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Psychiatric Diagnostic Evaluation

Evaluations & Screenings

The term “evaluation” can mean different things to different people. Terminology used for different types of evaluations can vary, and the names of specific tests are very diverse. Sometimes, it’s a question of semantics— certain test batteries are called one thing in one area of the country, and something else in another. With that caveat, here are a few generalities about the types of evaluations that are completed by psychologists:

01 Exposure Therapy

In this type of treatment, you are gradually and progressively exposed to what you fear. You might start by just thinking about your phobia trigger and then move slowly toward looking at images of the object and finally being near the object in real life.

Types of exposure-based treatments that may be used include:

  • In vivo exposure: This involves being exposed to the source of your fear in real life.

  • Virtual exposure: This involves the use of virtual reality to practice gradual exposure.

  • Systematic desensitization: This involves being gradually exposed until you become desensitized to the source of your fear.

During this process, you'll also practice relaxation techniques to help calm your body when your fear response kicks in.

02 Cognitive Behavioral Therapy

Often referred to as CBT, cognitive behavioral therapy involves learning to identify the underlying negative thoughts that contribute to feelings of fear. Once you become better at noticing these thoughts, you can then work on replacing them with more positive, helpful thoughts.

03 Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) therapy utilizes rhythmic eye movements to help people process and recover from traumatic experiences. It is frequently used in the treatment of post-traumatic stress disorder (PTSD), but can also be effective in the treatment of a variety of other mental health conditions including phobias.

04 Life Transitions Effects on Mental Health

While “life transitions” is not a clinical diagnosis itself, troubles adjusting to the transitions and changes can lead to diagnosable mental health conditions, including:

Adjustment disorders might be diagnosed in someone who becomes more distressed by a change than they might have expected, especially if this stress gets in the way of their relationships, jobs, or schoolwork for months after the transition has resolved.

05 Life Transitions: Examples of Scenarios That May Affect Mental Health

Both children and adults may be diagnosed with a mental health disorder after transitions such as:

  • Family crisis
  • Illness
  • The birth of a child
  • Financial problems
  • Job loss

06 Indications of Trouble Adjusting To A Life Transition

Difficulties adjusting to a life transition may cause symptoms similar to those during other stressful experiences.

These may include:

  • Insomnia

  • Low energy
  • Low moods
  • Headaches
  • Upset stomach
  • Frequent colds and infections
  • Significant decrease of sex drive
  • Either loss of appetite, or increased appetite
  • Feeling generally overwhelmed
  • More anxiety than usual
  • Tendency to socially isolate one’s self
  • Irritability

07 Generalized Anxiety Disorder

People who suffer from GAD experience chronic, sustained worries that interrupt their daily lives. Professionals diagnose people with GAD when they display these symptoms for about six months and have anxiety more days than not during that time.

The six-month timeline exists to ensure that people do not receive anxiety diagnoses when they experience acute problems. While trained professionals can effectively help people who have short-term anxiety disorders, they do not diagnose these patients with GAD.

08 Obsessive-Compulsive Disorder (OCD)

OCD is a type of anxiety disorder which causes people to obsess over what others would hardly give second thoughts. This obsession can create extreme fear of germs, repeating tasks that others find mundane, and ticks that impact daily life.

09 Agoraphobia

Agoraphobia is a fear of being in situations in which someone may feel cornered or powerless. It is not the anxiety that occurs while in helpless situations, but rather the fear that one could lose control within a location.

Patients with agoraphobia experience such intense fears of certain situations that they may avoid them altogether. Avoiding triggers interrupts everyday life. However, confronting these situations may cause panic attacks.

10 Panic Attacks

A panic attack is an acute event in which a person feels an intense feeling of dread and an array of physical symptoms like sweating, high pulse, and trouble breathing. While panic attacks can be symptoms of GAD, they can also happen to people with no underlying anxiety disorder.

11 Omega-3

Polyunsaturated fats (in particular omega-3 fatty acids) have a vital role in maintaining proper neuronal structure and function, as well as in modulating critical aspects of the inflammatory pathway in the body. Taking omega-3 supplements appears beneficial for addressing symptoms of depression, bipolar depression and post-traumatic stress disorder. And it may potentially help prevent psychosis.

Omega-3 fats can be found in nuts, seeds and oysters, although the highest amounts exist in oily fish such as sardines, salmon (especially King salmon), anchovies and mackerel. Due to higher levels of mercury, larger fish, such as mackerel, should be consumed in moderation.

12 B vitamins and folate

We need B vitamins for a range of cellular and metabolic processes, and they have a critical role in the production of a range of brain chemicals. Folate (B9) deficiency has been reported in depressed populations and among people who respond poorly to antidepressants.

Several studies have assessed the antidepressant effect of folic acid (the synthetic form of folate) with antidepressant medication. Some show positive results in enhancing either antidepressant response rates or the onset of response to these medications.

Folate is found in abundance in leafy green vegetables, legumes, whole grains, brewer’s yeast and nuts. Unprocessed meats, eggs, cheese, dairy, whole grains and nuts are, in general, richest in B vitamins. If you’re going to take supplements, it’s advisable to take B vitamins together as they have a synergistic effect.

13 Amino Acids

Amino acids are the building blocks for creating proteins, from which brain circuitry and brain chemicals are formed. Some amino acids are precursors of mood-modulating chemicals; tryptophan, for instance, is needed to create serotonin. Another example is cysteine, a sulphur-based amino acid that can convert into glutathione – the body’s most powerful antioxidant.

When given as a supplement, an amino acid form known as N-acetyl cysteine (NAC) converts into glutathione in the body. We have evidence that it’s helpful in bipolar depression, schizophrenia, trichotillomania and other compulsive and addictive behaviours. Another amino acid-based nutrient known as S-adenosyl methionine (SAMe) has antidepressant qualities.

Amino acids are found in any source of protein, most notably meats, seafood, eggs, nuts and legumes.

14 Minerals

Minerals, especially zinc, magnesium and iron, have important roles in neurological function.

Zinc is an abundant trace element, being involved in many brain chemistry reactions. It’s also a key element supporting proper immune function. Deficiency has been linked to increased depressive symptoms and there’s emerging evidence for zinc supplementation in improving depressed mood, primarily alongside antidepressants.

Magnesium is also involved in many brain chemistry reactions and deficiency has been linked to depressive and anxiety symptoms. Iron is involved in many neurological activities and deficiency is associated with anxiety and depressive symptoms as well as developmental problems. This is, in part, due to its role in transporting oxygen to the brain.

Zinc is abundant in lean meats, oysters, whole grains, pumpkin seeds and nuts, while magnesium is richest in nuts, legumes, whole grains, leafy greens and soy. Iron occurs in higher amounts in unprocessed meats and organ meats, such as liver, and in modest amounts in grains, nuts and leafy greens, such as spinach.

15 Vitamin D

Vitamin D is a fat-soluble compound that’s important as much for brain development as it is for bone development. Data suggests low maternal levels of vitamin D are implicated in schizophrenia risk, and deficiency is linked to increased depressive symptoms. But there’s little evidence to support the use of vitamin D supplements for preventing depression.

Vitamin D can be synthesized via sunlight. Dawn Ellner/Flickr, CC BY

Vitamin D can be synthesized via sunlight: 15 minutes a day on the skin between 10am and 3pm during summer, although be sure to seek professional health advice regarding skin cancer concerns. Aside from sunlight, vitamin D can also be found in oily fish, UVB-exposed mushrooms and fortified milk.

16 Plant-based Antioxidants

An increase in oxidative stress and damage to brain cells has been implicated in a range of mental disorders, including depression and dementia. Antioxidant compounds (such as “polyphenols”, which are found in fruits and certain herbs) may “mop up” free radicals that damage cells to provide a natural way to combat excessive oxidation.

Consuming natural antioxidant compounds through your diet is better than taking supplements of high doses of synthetic vitamin A, C or E, as the oxidative system is finely tuned and excess may actually be harmful.

Fruits and vegetables contain these antioxidant compounds in relative abundance, especially blackberries, blueberries, raspberries and goji berries; grapes; mangoes and mangosteen; onions; garlic; kale; as well as green and black tea; various herbal teas; and coffee.

17 Microbiotics

Research shows a connection between the bacteria in our guts and brain health, which may affect mental health. When the composition of the gut microbiota is less than optimal, it can result in inflammatory responses that may negatively affect the nervous system and brain function.

A balanced microfloral environment is supported by a diet rich in the foods that nourish beneficial bacteria and reduce harmful microbial species, such as Helicobacter pylori. Beneficial microflora can be supported by eating fermented foods such as tempeh, sauerkraut, kefir and yogurt, and also by pectin-rich foods such as fruit skin.

18 Developmental Evaluation

A test battery such as the Bayley Scales of Infant Development, administered before age 4, that gives information about a young child’s level of development in language skills, motor skills, cognitive skills, and social skills.

19 Neuropsychological Evaluation

A test battery – or series of several different tests – designed to measure a child’s cognitive skills and brain functioning in areas such as intelligence, attention, memory, learning, and visual perceptual. Tests typically given include an intelligence measure, such as the WISC-V; achievement/academic tests, such as the WIAT-III or Woodcock-Johnson to look for learning disabilities; language tests, such as the Boston Naming Test or PPVT-4; visual-motor tests, such as the VMI or Rey-Osterrieth Complex Figure Test; memory and executive function tests, such as the NEPSY-II, D-KEFS, or WRAML2; and finally, neuro-motor tests, such as Finger-Tapping or Grooved Pegboard. This kind of test battery is typically performed by a psychologist affiliated with a medical center or private practice.

20 Psychological Evaluation

A test battery for assessing a child’s emotional, social, and behavioral functioning and personality traits. Tests often include the Rorschach, Thematic Apperception Test (TAT), drawings, sentence-completion tests, self-reported measures such as the Children’s Depression Inventory, and parent-completed measures such as the Child Behavior Checklist or Behavior Assessment System for Children (BASC2). There is also the Minnesota Multiphasic Personality Inventory (MMPI) which is used for adolescents.

21 Speech and Language Testing

This evaluation assesses a child’s ability to speak clearly, understand language, and express him or herself with language. Social communication skills called “pragmatics,” which include eye contact, initiating social contact, turn-taking in conversation, and gestures, can also be assessed during a speech and language evaluation.

22 Educational/Achievement Evaluation

A test battery for measuring a child’s academic skills in decoding, reading comprehension, spelling, math, and writing. An intelligence measure should also be given to compare the child’s potential (intelligence level) with his or her achievement scores. Common tests used include the WIAT-III and Woodcock-Johnson.

23 Occupational Therapy Testing

An occupational therapist observes and evaluates a child’s fine and gross motor skills, visual-spatial and visual-motor skills, sensory processing and integration skills, and general self-help skills.

24 Physical Therapy Testing

This evaluation is usually necessary for assessing a child’s balance, gross-motor coordination, muscle strength, and movement.

25 Home Assessments

An assessment of pertinent family history and home situation factors, including parental divorce, living arrangements, etc., is often done as part of the school district’s evaluation. Home visits are sometimes made by a special education team member, and the child’s complete developmental history is taken through parent interviews. Estimates of adaptive behavior at home, school, and in the community are also made using interviews and certain measures such as the Vineland Adaptive Behavior Scale.

26 Vision/Hearing/General Health Assessments

Though most pediatricians will perform these evaluations, the school system is available to perform visual screenings, hearing tests, and physicals for children.

27 Psychiatric Evaluations

A psychiatric assessment is a mental health evaluation typically performed by a psychiatrist to gather information about a child’s symptoms, the purpose being to determine whether a diagnosis is appropriate. The psychiatrist will obtain detailed information about a child’s history, family history, development, medical history, social history, and, depending on the age of the child, history about behaviors such as substance use.

28 Neurofeedback Reduces Symptoms of Anxiety

Anxiety is a prevalent psychiatric disorders that affects children and adults all over the globe. People with anxiety disorders can experience chronic worrying, fearfulness, trouble relaxing, restlessness or feeling on edge, and irritability. When anxiety is severe, it can affect a person’s ability to manage their daily activities and relationships.

Anxiety and restlessness can lead to fatigue and trouble maintaining focus or concentration. Soon, day-to-day tasks feel like burdens. Worrying makes it more difficult to sleep.

Anxiety and stress can lead to health problems. Most specifically, uncontrolled stress or anxiety can affect adrenaline and cortisol production, reduce the production of growth hormones, and lead to abnormal activation of the immune system and inflammatory responses in the body.

Neurofeedback is a non-intrusive way to reduce symptoms of anxiety disorders and improve daily functioning.

Living with anxiety can be overwhelming—but it doesn’t need to stay this way.

The main advantage of neurofeedback therapy is that it can help your brain learn to calm itself, making it easier for you to use the coping strategies you already have – or to develop new ones. Neurofeedback is a great tool to use in combination with psychotherapy.

One study (1) monitored people with anxiety who received 30 sessions of EEG neurofeedback. After treatment, measures of anxiety decreased significantly. Furthermore, a year after the treatment, the patients were still feeling better and had maintained the improvements in their mood from treatment.

29 Neurofeedback Can Reduces Depressive Episodes

Feeling down or experiencing sadness is a normal part of life. But when sadness sticks around and makes it more difficult to get out of bed; or when none of your previous activities sound fun or exciting anymore, or if you start to feel hopeless about feeling better (or even have thoughts of suicide), this is a sign sadness has turned into depression. Usually, such episodes are temporary and manageable. But, not everybody recovers without some help.

People diagnosed with depression have a tougher time getting things done, integrating into social groups, and adapting to new circumstances.

Depression is a common mental disorder that affects people of all ages. 20% of the world’s population deals with depressive episodes during their lifetime. Also, 30% of people diagnosed with depression do not benefit from antidepressant medication or psychotherapy alone. Neurofeedback can be helpful in improving the mental health for those who have not responded to antidepressants or therapy.

Neurofeedback is a non-invasive procedure that can improve executive function and reduce the symptoms of depression. Moreover, side effects are limited. It can be a beneficial practice for patients with treatment-resistant depression.

30 Neurofeedback Improves Attention and Focus

The importance of neurofeedback stems from its ability to train the mind to help itself. With learning disabilities or problems with focus and concentration such as with attention deficit disorder, neurofeedback treatment is able to specifically help areas of the brain so that it is easier to focus, leading to enhanced learning and performance in school and work.

Signs of ADHD

  • Being easily distracted.

  • Forgetfulness, losing items.

  • Procrastinating tasks that require a lot of thinking or cognitive effort.

  • Having trouble finishing tasks.

  • Difficulty with organization.

ADHD can be caused by too much slow or fast-wave activity in the brain. Neurofeedback treatment can help reduce symptoms by changing the way the brain communicates and optimizing the activity that occurs in specific brain regions – and it is effective without medication (and medication side effects). In one article, researchers show the efficacy of neurofeedback for ADHD to be a Level 5, which is considered to be efficacious and specific. This was done by evaluating research where neurofeedback was used in treating ADHD.

31 Neurofeedback Provides Emotional Stability

People often experience sudden mood changes that affect their professional and personal life. Many situations in a person’s life can be stressful, especially in a professional environment. In these cases, getting overemotional can lead to low performance. When a person feels stuck in difficult circumstances or is stuck with negative thoughts and feelings it can be difficult to attempt or perform routine tasks.

Moreover, uncontrollable emotions can lead to challenges in our most important relationships. Sometimes, it’s the people closest to us that suffer when we struggle with emotional control.

Neurofeedback helps the brain learn to regulate itself in a healthier way so emotional control doesn’t have to be so hard, even when you are experiencing difficult experiences. Moreover, it changes the brain’s pattern of becoming stuck on negative thoughts (rumination) and helps with better mood regulation. In short, neurofeedback sessions can substantially contribute to improved brain health.

32 Neurofeedback Helps Treat PTSD Symptoms

Post-Traumatic Stress Disorder also called posttraumatic stress disorder a psychiatric condition caused by experiencing (or observing) a serious threat or traumatic event. As a result, our body’s natural (or adaptive) way to manage stress – our fight, flight, and freeze response – can become stuck. When this happens, the resulting traumatic memories may cause us to struggle to manage our thoughts and feelings, we may feel chronically hyper-alert, and we may have a hard time feeling safe and secure.

Neurofeedback uses QEEG and brain mapping to identify the areas of a patient’s brainwaves that require training to reduce PTSD symptoms.

A study conducted on patients with PTSD showed that neurofeedback reduced abandonment issues, identity impairment, and also revealed improvement in brain function and affect regulation.

Advantages of using neurofeedback for PTSD:

  • Better sleep patterns

  • Decrease in stress

  • Good coping mechanisms in day-to-day situations

  • Mood improvement

  • Less hypervigilance

  • Fewer fear responses

  • Fewer triggers
  • Less mood swings

33 Anxiety

Anxiety is normal. It is a natural reaction to a stressful event. However, sometimes the feelings of stress we associate with anxiety don’t go away and can even worsen over time. This anxiety can be experienced through stress but also through nightmares, racing pulse, and excessive worry or fear.

34 Depression

Depression is defined by consistent feelings of sadness/despair and or depressed mood. This mental health concern can go on to affect numerous aspects of everyday life and grow in severity if left untreated. The most common symptoms of depression are sensations of hopelessness, angry outbursts and irritability, issues with sleep and appetite, and social disengagement.

35 Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition triggered by a traumatic event. Whether the event is witnessed or experienced, people who have PTSD can experience various symptoms:

  • Intrusive or recurrent thoughts

  • Unwanted memories

  • Bad dreams

  • Flashbacks

36 Substance Abuse

Substance abuse is a common reaction to traumatic experiences as using these substances provides a momentary sense of relief from feelings of pain or anguish. However, substance abuse is typically a sign of greater or more serious issues.

37 Suicidal Ideation

Suicidal ideations can be attributed to several influencing factors. This includes the mental health conditions described above. Leaving these conditions untreated can lead to them increasing in severity, thereby increasing the risk of suicidal ideations. If you or someone you know is a veteran experiencing any of the issues listed above, there are services available that can help.