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

• Treatment

1) Referral to psychotherapy

2) Pharmacotherapy

3) Lifestyle modifications and reduction of outside stressors