ABSTRACT
A comprehensive psychiatric evaluation is essential because many psychiatric symptoms are nonspecific. This situation is analogous to a patient presenting in general internal medicine with fever or nausea. The presence of a single symptom, for example, depressed mood, is never pathognomonic of a specific disorder. All psychiatric disorders are based on a set of inclusion and exclusion criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is periodically updated by the American Psychiatric Association. The fourth edition (DSM-IV) is currently in use. It was published in 1994 and is expected to be revised in 2006 or 2007. For patients with psychiatric symptoms, the biopsychosocial model is widely used. With this approach, the biologic, psychologic, and social factors contributing to the patient’s clinical presentation are evaluated. Some psychiatric symptoms indicate severe problems, whereas others are much less important to the extent that they may not be clinically relevant. A key concept is whether the symptom interferes with a patient’s functioning or causes distress. For example, a patient may have a fear of heights. If this acrophobia never causes an alteration in activity, then intervention likely is not necessary. However, if a patient hesitates to visit offices on higher floors of an office building, the distress during the visits or avoidance of these situations warrants intervention.
