Assignment Prompt & Instructions
– 2 years ago
**files (2)**
– ## DiagnosticEvaluationDraftReport.docx
– ## DiagnosticTemplate.docx
**## DiagnosticEvaluationDraftReport.docx**
Diagnostic Evaluation Draft Report
NOTE! If you do a great job on this draft and would like to make no changes and keep the same grade for your final report, that's fine with me. If you earn 100, I'll do that for you automatically. If you don't submit a final diagnostic evaluation, I'll use the score from your draft as your final evaluation score. It would help if you add the comment "please use my midterm evaluation grade for my final evaluation grade" just so we're clear.
[Diagnostic Evaluation Draft Report Template – you must use this document](https://uncfsu.instructure.com/courses/43251/files/8352708?wrap=1) [Download Diagnostic Evaluation Draft Report Template – you must use this document](https://uncfsu.instructure.com/courses/43251/files/8352708/download?download_frd=1)
_Diagnostic Evaluation Draft Report_: You will create a diagnostic evaluation draft report using the template above. Please assess and diagnose
**a fictional character from a well-known movie, book, or television program that has a diagnosis covered in the class**. IMAGINE THAT THE CHARACTER HAS LEFT THE MOVIE/BOOK/SHOW AND WALKED INTO YOUR THERAPY OFFICE. How would that character respond to your questions?
_Submission Guidelines_: Reports must be submitted through Canvas. Plagiarism or other forms of academic dishonesty will not be tolerated and will result in at least an automatic “F” for the assignment (also see FSU regulations).
Please include the following statement on every assignment: "I hereby declare that I have not utilized any generative artificial intelligence (AI) tools or technologies in the creation of this work."
**Diagnostic Evaluation Guidelines**
· Please use the provided report template.
· Please address all of the components for each section.
· If the book, movie, or TV show does not provide you with much information about your character, it may be wise to select a character from another source that provides more detail.
· It is also permissible to take some creative license and fill in the blanks with made-up information if you feel it will bring your character to life.
· For this reason, I ask that you only choose fictional (not real) characters. Please do not choose a book/show/movie that portrays the life of a real person, alive or deceased.
· While it is helpful to report some information about the client’s family and friends, please avoid the mistake of over-analyzing a family member. Keep the focus on the client.
· I DO NOT need a plot summary. Only share what is relevant to the client’s diagnosis and DO NOT start detailing what happened in the movie. I should feel like I am reading about a real person that you met, not about a movie or show.
· Please follow APA format where necessary. Cite sources. Provide a references page which includes the full citation for the move/book/show.
Need help finding a movie? Here are some resources…
[https://www.bustle.com/p/25-movies-about-mental-health-to-watch-this-month-58200Links to an external site.](https://www.bustle.com/p/25-movies-about-mental-health-to-watch-this-month-58200)
[https://en.wikipedia.org/wiki/List_of_mental_disorders_in_filmLinks to an external site.](https://en.wikipedia.org/wiki/List_of_mental_disorders_in_film)
**## DiagnosticTemplate.docx**
**Diagnostic Evaluation Template**
Demographic Information:
_Age:_
_Sex:_
_Race/Ethnicity:_
_Culture:_
_Religion:_
_Marital/Relationship status:_
_Any other pertinent information:_
#### Current Mental Status: USE A MOOD DISORDER SUCH AS BIPOLAR
#### Choose the most appropriate answers from the following options. If you do not know what a word means, please look it up in a dictionary or in the textbook.
| | |
| — | — |
| _Orientation:_ | (X3: Oriented to Person, Place, and Time) |
| _General Appearance:_ | (Appropriate/Disheveled/Emaciated/Poor Hygiene) |
| _Dress:_ | (Appropriate/Eccentric/Seductive/Bizarre) |
| _Motor Activity:_ | (Unremarkable/Agitated/Retardation/Repetitive Actions/Tics/Tremor/Unusual Gait) |
| _Interview Behavior:_ | (Appropriate/Aggressive/Angry/Apathetic/Argumentative/Childlike/Demanding/Evasive/Hostile/Irritable/Passive/Manipulative/Withdrawn/Uncooperative) |
| _Speech:_ | (Normal/Hesitant/Slurred/Soft/Stuttering/Mute/Verbose) |
| _Mood:_ | (Euthymic/Dysphoric/Depressed/Euphoric/Grandiose/Anxious/Labile/Irritable/Angry) |
| _Affect:_ | (Appropriate/Inappropriate/Reactive/Constricted/Blunted/<br>Flat/Congruent/Incongruent) |
| _Insight:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Judgment/Impulse Control:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Memory:_ | (Intact/Poor Remote/Poor Recent) |
| _Attention/Concentration:_ | (Good/Distractible/Variable) |
| _Thought Process:_ | (Unremarkable/Blocking/Circumstantial/Flight of Ideas/Loose Associations/Perseveration/Tangential) |
| _Thought Content:_ | (Appropriate/Preoccupied/Obsessions/Delusions: Persecutory/Delusions: Bizarre/Delusions: Grandeur/ Delusions: Guilt/Delusions: Somatic/Delusions: Ideas of Reference/Delusions: Thought Broadcasting/Delusions: Thought Control) |
| _Perception:_ | (Unremarkable/Auditory Hallucinations/Visual Hallucinations/Olfactory Hallucinations/Tactile Hallucinations/Gustatory Hallucinations) |
| _Functional Status:_ | (Intact/Mildly Impaired/Moderately Impaired/Severely Impaired/Variably Impaired) |
Current Problems/Presenting Problems:
_Provide a thorough account of the reason client came to see you and/or was brought to you by friends/family; detail will help here (but do not do a plot summary):_
Problematic symptoms:
_First, list each symptom (HINT- they should be consistent with your diagnosis):_
Then, please note the…
_Frequency of symptoms (how often they occur?):_
_Duration of symptoms (how long have they been present):_
_Severity of symptoms (how serious they are):_
_Symptom triggers (events or situations that trigger the symptoms):_
Social and Occupational History:
Information on family of origin including ethnic/cultural information
_Where did the patient grow up?_
_Who did the patient live with as a child?_
_Were parents/caregivers married/separated/estranged?_
_Does patient have siblings?_
_Does patient have strong ties with Grandparents?_
_Additional Information:_
General information on childhood
_Traumatic events:_
_History of abuse:_
_Notable events:_
_Additional Information:_
Occupational history
_Current employment_
_Past employment_
_Employment struggles/successes_
Educational history
_Highest level of education achieved:_
_Educational struggles/successes:_
Current family constellation
_General information on spouse/partner (remember to focus on your client’s symptoms,_ _you are only diagnosing one person; report whatever you think may be impacting your_ _client):_
_General information on children and close family members:_
_Is client satisfied with current family situation?:_
Psychiatric History
_Provide history of mental health diagnoses prior to when you met the client as well as any treatment received:_
_Include a family history of psychiatric conditions in this section (if no history state that there is no family history:_
Medical History
_Note all medical conditions the client has (these are conditions that are not psychiatric in nature, such as diabetes):_
_Especially for conditions that might impact mental functioning, provide details about treatment, prognosis, etc. For example, is the client managing their diabetes well?:_
Substance Use:
Note any previous or current substance use. Report which drug as well as amount/frequency of use.
Diagnostic Summary
_First, summarize the information you obtained in your report in 1-2 paragraphs (hint: focus on what most directly connects to your diagnosis:_
Then, explain each diagnosis you made and why
_Specifically list which criteria from the DSM the client meets:_
_Explain any other diagnoses you considered and explain why you ruled them out?:_
_Provide a brief prognosis – is this treatable?:_
Then, provide a brief treatment plan
_What type of therapy would be beneficial?_
_Would you refer this client to a psychiatrist for medication?_
_Does this client need to be hospitalized immediately?_
**## DiagnosticTemplate.docx**
**Diagnostic Evaluation Template**
Demographic Information:
_Age:_
_Sex:_
_Race/Ethnicity:_
_Culture:_
_Religion:_
_Marital/Relationship status:_
_Any other pertinent information:_
#### Current Mental Status: USE A MOOD DISORDER SUCH AS BIPOLAR
#### Choose the most appropriate answers from the following options. If you do not know what a word means, please look it up in a dictionary or in the textbook.
| | |
| — | — |
| _Orientation:_ | (X3: Oriented to Person, Place, and Time) |
| _General Appearance:_ | (Appropriate/Disheveled/Emaciated/Poor Hygiene) |
| _Dress:_ | (Appropriate/Eccentric/Seductive/Bizarre) |
| _Motor Activity:_ | (Unremarkable/Agitated/Retardation/Repetitive Actions/Tics/Tremor/Unusual Gait) |
| _Interview Behavior:_ | (Appropriate/Aggressive/Angry/Apathetic/Argumentative/Childlike/Demanding/Evasive/Hostile/Irritable/Passive/Manipulative/Withdrawn/Uncooperative) |
| _Speech:_ | (Normal/Hesitant/Slurred/Soft/Stuttering/Mute/Verbose) |
| _Mood:_ | (Euthymic/Dysphoric/Depressed/Euphoric/Grandiose/Anxious/Labile/Irritable/Angry) |
| _Affect:_ | (Appropriate/Inappropriate/Reactive/Constricted/Blunted/<br>Flat/Congruent/Incongruent) |
| _Insight:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Judgment/Impulse Control:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Memory:_ | (Intact/Poor Remote/Poor Recent) |
| _Attention/Concentration:_ | (Good/Distractible/Variable) |
| _Thought Process:_ | (Unremarkable/Blocking/Circumstantial/Flight of Ideas/Loose Associations/Perseveration/Tangential) |
| _Thought Content:_ | (Appropriate/Preoccupied/Obsessions/Delusions: Persecutory/Delusions: Bizarre/Delusions: Grandeur/ Delusions: Guilt/Delusions: Somatic/Delusions: Ideas of Reference/Delusions: Thought Broadcasting/Delusions: Thought Control) |
| _Perception:_ | (Unremarkable/Auditory Hallucinations/Visual Hallucinations/Olfactory Hallucinations/Tactile Hallucinations/Gustatory Hallucinations) |
| _Functional Status:_ | (Intact/Mildly Impaired/Moderately Impaired/Severely Impaired/Variably Impaired) |
Current Problems/Presenting Problems:
_Provide a thorough account of the reason client came to see you and/or was brought to you by friends/family; detail will help here (but do not do a plot summary):_
Problematic symptoms:
_First, list each symptom (HINT- they should be consistent with your diagnosis):_
Then, please note the…
_Frequency of symptoms (how often they occur?):_
_Duration of symptoms (how long have they been present):_
_Severity of symptoms (how serious they are):_
_Symptom triggers (events or situations that trigger the symptoms):_
Social and Occupational History:
Information on family of origin including ethnic/cultural information
_Where did the patient grow up?_
_Who did the patient live with as a child?_
_Were parents/caregivers married/separated/estranged?_
_Does patient have siblings?_
_Does patient have strong ties with Grandparents?_
_Additional Information:_
General information on childhood
_Traumatic events:_
_History of abuse:_
_Notable events:_
_Additional Information:_
Occupational history
_Current employment_
_Past employment_
_Employment struggles/successes_
Educational history
_Highest level of education achieved:_
_Educational struggles/successes:_
Current family constellation
_General information on spouse/partner (remember to focus on your client’s symptoms,_ _you are only diagnosing one person; report whatever you think may be impacting your_ _client):_
_General information on children and close family members:_
_Is client satisfied with current family situation?:_
Psychiatric History
_Provide history of mental health diagnoses prior to when you met the client as well as any treatment received:_
_Include a family history of psychiatric conditions in this section (if no history state that there is no family history:_
Medical History
_Note all medical conditions the client has (these are conditions that are not psychiatric in nature, such as diabetes):_
_Especially for conditions that might impact mental functioning, provide details about treatment, prognosis, etc. For example, is the client managing their diabetes well?:_
Substance Use:
Note any previous or current substance use. Report which drug as well as amount/frequency of use.
Diagnostic Summary
_First, summarize the information you obtained in your report in 1-2 paragraphs (hint: focus on what most directly connects to your diagnosis:_
Then, explain each diagnosis you made and why
_Specifically list which criteria from the DSM the client meets:_
_Explain any other diagnoses you considered and explain why you ruled them out?:_
_Provide a brief prognosis – is this treatable?:_
Then, provide a brief treatment plan
_What type of therapy would be beneficial?_
_Would you refer this client to a psychiatrist for medication?_
_Does this client need to be hospitalized immediately?_
**## DiagnosticEvaluationDraftReport.docx**
Diagnostic Evaluation Draft Report
NOTE! If you do a great job on this draft and would like to make no changes and keep the same grade for your final report, that's fine with me. If you earn 100, I'll do that for you automatically. If you don't submit a final diagnostic evaluation, I'll use the score from your draft as your final evaluation score. It would help if you add the comment "please use my midterm evaluation grade for my final evaluation grade" just so we're clear.
[Diagnostic Evaluation Draft Report Template – you must use this document](https://uncfsu.instructure.com/courses/43251/files/8352708?wrap=1) [Download Diagnostic Evaluation Draft Report Template – you must use this document](https://uncfsu.instructure.com/courses/43251/files/8352708/download?download_frd=1)
_Diagnostic Evaluation Draft Report_: You will create a diagnostic evaluation draft report using the template above. Please assess and diagnose
**a fictional character from a well-known movie, book, or television program that has a diagnosis covered in the class**. IMAGINE THAT THE CHARACTER HAS LEFT THE MOVIE/BOOK/SHOW AND WALKED INTO YOUR THERAPY OFFICE. How would that character respond to your questions?
_Submission Guidelines_: Reports must be submitted through Canvas. Plagiarism or other forms of academic dishonesty will not be tolerated and will result in at least an automatic “F” for the assignment (also see FSU regulations).
Please include the following statement on every assignment: "I hereby declare that I have not utilized any generative artificial intelligence (AI) tools or technologies in the creation of this work."
**Diagnostic Evaluation Guidelines**
· Please use the provided report template.
· Please address all of the components for each section.
· If the book, movie, or TV show does not provide you with much information about your character, it may be wise to select a character from another source that provides more detail.
· It is also permissible to take some creative license and fill in the blanks with made-up information if you feel it will bring your character to life.
· For this reason, I ask that you only choose fictional (not real) characters. Please do not choose a book/show/movie that portrays the life of a real person, alive or deceased.
· While it is helpful to report some information about the client’s family and friends, please avoid the mistake of over-analyzing a family member. Keep the focus on the client.
· I DO NOT need a plot summary. Only share what is relevant to the client’s diagnosis and DO NOT start detailing what happened in the movie. I should feel like I am reading about a real person that you met, not about a movie or show.
· Please follow APA format where necessary. Cite sources. Provide a references page which includes the full citation for the move/book/show.
Need help finding a movie? Here are some resources…
[https://www.bustle.com/p/25-movies-about-mental-health-to-watch-this-month-58200Links to an external site.](https://www.bustle.com/p/25-movies-about-mental-health-to-watch-this-month-58200)
[https://en.wikipedia.org/wiki/List_of_mental_disorders_in_filmLinks to an external site.](https://en.wikipedia.org/wiki/List_of_mental_disorders_in_film)
**## DiagnosticTemplate.docx**
**Diagnostic Evaluation Template**
Demographic Information:
_Age:_
_Sex:_
_Race/Ethnicity:_
_Culture:_
_Religion:_
_Marital/Relationship status:_
_Any other pertinent information:_
#### Current Mental Status: USE A MOOD DISORDER SUCH AS BIPOLAR
#### Choose the most appropriate answers from the following options. If you do not know what a word means, please look it up in a dictionary or in the textbook.
| | |
| — | — |
| _Orientation:_ | (X3: Oriented to Person, Place, and Time) |
| _General Appearance:_ | (Appropriate/Disheveled/Emaciated/Poor Hygiene) |
| _Dress:_ | (Appropriate/Eccentric/Seductive/Bizarre) |
| _Motor Activity:_ | (Unremarkable/Agitated/Retardation/Repetitive Actions/Tics/Tremor/Unusual Gait) |
| _Interview Behavior:_ | (Appropriate/Aggressive/Angry/Apathetic/Argumentative/Childlike/Demanding/Evasive/Hostile/Irritable/Passive/Manipulative/Withdrawn/Uncooperative) |
| _Speech:_ | (Normal/Hesitant/Slurred/Soft/Stuttering/Mute/Verbose) |
| _Mood:_ | (Euthymic/Dysphoric/Depressed/Euphoric/Grandiose/Anxious/Labile/Irritable/Angry) |
| _Affect:_ | (Appropriate/Inappropriate/Reactive/Constricted/Blunted/<br>Flat/Congruent/Incongruent) |
| _Insight:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Judgment/Impulse Control:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Memory:_ | (Intact/Poor Remote/Poor Recent) |
| _Attention/Concentration:_ | (Good/Distractible/Variable) |
| _Thought Process:_ | (Unremarkable/Blocking/Circumstantial/Flight of Ideas/Loose Associations/Perseveration/Tangential) |
| _Thought Content:_ | (Appropriate/Preoccupied/Obsessions/Delusions: Persecutory/Delusions: Bizarre/Delusions: Grandeur/ Delusions: Guilt/Delusions: Somatic/Delusions: Ideas of Reference/Delusions: Thought Broadcasting/Delusions: Thought Control) |
| _Perception:_ | (Unremarkable/Auditory Hallucinations/Visual Hallucinations/Olfactory Hallucinations/Tactile Hallucinations/Gustatory Hallucinations) |
| _Functional Status:_ | (Intact/Mildly Impaired/Moderately Impaired/Severely Impaired/Variably Impaired) |
Current Problems/Presenting Problems:
_Provide a thorough account of the reason client came to see you and/or was brought to you by friends/family; detail will help here (but do not do a plot summary):_
Problematic symptoms:
_First, list each symptom (HINT- they should be consistent with your diagnosis):_
Then, please note the…
_Frequency of symptoms (how often they occur?):_
_Duration of symptoms (how long have they been present):_
_Severity of symptoms (how serious they are):_
_Symptom triggers (events or situations that trigger the symptoms):_
Social and Occupational History:
Information on family of origin including ethnic/cultural information
_Where did the patient grow up?_
_Who did the patient live with as a child?_
_Were parents/caregivers married/separated/estranged?_
_Does patient have siblings?_
_Does patient have strong ties with Grandparents?_
_Additional Information:_
General information on childhood
_Traumatic events:_
_History of abuse:_
_Notable events:_
_Additional Information:_
Occupational history
_Current employment_
_Past employment_
_Employment struggles/successes_
Educational history
_Highest level of education achieved:_
_Educational struggles/successes:_
Current family constellation
_General information on spouse/partner (remember to focus on your client’s symptoms,_ _you are only diagnosing one person; report whatever you think may be impacting your_ _client):_
_General information on children and close family members:_
_Is client satisfied with current family situation?:_
Psychiatric History
_Provide history of mental health diagnoses prior to when you met the client as well as any treatment received:_
_Include a family history of psychiatric conditions in this section (if no history state that there is no family history:_
Medical History
_Note all medical conditions the client has (these are conditions that are not psychiatric in nature, such as diabetes):_
_Especially for conditions that might impact mental functioning, provide details about treatment, prognosis, etc. For example, is the client managing their diabetes well?:_
Substance Use:
Note any previous or current substance use. Report which drug as well as amount/frequency of use.
Diagnostic Summary
_First, summarize the information you obtained in your report in 1-2 paragraphs (hint: focus on what most directly connects to your diagnosis:_
Then, explain each diagnosis you made and why
_Specifically list which criteria from the DSM the client meets:_
_Explain any other diagnoses you considered and explain why you ruled them out?:_
_Provide a brief prognosis – is this treatable?:_
Then, provide a brief treatment plan
_What type of therapy would be beneficial?_
_Would you refer this client to a psychiatrist for medication?_
_Does this client need to be hospitalized immediately?_
**## DiagnosticEvaluationDraftReport.docx**
Diagnostic Evaluation Draft Report
NOTE! If you do a great job on this draft and would like to make no changes and keep the same grade for your final report, that's fine with me. If you earn 100, I'll do that for you automatically. If you don't submit a final diagnostic evaluation, I'll use the score from your draft as your final evaluation score. It would help if you add the comment "please use my midterm evaluation grade for my final evaluation grade" just so we're clear.
[Diagnostic Evaluation Draft Report Template – you must use this document](https://uncfsu.instructure.com/courses/43251/files/8352708?wrap=1) [Download Diagnostic Evaluation Draft Report Template – you must use this document](https://uncfsu.instructure.com/courses/43251/files/8352708/download?download_frd=1)
_Diagnostic Evaluation Draft Report_: You will create a diagnostic evaluation draft report using the template above. Please assess and diagnose
**a fictional character from a well-known movie, book, or television program that has a diagnosis covered in the class**. IMAGINE THAT THE CHARACTER HAS LEFT THE MOVIE/BOOK/SHOW AND WALKED INTO YOUR THERAPY OFFICE. How would that character respond to your questions?
_Submission Guidelines_: Reports must be submitted through Canvas. Plagiarism or other forms of academic dishonesty will not be tolerated and will result in at least an automatic “F” for the assignment (also see FSU regulations).
Please include the following statement on every assignment: "I hereby declare that I have not utilized any generative artificial intelligence (AI) tools or technologies in the creation of this work."
**Diagnostic Evaluation Guidelines**
· Please use the provided report template.
· Please address all of the components for each section.
· If the book, movie, or TV show does not provide you with much information about your character, it may be wise to select a character from another source that provides more detail.
· It is also permissible to take some creative license and fill in the blanks with made-up information if you feel it will bring your character to life.
· For this reason, I ask that you only choose fictional (not real) characters. Please do not choose a book/show/movie that portrays the life of a real person, alive or deceased.
· While it is helpful to report some information about the client’s family and friends, please avoid the mistake of over-analyzing a family member. Keep the focus on the client.
· I DO NOT need a plot summary. Only share what is relevant to the client’s diagnosis and DO NOT start detailing what happened in the movie. I should feel like I am reading about a real person that you met, not about a movie or show.
· Please follow APA format where necessary. Cite sources. Provide a references page which includes the full citation for the move/book/show.
Need help finding a movie? Here are some resources…
[https://www.bustle.com/p/25-movies-about-mental-health-to-watch-this-month-58200Links to an external site.](https://www.bustle.com/p/25-movies-about-mental-health-to-watch-this-month-58200)
[https://en.wikipedia.org/wiki/List_of_mental_disorders_in_filmLinks to an external site.](https://en.wikipedia.org/wiki/List_of_mental_disorders_in_film)
**## DiagnosticTemplate.docx**
**Diagnostic Evaluation Template**
Demographic Information:
_Age:_
_Sex:_
_Race/Ethnicity:_
_Culture:_
_Religion:_
_Marital/Relationship status:_
_Any other pertinent information:_
#### Current Mental Status: USE A MOOD DISORDER SUCH AS BIPOLAR
#### Choose the most appropriate answers from the following options. If you do not know what a word means, please look it up in a dictionary or in the textbook.
| | |
| — | — |
| _Orientation:_ | (X3: Oriented to Person, Place, and Time) |
| _General Appearance:_ | (Appropriate/Disheveled/Emaciated/Poor Hygiene) |
| _Dress:_ | (Appropriate/Eccentric/Seductive/Bizarre) |
| _Motor Activity:_ | (Unremarkable/Agitated/Retardation/Repetitive Actions/Tics/Tremor/Unusual Gait) |
| _Interview Behavior:_ | (Appropriate/Aggressive/Angry/Apathetic/Argumentative/Childlike/Demanding/Evasive/Hostile/Irritable/Passive/Manipulative/Withdrawn/Uncooperative) |
| _Speech:_ | (Normal/Hesitant/Slurred/Soft/Stuttering/Mute/Verbose) |
| _Mood:_ | (Euthymic/Dysphoric/Depressed/Euphoric/Grandiose/Anxious/Labile/Irritable/Angry) |
| _Affect:_ | (Appropriate/Inappropriate/Reactive/Constricted/Blunted/<br>Flat/Congruent/Incongruent) |
| _Insight:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Judgment/Impulse Control:_ | (Excellent/Good/Fair/Poor/Nil) |
| _Memory:_ | (Intact/Poor Remote/Poor Recent) |
| _Attention/Concentration:_ | (Good/Distractible/Variable) |
| _Thought Process:_ | (Unremarkable/Blocking/Circumstantial/Flight of Ideas/Loose Associations/Perseveration/Tangential) |
| _Thought Content:_ | (Appropriate/Preoccupied/Obsessions/Delusions: Persecutory/Delusions: Bizarre/Delusions: Grandeur/ Delusions: Guilt/Delusions: Somatic/Delusions: Ideas of Reference/Delusions: Thought Broadcasting/Delusions: Thought Control) |
| _Perception:_ | (Unremarkable/Auditory Hallucinations/Visual Hallucinations/Olfactory Hallucinations/Tactile Hallucinations/Gustatory Hallucinations) |
| _Functional Status:_ | (Intact/Mildly Impaired/Moderately Impaired/Severely Impaired/Variably Impaired) |
Current Problems/Presenting Problems:
_Provide a thorough account of the reason client came to see you and/or was brought to you by friends/family; detail will help here (but do not do a plot summary):_
Problematic symptoms:
_First, list each symptom (HINT- they should be consistent with your diagnosis):_
Then, please note the…
_Frequency of symptoms (how often they occur?):_
_Duration of symptoms (how long have they been present):_
_Severity of symptoms (how serious they are):_
_Symptom triggers (events or situations that trigger the symptoms):_
Social and Occupational History:
Information on family of origin including ethnic/cultural information
_Where did the patient grow up?_
_Who did the patient live with as a child?_
_Were parents/caregivers married/separated/estranged?_
_Does patient have siblings?_
_Does patient have strong ties with Grandparents?_
_Additional Information:_
General information on childhood
_Traumatic events:_
_History of abuse:_
_Notable events:_
_Additional Information:_
Occupational history
_Current employment_
_Past employment_
_Employment struggles/successes_
Educational history
_Highest level of education achieved:_
_Educational struggles/successes:_
Current family constellation
_General information on spouse/partner (remember to focus on your client’s symptoms,_ _you are only diagnosing one person; report whatever you think may be impacting your_ _client):_
_General information on children and close family members:_
_Is client satisfied with current family situation?:_
Psychiatric History
_Provide history of mental health diagnoses prior to when you met the client as well as any treatment received:_
_Include a family history of psychiatric conditions in this section (if no history state that there is no family history:_
Medical History
_Note all medical conditions the client has (these are conditions that are not psychiatric in nature, such as diabetes):_
_Especially for conditions that might impact mental functioning, provide details about treatment, prognosis, etc. For example, is the client managing their diabetes well?:_
Substance Use:
Note any previous or current substance use. Report which drug as well as amount/frequency of use.
Diagnostic Summary
_First, summarize the information you obtained in your report in 1-2 paragraphs (hint: focus on what most directly connects to your diagnosis:_
Then, explain each diagnosis you made and why
_Specifically list which criteria from the DSM the client meets:_
_Explain any other diagnoses you considered and explain why you ruled them out?:_
_Provide a brief prognosis – is this treatable?:_
Then, provide a brief treatment plan
_What type of therapy would be beneficial?_
_Would you refer this client to a psychiatrist for medication?_
_Does this client need to be hospitalized immediately?_