, or recreational activities are given up or
reduced because of alcohol use.
Alcohol Use Disorder: Patient denies Recurrent alcohol use in situations in which it is physically hazardous.
Alcohol Use Disorder: Patient denies Alcohol use is continued despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Alcohol Use Disorder: Patient endorses a need for markedly increased amounts (over this past year) of alcohol to
achieve intoxication or desired effect.
Alcohol Use Disorder: Patient denies symptoms of alcohol withdrawal

Past History (Medical)

Do you any medical illnesses?
Do you take medications for them?
Do you have a primary care provider?
Do you have any allergies, reactions, or side effects from any medications?
Have you had any surgeries?

Any recent fever, cough, sore throat?

Any cardiac issues?
Any other medical issues?

Mental Status Exam:

Mood: "good"
Affect: quality [dysphoric/happy/euthymic/irritable/angry/agitated/tearful/sobbing/flat/ blunted], quantity
(intensity), range [flat/blunted/restricted/normal/labile], appropriateness, congruence [Mood-
congruent/incongruent]
Appearance: [calm/distressed, hygiene, grooming, dressed]
Sensorium/Level of awareness: [awake, alert]
Orientation: [person, place, time, situation]
Behavior: [calm/agitated/anxious, cooperative/resistant, engaged/disinterested/attentive,
appropriate/disinhibited, eye contact]
Psychomotor Activity: [normal/slowed (bradykinesia)/hyper(hyperkinesia), gait, posture, pacing,
restlessness, tics, akathisia (severe restlessness)
Speech/Language: fluency, amount, rate (slow/norm/pressured), tone, volume
Thought Process/Form of thought: [linear organized goal directed/flight of ideas(racing)/thought blocking/
circumstantial/tangential/loose thoughts]
Thought Content/Perceptions: [perseveration/rumination, poverty of content, obsessional thoughts,
compulsions, delusions (bizarre/non-bizarre, grandiose, erotomanic, jealous, somatic,
persecutory), paranoia, suicidality, homicidality]
Perceptual Disturbances: [hallucinations/illusions/depersonalization/derealization]

COGNITION:
Attention/Concentration: (alphabet backwards, 100 back by 7) attended well to all questions.
Memory 3 object/recent/remote: (orientation, 3-object recall, remote personal events, recall general
culture)
Calculations: (cost $3.75 pay $5 what is change; 3x3)
Fund of Knowledge: (Capital of Louisiana, US, name 3 oceans)
Abstract reasoning: (“Grass is greener”, “Don’t rock the boat”, Which does not belong: scissors, dog,
spider? How are apple and orange alike?)
Best estimate of intelligence: [average, below average, above average, high, low]
Insight: (into how they are feeling and functioning, potential causes of psych presentation)
Judgment: “If you found stamped and addressed envelope lying in street, what would you do?”
Impulse Control:
Reliability:
3 wishes:

Conclusion
Do you think you might try and hurt yourself while you are here?
Any questions for us?
Average stay is one week, plus or minus. Sometimes more sometimes less.
Everyone is different.
Participation is really the key to progress in this program.

I want to thank you for coming in and trusting us to help you.

We hope we can help you. We will do our best. We ask that you help us to help you.

Screening Tools
Alcohol Use Disorder
• Alcohol Use Disorder Identification Test (AUDIT) – (World Health Organization[WHO], 2001).
• Cut-Annoyed-Guilty-Eye (CAGE)
• CRAFFT Screening Tool (adolescents under 21)
• Tolerance-Worried-Eye opener-Amnesia-Kut down (TWEAK)

Alcohol Use Disorder Identification Test (AUDIT) – (WHO, 2001):

Scores across three domains (hazardous use, dependence symptoms, and harmful use) five-point (0 1 2 3 4)
answer scale for the first eight questions and a three-point scale (0 2 4) for the last two. Each question is scored
from 0 to 4 corresponding to the patient’s response, then all question scores are totaled. Total scores of 8 or
higher are considered clinically significant indicating hazardous and harmful alcohol use, as well as possible
alcohol dependence. Cut-off point should be influenced by national and cultural standards and by clinician
judgment. The maximum score possible is 40 and the lowest score possible is 0.

Depression
• Patient Health Questionnaire (PHQ-9) – (Siu & USPSTF, 2016).
• Beck Depression Inventory (BDI)
• Center for Epidemiologic Studies Depression Scale (CES-D)
• Hamilton Depression Rating Scale (HAM-D)

Patient Health Questionnaire (PHQ-9) – (Siu & USPSTF, 2016).

Scores across four domains (mood, self, psychomotor, suicide) four-point (0 1 2 3) answer scale for all
questions. Scores (0-4) suggests the patient may not need depression treatment. Scores (5-9) suggest mild
depression and scores (10-14) suggest moderate depression. Physician uses clinical judgment about treatment,
based on patient's duration of symptoms and functional impairment. Scores (15-19) suggest moderately severe
depression and scores (20-27) suggest severe depression. Physician uses clinical judgment about treatment,
based on patient's duration of symptoms and functional impairment either of which warrant treatment for
depression, using antidepressant, psychotherapy and/or a combination of treatment.

Anxiety
• Generalized Anxiety Disorder 7-item scale (GAD-7) – (Spitzer et al., 2006)
• Generalized Anxiety Disorder full scale (GAD)
• Generalized Anxiety Disorder QUESTIONNAIRE-IV (GADQ-IV)
• Overall Anxiety Severity and Impairment Scale (OASIS)
• Patient Health Questionnaire 4 (PHQ-4)

Generalized Anxiety Disorder 7-item scale (GAD-7) – (Spitzer et al., 2006).

Scores across one domains (anxious/worry/stress/restless/irritable/fear) four-point (0 1 2 3) answer scale for all
questions. Cut points of 5, 10, and 15 might be interpreted as representing mild, moderate, and severe levels of
anxiety on the GAD-7. A score of 10 or greater represents a reasonable cut point for identifying cases
of Generalized Anxiety Disorder.
Schizophrenia

• Clinical Global Impression Schizophrenia (CGI-SCH)

• Clinical Assessment Interview for Negative Symptoms (CAINS)
• Brief Negative Symptom Scale (BNSS)
• Positive and Negative Symptoms Scale (PANSS)
• Scale for the Assessment of Positive Symptoms (SAPS)
• Scale for the Assessment of Negative Symptoms (SANS)