Psychiatry

I. Overview

A. General Approach

  1. 1. Screening:
    1. a. Surveillance for mental health issues should occur at all well child visits from early childhood through adolescence.
    2. b. The Pediatric Symptom Checklist (PSC) is a general mental health checklist that screens for a broad array of disorders (Table 24.1).1
  2. 2. See the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), for a full list of psychiatric diagnoses.2
  3. 3. Pharmacotherapy for many disorders may be managed or monitored by the pediatrician.3

B. Mental Status Exam

  1. 1. General appearance: Dress, self-care, demeanor, attitude, behavior, developmental milestones
  2. 2. Motor activity: Activity level (restless, fidgety, stereotyped, or ritualized movements)
  3. 3. Speech and language: Fluency, comprehension, rate, rhythm, volume, expressive and receptive skills
  4. 4. Mood and affect: Stated by patient and observed by clinician
  5. 5. Thought form: Goal directed nature of thoughts, coherence, organization
  6. 6. Thought content:
    1. a. What patient is thinking about
    2. b. Mood, suicidal ideation, homicidal ideation, delusions
  7. 7. Abnormal perceptual phenomena: Illusions, hallucinations
  8. 8. Insight, judgment, cognition developmentally appropriate

C. Behavioral Interventions

  1. 1. Brief behavioral interventions can be done based on primary presenting problem or symptoms prior to escalation of care (Table 24.4).

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