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Occupational Therapy - Psychiatry Assessment: Demographic Data

The document outlines an occupational therapy assessment for a psychiatric evaluation, including demographic data, occupational profile, and various histories (present, past, childhood, educational, family, marital, and vocational). It details mental status examination components, performance analysis, cognitive skills, intrapersonal skills, values, habits, self-maintenance skills, and family attitudes towards the illness. The assessment concludes with goals and a space for the therapist's signature and date.

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gn6966
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12 views7 pages

Occupational Therapy - Psychiatry Assessment: Demographic Data

The document outlines an occupational therapy assessment for a psychiatric evaluation, including demographic data, occupational profile, and various histories (present, past, childhood, educational, family, marital, and vocational). It details mental status examination components, performance analysis, cognitive skills, intrapersonal skills, values, habits, self-maintenance skills, and family attitudes towards the illness. The assessment concludes with goals and a space for the therapist's signature and date.

Uploaded by

gn6966
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

OCCUPATIONAL THERAPY -

PSYCHIATRY ASSESSMENT

DEMOGRAPHIC DATA:
NAME: IP NUMBER :

AGE/SEX : UHID NO :

OCCUPATION : MARITAL STATUS :

ADDRESS : DATE :

OCCUPATIONAL PROFILE:
CHIEF COMPLAINTS:

DURATION OF ILLNESS:

O-

D-

P-

HISTORY:

PRESENT ILLNESS:

1 PSYCHIATRY DEPARTMENT |
SRM COLLEGE OF OCCUPATIONAL THERAPY
PAST HISTORY:

CHILDHOOD HISTORY:

EDUCATIONAL HISTORY:

FAMILY HISTORY:

MARITAL HISTORY:

VOCATIONAL HISTORY :

SUBTANCE USE & SUICIDAL IDEAS:

2 PSYCHIATRY DEPARTMENT |
SRM COLLEGE OF OCCUPATIONAL THERAPY
PREMORBID PERSONALITY:

ANALYSIS OF PERFORMANCE COMPONENTS:


ON OBSERVATION:

EYE CONTACT :

GENERAL APPEARANCE :

MENTAL STATUS EXAMINATION

GENERAL APPREARANCE & BEHAVIOUR:

SPEECH :

MOOD & AFFECT :

THOUGHT PROCESS :

ATTENTION :

CONCENTRATION :

ORIENTATION :

MEMORY :

HALLUCINATION :

JUDGEMENT :

INSIGHT :

TASK BEHAVIOUR (STRUCTURED / SEMI STRUCTURED / UNSTRUCTURED)- (Comprehensive


Occupational Therapy Evaluation)

ACTIVITY OBSERVED:

3 PSYCHIATRY DEPARTMENT |
SRM COLLEGE OF OCCUPATIONAL THERAPY
4 PSYCHIATRY DEPARTMENT |
SRM COLLEGE OF OCCUPATIONAL THERAPY
SCORING

0-NORMAL 1-MINIMAL 2-MILD 3-MODERATE 4-SEVERE

Total score of 0-20 indicates Normal Functioning

COGNITIVE & PEERCEPTUAL SKILLS

PROBLEM SOLVING :

DECISION MAKING :

ABSTRACT THINKING :

IMAGINATION & CREATIVITY:

BODY IMAGE :

RIGHT LEFT DISCRIMINATION :

SPATIAL ORIENTATION :

FIGURE GROUND PERCEPTION :

INTRAPERSONAL SKILLS

EXPRESSION OF FEELINGS : (Adequate / inadequate)

CONTROL OF FEELINGS : (Adequate / inadequate)

FRUSTRATION TOLERANCE : (Adequate / Low)

SELF / SEXUAL IDENTITY :

SELF CONFIDENCE :

SELF ESTEEM :

IMPULSE CONTROL :

COPING SKILLS :

SELF ASSERTION :

VALUES & HABITS

IDENTIFICATION OF ROLES
5 PSYCHIATRY DEPARTMENT |
SRM COLLEGE OF OCCUPATIONAL THERAPY
RESPONSIBILITIES OF ROLE

PERFORMANCE OF ROLES

PERFORMANCE OF ROUTIENS

PERSONAL BELIEFS

ACTIVITY CONFIGURATION

SELF MAINTENANCE SKILLS

ADL

IADL

MONEY HANDELING

ACTIVITIES IN COMMUNITY (Shopping, Public Transport, Medications, Billing)

FAMILY ATTITUDE

TOWARDS ILLNESS:

TOWARDS PATIENT:

EXPRESSED EMOTIONS (Present / Absent)

ADDITIONAL SCALES

6 PSYCHIATRY DEPARTMENT |
SRM COLLEGE OF OCCUPATIONAL THERAPY
GOALS

THERAPIST’S SIGN & DATE

7 PSYCHIATRY DEPARTMENT |
SRM COLLEGE OF OCCUPATIONAL THERAPY

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