Chapter 4: Affective Changes Assessment

Affective Changes Assessment on affective changes equips primary care practitioners with the diagnostic reasoning tools necessary to evaluate psychological and psychosocial symptoms, emphasizing the critical first step of ruling out organic physiological causes such as thyroid dysfunction, metabolic abnormalities, or medication side effects using the THINC MED framework. The text provides a structured approach to patient interviews, utilizing the BATHE technique to establish rapport and screen for situational stress, while employing the HEEADSSS assessment for a thorough psychosocial review of systems in adolescents. Detailed screening protocols are outlined for major mental health conditions, including the use of the PHQ-2 and neurovegetative symptom analysis for Major Depressive Disorder, and the differentiation of Generalized Anxiety Disorder, Panic Disorder, and Social Phobia from normal stress or grief reactions. The chapter further explores the identification of Bipolar Disorder by assessing for mania or hypomania using the DIG FAST mnemonic to recognize symptoms like grandiosity and flight of ideas, distinguishing Bipolar I from Bipolar II. Substance use disorders are addressed through validated screening instruments such as CAGE for adults, CRAFFT for adolescents, and T-ACE for prenatal risk, alongside physical examination clues like pupillary changes, nasal septum perforation, or track marks. Furthermore, the content covers the evaluation of vulnerable populations, detailing red flags for domestic violence, partner abuse, and elder abuse, as well as the early detection of Autism Spectrum Disorder in toddlers using the M-CHAT-R/F tool. The diagnostic process concludes with a review of essential laboratory studies, such as thyroid function tests, complete blood counts, and toxicology screens, to confirm diagnoses and facilitate appropriate referrals for psychiatric evaluation when risks, particularly suicidality, are identified.