Essay on Axes in Comprehensive Psychiatric Evaluation

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Axes in Comprehensive Psychiatric Evaluation

A comprehensive psychiatric evaluation usually requires information for five major axes. To diagnose as well as give a description to a patient by the use of DSM-IV, a clinician on five major dimensions usually rates the patient (Goolsby & Grubbs, 2011). These dimensions are usually what are referred to as axes and are as follows:
a.Axis 1

The first axis referred to as Axis 1, usually describes clinical disorders. Axis 1 also describes any other conditions of a patient that may be considered as a focus of clinical attention. These problems of patients are usually problems that require attention that is immediate from the clinicians (Lynn, 2010). A good example of an Axis 1 clinical disorder is fresh wound from an accident.
b.Axis 2

Axis 2 has its major focus on personality disorders. It contains a rating scale for retardation of the mind. The problems involved in Axis 2 may not require immediate attention but, however, may interfere with treatments for the patients. It is recommended that any clinician who treats a patient to take into account these personality disorders without which the treatment of the patient will be interfered with (Lynn, 2010). A good example of such personality disorders may include such disorders as Anxiety, Fear, and Depression.
c.Axis 3

Axis 3 generally labels any general medical conditions. Labeling of general medical conditions is particularly very important whether or not the problem is mental or behavioral. The reason the labeling of Axis 3 is very important is because there are cases in which psychological problems result from previous illnesses or current illnesses of a patient (Goolsby & Grubbs, 2011). Examples of Axis 3 medical conditions are heart diseases and diabetes.
d.Axis 4

Axis 4 in Psychiatric Evaluation generally specifies problems that are either environmental or psychological or both. These are usually problems that result from the psychological upbringing of a person and the environment in which a person spends most of his in her time, which are influenced by factors such as poverty and dysfunctional families. An example of an Axis 4 disorder is repression.

e.Axis 5
The fifth axis usually considers the assessment of the functioning scale globally. It usually deals with the overall rating of the ability of a person to cope with normal life. Their ratings are usually a range starting from 1 to 100. A rating of 10 for instance is a low rating and describes a patient who is dangerous and hurts himself or herself and others as well persistently while a rating of 100, on the other hand, describes superior functioning in a wide range of activities.

Question 2

Type of Anxiety Disorder: Social Anxiety Disorder

Social Anxiety Disorder is generally the considered as the great fear that a person undergoes for being scrutinized and judged by other people. This is both in social and performance situations. Social Anxiety Disorder has been on various occasions confused with shyness that is inappropriately medicalized.

Symptoms of Social Anxiety Disorder

Social Anxiety Disorder has emotional, physical and behavioral symptoms. The emotional symptoms include: excessive self-consciousness, intense worries before upcoming social situations, excess fear of being watched or being judged by other people, fear of acting in ways that are embarrassing to oneself and the fear of other people noticing your nervousness. The physical symptoms include: blushing or red face, feeling dizzy or faint, hot flashes or sweating, shortness of breath, upset stomach and feeling of nausea, trembling and shaking, and tightness in the chest and a racing heart (Porth & Matfin, 2009). The behavioral symptoms on the other hand include: avoiding social situations to the extent that it affects oneself day-to-day activities, drinking before social situations, a need to always bring friends to social gatherings, and frequently staying quiet or hiding in the background in order to escape being noticed or embarrassments.

Diagnostic Tests

Mental health providers perform tests and diagnosis of Social Anxiety Disorders so as to determine if there are conditions causing the disorders or if the disorder is accompanied by another mental disorders. The tests performed by the doctors usually include performing a physical exam in order to determine the possibility of existence of other physical causes that trigger the disorder symptoms, reviewing a list of situations to find out if they make the patients anxious, having patients filling questionnaires in order to help with pinpointing diagnosis, and asking the patients to describe their signs and symptoms, the situations in which they occur and how often they occur (Porth & Matfin, 2009). In these tests and diagnosis the medical problem that are being ruled out is panic disorder since it is in a number of occasions confused with social anxiety disorder due to very close similarities in the symptoms of the two.

Question 3

Substance Abuse

Substance abuse is the excessive use of alcohol or other drugs. The substance is usually characterized by the daily intoxication and the inability to reduce the consumption of a drug or alcohol. It is also characterized by the impairment in functioning of economical and social behaviors. In some cases, substance abuse is also called alcohol or drug addiction. Screening of substance abuse is most appropriate to be started at the age of 18. There are several reasons why it is necessary for substance abuse to be screened at this age (Porth & Matfin, 2009). The first reason is that at 18 years, most teenagers are involved in peer groups that are most likely influential I the decisions that they make and, therefore, a number of them may be easily lured into alcohol and drug use. The other reason screening for substance abuse is necessary for this age is because in the occurrence of negative screens then the clinicians can play health promotion and prevention role. This information can also be used to reinforce the wisdom of abstinence from illicit drugs.

For screening of the 18-year-olds for substance abuse, the CRAAFT screening test can be used. This is because this tool can be both self-administered and by clinicians. This is very convenient for the adolescents who might not feel very confident to interact with clinicians. CRAAFT screening test is divided into parts, with each part having different questions asked to those being tested. It asks about the drugs that the people have used, the safety precautions that they undertake when on drugs and the general experiences with the drugs (Cash & Glass, 2014). It is very reliable because those being screened feel confident in answering the questions and are less likely to lie or hold anything back. It is also very specific with the questions of which answers are required.

Question 4


Depression is a mental disorder that is characterized by loss of interest pleasure, sadness, low self-worth, disturbed sleep and appetite, poor concentration, feelings of tiredness and feelings of guilt (Buttaro et al, 2013). The screening tool that would be most effective in screening children of 10 years for depression is the Weinberg Depression Scale For Children and Adolescents (WDSCA). For an adolescent of 16 years, the most appropriate tool for screening for depression is the Moods and Feelings Questionnaire (MFQ). For a 30-year-old mother with postpartum, on the other hand, the most appropriate screening tool is the Beck Depression Inventory (BDI). For a 67-year-old male who has jus retired from a job of more that 40 years is the Geriatric Depression Scale. For an 80-year-old man who has just become a widower, the depression can also be screened by the Geriatric Depression Scale as the most appropriate tool for screening that kind of depression.

Among the five patients mentioned above the most likely patient to commit suicide as a result of depression is the 16-year-old teen. This is because at this age is when a person experiences the most challenges in life due to depression (Buttaro et al., 2013). Also at this age, a person already has an evil mind and has poor judgment and is incapable of making sober decisions. The 10-year-old child in most cases will just suffer in silence. `The 30-year-old mother, on the other hand, has a child that she cares about and is less likely to commit suicide.


Goolsby, M., & Grubbs, L., (2011). Advanced assessment: Interpreting findings and formulating differential diagnoses (2nd ed.). Philadelphia: F.A. Davis.
Cash, J., & Glass, C. (2014). Family practice guidelines (Third ed.). New York: Springer Publishing Company, LLC.
Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Elsevier Mosby. Retrieved from
Lynn S. Bickley. (2010). Guide to Physical Examination and History Taking. Lippincott Willians & Wilkins, ISBN: 9781609137625.
Porth, C.M., & Matfin, G. (2009) Pathophysiology: Concepts of altered health states. (Eight ed.) Philadelphia, PA: Lippincott Williams & Wilkins