Further assessments

Most general psychiatry is now done as part of a Community Mental Health Team (CMHT). Mild cases may be seen by just the psychiatrist. More severe or complex cases, or where the nature of the problems is unclear, may also be seen by a CMHT member as well as the psychiatrist. Often, CMHT staff work 'generi-cally', so that the patient may be seen by a community psychiatric nurse, a social worker, or a member of another discipline such as an occupational therapist. By talking to the patient, preferably at home, and interviewing (with the patient's agreement) relatives, friends, neighbours, or workmates, the professional can obtain additional information about the psychiatric history and any other relevant problems, such as those concerning marriage, family, work, and finance.

This is then fed back and discussed at a team meeting, and a plan of management is formulated.

Most CMHTs have a psychologist, or access to one, and the main way in which this resource is used is in various forms of treatment. This usually depends on the psychologists forming an independent assessment of their own, which is very useful as part of the overall formulation of the case, even if the patient is deemed unsuitable for psychotherapy.

Psychometric tests, measuring such parameters as intelligence, memory, perception, behaviour, and personality, may be useful aids to assessment in patients with organic brain damage, or in assessing child or learning-disability patients. However, they are not routinely used in general psychiatry, because the clinical psychologists who used routinely to administer them have now -probably rightly - become more concerned with therapy than with diagnostic assessment.

Psychological tests that quantify the type and severity of impairments, and identify those abilities that still remain intact, are helpful in planning rehabilitation programmes, and also provide a baseline for monitoring long-term progress.

In medico-legal cases, especially those involving head injury, scores on memory testing can be reduced, owing either to genuine reduction in intellectual capability or to poor effort in testing. Effort testing allows assessment of the effort the patient brings to cognitive testing, by examining the pattern of scores on tests of varying degrees of difficulty. Someone making a good effort scores well on tests that are in fact easy (even though they may look hard), and scores lower on more difficult tests (http://www.wordmemorytest.com). Effort testing is important in medico-legal and disability assessments.

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