Psychiatric Evaluations and Medication Management - My Process

In my psychiatric practice, I see both children and adults.

During my first visit with you, I take a thorough history. I’m interested in knowing:

  • your chief complaint; and
  • the reason you seek psychiatric services, in your own words.

Then I focus on your current problems:

  • when they started;
  • how they developed; and
  • how your functioning is affected:
    • Are you depressed?
    • Are you anxious?
    • Have you been experiencing manic or psychotic symptoms?
    • What are your health issues--your current allergies and medications?
    • Have you sought psychiatric or psychological services in the past?
    • Do you have a history of suicidal or self-injurious behavior?
    • Does mental illness, suicide, or substance abuse run in your family?
    • Do you have serious medical issues in the family?
    • Do you have problems with substance abuse?

I like to know your social history:

  • where you’re from;
  • your family dynamic;
  • your support systems;
  • your educational and work history;
  • any legal problems; and
  • any past exposure to trauma.

Throughout this process, I am able to complete a mental status exam, where I assess, among other things:

  • your speech;
  • your current mood and affect;
  • your thought process and the content of your thoughts;
  • your level of insight and judgment;
  • your memory;
  • the presence of any active suicidal or homicidal thoughts, intentions, or plans.

family kayaking

I may also measure your blood pressure, pulse, and weight. At the end of this interview, I establish a diagnosis and treatment plan.

I may ask your permission to contact your therapist, family members, or treating physicians to obtain additional information. Any questions you have throughout this process will be addressed and answered.

If you are a child coming to see me for the first time, I interview both you and your parent(s) or guardian, ideally separately. In addition to the questions mentioned above, I ask about your birth history and early development, as well as any attention or focus problems and behavioral issues.

When prescribing medication, I consider various factors. I get to know your concerns about any potential medications and explain the risks, benefits, potential side effects, and alternative treatments available to you. I look at the medications you are currently taking to make sure there are no potential drug interactions with any new medication I prescribe. I follow you closely while you are on the medication(s) and make sure you tolerate them well and are on an optimum dose.

In addition to medications, I am also trained in various psychotherapy modalities including, but not limited to, psychoanalytic, cognitive-behavioral, supportive, and play therapies. My goal is to find the root cause of the problem at hand and, through a process of self-understanding, guide you back to a rich and functioning life.

Recommended Reading:

Check our list of books below personally recommended by our psychiatrist, Dr. Ana Maria Muñiz-Leen.

Recommended reading Psych

family kayaking

Resources:

For a list of community resources recommended by Dr. Muñiz-Leen, see list below.

Community resources Psych