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National Guidelines on Management of Sexual Violence in Kenya

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Psychological Assessment (Should be d<strong>on</strong>e by: -Psychiatrists, Medical Doctors, Psychologists, Psychiatry-<br />

tra<strong>in</strong>ed nurses, Psychiatry social workers or Counsel<strong>in</strong>g psychologists <strong>of</strong> repute)<br />

P<br />

S<br />

Y<br />

C<br />

H<br />

O<br />

L<br />

O<br />

G<br />

I<br />

C<br />

A<br />

L<br />

A<br />

S<br />

S<br />

E<br />

S<br />

S<br />

E<br />

S<br />

M<br />

E<br />

N<br />

T<br />

PREMORBID HISTORY (state the mental c<strong>on</strong>diti<strong>on</strong> <strong>of</strong> survivor prior to assault)<br />

________________________________________________________________________________________<br />

________________________________________________________________________________________<br />

Mental Status Evaluati<strong>on</strong> (Tick as appropriate)<br />

• Appearance (kempt, unkempt,<br />

other)(specify)__________________________________________________________________________<br />

• Behaviour (appropriate, restless, calm, absent m<strong>in</strong>dedness, other)<br />

(specify)______________________________________________________________________________<br />

_____________________________________________________________________________________<br />

• Mood (low, excited, depressed, tense, irritable, tearful, anxious, angry,<br />

other)_____________________________________________________________________________<br />

• Speech (flow, t<strong>on</strong>e, amount<br />

)(specify)__________________________________________________________________________<br />

_<br />

• Percepti<strong>on</strong> (halluc<strong>in</strong>ati<strong>on</strong>s, illusi<strong>on</strong>s, derealizati<strong>on</strong>, depers<strong>on</strong>alizati<strong>on</strong>, dissociati<strong>on</strong>, other) (specify)<br />

(specify)___________________________________________________________________________<br />

• Thought (Preoccupati<strong>on</strong>, Stream <strong>of</strong> thought, suicidal thoughts, helplessness, hopelessness,<br />

worthlessness, odd beliefs, flashbacks, specific fears e.g.. <strong>of</strong> open places, enclosed spaces, men, women,<br />

adults, strangers, other)<br />

(specify)___________________________________________________________________________<br />

Dim<strong>in</strong>ished capacity to enjoy life_________________________________________________________<br />

• Cognitive Disturbance (Orientati<strong>on</strong> <strong>in</strong> time, place, pers<strong>on</strong>, Level <strong>of</strong> attenti<strong>on</strong>, C<strong>on</strong>centrati<strong>on</strong> (use serial<br />

seven subtracti<strong>on</strong>s<br />

____________________________________________________________________<br />

Memory: short term __________, l<strong>on</strong>g term _________________<br />

Judgement_____________________________________________________________________<br />

Insight – does the survivor understand what happened to her/him, possible c<strong>on</strong>sequences, any legal<br />

implicati<strong>on</strong>s, any wishes <strong>of</strong> the survivor?<br />

Diagnosis:<br />

________________________________________________________________________________________<br />

44

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