Assessment and Management of Psychiatric Conditions

Critical Considerations for Patient Evaluation

• The American Academy of Pediatrics recommends assessing for suicidal ideation, homicidal ideation, and self-harm thoughts in all patients, as these must never be omitted regardless of presentation 1, 2, 3
• The American Academy of Pediatrics suggests using formal screening tools like Mini-Mental State Examination or Mini-Cog when cognitive impairment is suspected 2
• If any risk of self-harm or harm to others is identified, immediately refer for emergency psychiatric evaluation, facilitate a safe environment, implement one-to-one observation, and initiate risk reduction interventions 1, 2, 4
• Before attributing symptoms to depression, exclude uncontrolled pain, fatigue, delirium from infection or electrolyte imbalance, thyroid disorders, and medication side effects 2, 3, 5, 6
• Document how symptoms interfere with work, relationships, self-care, and daily activities, and for moderate depression (PHQ-9 score 8-14), expect mild to moderate functional impairment 1, 4, 5
• The American Academy of Pediatrics recommends interviewing patient and collateral sources (family, caregivers) both together and separately, as patients frequently minimize symptom severity, making collateral information essential 2
• Never omit the suicidal ideation assessment, as doing so artificially lowers risk detection and misses critical safety information 1, 3
• Do not rely solely on symptom counts; assess functional impairment and duration 1, 4
• Avoid using PHQ-9 in patients with cognitive impairment, as it loses accuracy in this population 3