Initial Neuropsychiatry Appointment Guide

Practical approach to neuropsychiatry initial appointment (60 minutes interview / examination, 30 minutes staffing). The visit will be largely consisting of clinical interview. As appropriate, additional neurological and cognitive examination may be in order. The core components of the appointment include:

Core questions to obtain during the history:

History of current complaint

1) Description of complaint

2) Duration of symptoms

3) Inciting factors (though the patient may not appreciate the source of symptoms)

4) Current stressors

Psychiatric and medical history

1) Previous diagnoses

2) Previous harm to self or others

3) History of psychotic symptoms

4) History of hospitalizations

5) Prior treatments (medication, psychotherapy)

Social and family history

1) Significant relationships / supports

2) Highest degree of education

3) Occupation

4) Substances (alcohol, recreational substances, caffeine)

5) Family history of psychiatric illness

Core components of mental status examination

1) Appearance and behavior

2) Mood (reported by patient) and affect (how they appear)

3) Thought process (can answer questions linearly vs tangential / circumstantial responses)

4) Psychotic content (report of auditory hallucinations, paranoia, ideas of reference)

5) Thoughts of self-harm or harm towards others

Core components of laboratory or imaging review

1) MRI

- T2 FLAIR axial images to review white matter disease

- Coronal T1 to review hippocampus

- SWI to review for hemosiderin deposits

2) Laboratory

- Vitamin B12, TSH, CBC, BMP

Basic summary of the patient:

1) One-liner and reason for referral

2) Chief complaint and associated symptoms with relevant current stressors

3) Relevant history

4) Mental status relevant findings and objective testing

5) Differential diagnosis

Plan

1) Referral to psychotherapy

2) Pharmacotherapy

3) Lifestyle modifications and reduction of outside stressors