Symptom Analysis Evaluation Template
Symptom:
Identify appropriate history questions to be asked of your patient to discriminate critical characteristics or attributes about the above presenting complaint. Incorporate COLDSPA (Characteristics, Onset, Lingering, Duration, Stressors, Precipitating factors/triggers, Alleviating factors).
Delineate 4 hypotheses (differential diagnosis) that could support the above symptoms in relation to pertinent answers given the history. MOST use appropriate DSM 5 diagnosis and provide rationale for each choice base on the presenting case.
Differential 1
Differential 2
Differential 3
Differential 4
What mental status exam findings, would be associated with each listed hypothesis above? What subjective data might the patient report? Use all component of MSE listed- Appearance, Behavior, Speech, Affect, Thought process, Thought content, Insight, Judgement, Cognitive examination (level of awareness, Attention and Concentration, Memory, Orientation etc). Must support with literature and use the appropriate descriptors in each component. Avoid using “normal” or “Good” as a descriptor.
Differential 1 Appearance-
Speech-
Affect-
Behavior-
Thought process-
Thought content-
Attention and concentration-
Memory-
Orientation-
Insight-
Judgement-
Differential 2 Appearance-
Speech-
Affect-
Behavior-
Thought process-
Thought content-
Attention and concentration-
Memory-
Orientation-
Insight-
Judgement-
Differential 3 Appearance-
Speech-
Affect-
Behavior-
Thought process-
Thought content-
Attention and concentration-
Memory-
Orientation-
Insight-
Judgement-
Differential 4 Appearance-
Speech-
Affect-
Behavior-
Thought process-
Thought content-
Attention and concentration-
Memory-
Orientation-
Insight-
Judgement-
What is the physiology, pathophysiology and/or etiology associated with each hypothesis?
Differential 1
Differential 2
Differential 3
Differential 4
What diagnostic tests would you obtain to rule out medical issues that mimic each of the differential diagnosis? What diagnostic screening tool would you use for each of the differential diagnosis?
Differential 1
Differential 2
Differential 3
Differential 4
Analysis:
What pharmacotherapy and non-pharmacological treatments would you suggest for the primary diagnosis?’
References
