Passing the commission: what questions does the psychiatrist ask?

The public organization “Russian Society of Psychiatrists” (ROS) is an independent organization of psychiatrists, narcologists, psychotherapists, medical psychologists and other specialists working in practical and scientific psychiatry and narcology. The activities of the ROP are aimed at improving and improving the quality of medical care for people suffering from mental disorders, protecting their rights and legitimate interests, increasing the professional level of specialists working in the field of psychiatry, narcology, psychotherapy, medical psychology, ensuring their rights and interests, developing psychiatric science, promoting the improvement of mental health of the population. Psychiatr.ru - official website of the ROP

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What does a psychiatrist check?

This doctor looks at the patient for the presence or absence of mental abnormalities and disorders, determines the cause and level of brain disorders. He conducts examinations, makes diagnoses and prescribes treatment, and oversees the rehabilitation of patients. There is a psychiatrist in any clinic; he is part of the medical commissions that determine a person’s disability.

He is also required to be present during forced inspection of those suspected of a crime.

During the examination, a psychiatrist may identify the following problems:

• Autism is a disorder of the process of adaptation in society.
• Depression - severe forms lead to suicide attempts.
• Neurosis – occurs with prolonged psycho-emotional stress and can lead to malfunctions of internal organs.
• Anxiety disorder – often due to chronic stress.
• Schizophrenia is a thinking disorder that manifests itself in speech problems, hallucinations, and delusions.
• Personality disorder is dangerous due to psychosis, severe depression, and aggression.

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Why see a psychiatrist?

An examination by this specialist is mandatory for people who are involved in dangerous work, service, or are involved in society (doctors, educators). You will also have to undergo a psychiatrist for a license or permit to carry a weapon, because this has an impact on the life of the person himself and those around him.

Screening is required for children going to school.

Other people don't need it. The procedure is carried out on a paid basis.

Obtaining permission to carry weapons

A psychiatrist, as part of a commission including a therapist, an ophthalmologist and a narcologist, must confirm that a person will not harm himself or others with such a dangerous object. To do this, they check the mental state for a tendency to aggression, depression, mood swings, and personality disorders.

It is important that the person has not previously been registered for these problems.

If everything is in order, a positive conclusion is issued. The certificate is valid for six months.

Obtaining a driver's license

In order for a person to be allowed to drive a car, he must be mentally stable, otherwise he may harm the health and lives of others. The driver must undergo a commission that includes a psychiatrist. He checks the degree of adequacy of the individual, mental deviations. Even depression can cause a license to be denied. Then the person undergoes treatment and goes back to the medical examination.

After receiving the certificate, the inspection is carried out again every 1-3 years.

Apparatus employed

People whose activities require increased concentration, control of dangerous, complex mechanisms, and are associated with responsibility for the lives of others are examined by a psychiatrist (as part of a medical examination). During the examination, the doctor tries to identify mental instability, chronic disorders that may interfere with the performance of these tasks.

If there are deviations, the person will receive a work ban and a treatment plan.

This is required for the following specialties:

• drivers, pilots;
• builders;
• military;
• scientists, doctors;
• teachers.

Admission of a child to kindergarten or school

This examination is as mandatory as other examinations by doctors. Before moving to a new educational institution, a psychiatrist checks the child’s level of development and psycho-emotional readiness. It is important to see the ability to communicate, express emotions, thoughts, and detect deviations in behavior in time. Many problems can be identified already at the age of 3-5 years, and starting to work with them so early is easier than at 10-14.

In case of serious deviations, they are given a referral to a special school.

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Where can I see a psychiatrist?

The procedure is available at the state dispensary at the place of registration. It is important that the institution has a license. For a preventive examination, you can get to a psychiatrist simply by making an appointment through the registry or visiting a private center.

According to indications, a referral is given by a neurologist, pediatrician, or family doctor. If you need to get a certificate and undergo a medical examination, you will have to start with a therapist.

Procedure steps:

1. Get a bypass sheet from the registration office of the district clinic.
2. Visit a therapist, take a referral to a psychiatrist, narcologist (not relevant for children’s examinations).
3. Get a report from a narcologist.
4. Come to the psychoneurological clinic for examination.

How is the appointment going?

The state has not established a single approved approach to conducting an inspection, so there is no universal inspection scheme. The doctor can use several methods, combine them with each other, choosing depending on the purpose of the appointment and the patient’s condition. So, for driving a vehicle it is important to test the ability to concentrate, for working in a hospital - the ability to make decisions and take responsibility.

The conversation lasts up to 15 minutes.

Recommendations:

• Don't be silent, don't lower your eyes. If a question is unclear, ask for repetition or clarification.
• Be calm and open to dialogue.
• Answer a clearly stated question, avoid inappropriate jokes.

Survey

The examination by a psychiatrist often begins in a standard way: the doctor finds out the first and last name, basic information about the patient - education, place of birth, family, work. Then he can ask questions, the answers to which seem obvious: day of the week, time of year, day, location (city, country). It is important to answer calmly and not try to understand why they are asking this.

The doctor evaluates coherence of thoughts, logic, clarity of speech, ability to respond, and not knowledge.

If a person has already been to a psychiatrist or has problems, questions related to the diagnosis will arise:

• Do you often suffer from insomnia?
• Do you have any fears?
• What are your relationships like with loved ones?
• Do you have thoughts that are unusual for you?

Provocative questions are not excluded:

• Have you ever had suicidal thoughts?
• Were you not registered?
• How often do you become aggressive?

A standard set of clarifying questions about the condition is often enough to make a conclusion and issue a certificate. If a psychiatrist sees deviations or wants to clarify something, he may suggest starting to talk about himself and, in the middle of the patient’s monologue, ask him something off topic. "Where do penguins live?" or “What color is the sun?” Questions may arise that seem unrelated to the person’s mental state: “What is the difference between an airplane and a bird?”

Open

The patient must give a detailed answer, clearly explain and justify his opinion. There is no right or wrong option here: it is important to convey the idea clearly, not to remain silent for a long time, but also not to rush to say as much as possible in a minute. Many open questions concern the patient's habits, affections, actions and thoughts, so there are no uniform answer patterns.

It is better to tell the truth, not to think what conclusion the psychiatrist will draw, what he wants to find in the words.

The doctor may ask:

• What will make you smile?
• What country would you like to live in?
• What kind of music do you listen to all the time?
• What people would you remove from your life if you could?

Closed

Answers require 1 word, it is better to avoid attempts to reason. If the doctor wants the patient to justify his point of view, he will ask for an explanation. Elaborate reasoning is one of the signs of problems with thinking or attempts to hide the truth. So, to the question “Are you a conflict person?” there is no need to remember in detail all the quarrels and behavior in them. Stop answering “yes” or “no.”

Alternative

Choosing from the proposed options seems to be the most difficult for patients, but it is no more difficult than other issues. There is no right or good answer here. The doctor evaluates the logic and coherence of a person’s thoughts.

It is better to answer quickly and clearly, not to think for a long time, and to look the psychiatrist in the eyes. Don't laugh, don't show your tension or excitement.

Testing

This method is one of the basic ones in a psychiatric examination. It, like a survey, helps assess the patient’s ability for coherent logical thinking, identify hidden harmful tendencies (towards alcohol, violence, etc.), depression, phobias, mania, and test the stability of the nervous system.

Tests are often needed for bank employees, politicians, lawyers, and service professionals. They are also desirable for the military, security guards, and special forces.

Types of tests:

• To determine the emotional state. This is often a Luscher test with color selection. It is impossible to prepare and “answer correctly”, but it is better to avoid black - it is depression. The first ones to choose are red, green, yellow.
• On the perception of the world. Classic black blot test. Even a negative picture should be explained neutrally.
• On concentration. It is important to calmly go through all the stages, not to fuss, not to look for a double bottom in the task.
• On behavior in a stressful situation. This is often a Schreiner's test: a self-assessed questionnaire. For each “yes” – 1 point. The higher the final number, the worse the resistance to stress. The norm is 4-5. Another option: the Ivanchenko test. You need to rate on a scale from 1 to 4 how often the listed symptoms occur. The final norm values ​​are no more than 45 points.
• To the IQ level. Testing intelligence in a short time (up to half an hour) on questions from different areas: mathematics, logic, physics, etc. It is important to carefully read each task, because many have a catch.

Hypnosis

A person is immersed in a state of trance, which helps him reveal himself, speak honestly, without the influence of external factors and internal attitudes. Hypnosis is used for 2 purposes: to see the patient’s hidden problems or to influence his psyche. During the examination, the method is used for a person who has personality disorders and pathological anxiety. More often, hypnosis is a treatment method used by a psychotherapist.

Indications:

• malfunction;
• neuroses, sleep problems;
• chronic fatigue, anxiety.

Physical examination

If a psychiatrist sees signs of pathologies in a patient, he may prescribe (or conduct) an EEG - electroencephalography. This is a method for diagnosing the state of the brain, which is based on the activity of neurons: nerve cells. Images appear on the monitor with areas of organic lesions in different areas, which helps to clarify the diagnosis and determine its cause. The result can be displayed on paper.

Thanks to encephalography, they diagnose:

• tumors;
• depression;
• inflammation;
• epilepsy at an early stage;
• vascular pathologies.

Indications for the procedure:

• head and neck injuries;
• convulsive states and seizures;
• infections of the brain and blood vessels of the head;
• frequent migraines;
• severe mood swings.

EEG is prescribed to children and adults only when indicated, but the procedure is completely safe. Electrodes are attached to the head, through which the device records signals from neurons for half an hour. Diagnostics can be carried out under load: light flashes and loud sounds are given through glasses and headphones. This is necessary to assess the brain's response to stimuli.

Analyzes

This method does not make sense for assessing a person’s mental health. Tests are taken to clarify the diagnosis, especially if the patient is suspected of having a tumor. A psychiatrist may prescribe a biochemical blood test, a general urine test and an ECG - cardiogram. They are needed by drivers and people who get jobs with complex mechanisms: many heart and vascular diseases are a strict ban on such activities.

Visiting a psychiatrist at the military registration and enlistment office

When passing a driving commission, it is beneficial for a specialist to quickly issue a certificate, so problems can arise only in special cases. At the military registration and enlistment office everything is much more complicated. On the one hand, doctors need to provide the required number of recruits. On the other hand, prevent guys with obvious disabilities from getting weapons. Therefore, the questions here are much more diverse:

1. Describe the difference between a bird and an airplane.
2. Are you crazy?
3. Tell me the multiplication table.
4. Do epilepsy attacks occur?
5. Do you have phobias?
6. What is heavier, 1 kg of brick or cotton wool?
7. Is anything bothering you?
8. Where is Italy located?
9. What troops do you want to serve in?
10. Have you had suicidal thoughts?

Advice. A psychiatrist, like a narcologist, may ask to show your hands for injection marks. There is no need to refuse an inspection. Perhaps this is the only thing that is important for a specialist to know.

In some military registration and enlistment offices, psychiatrists prepare in advance for a conversation with a conscript by studying characteristics from the place of study or work. And in others, they don’t ask questions at all if the visitor has no complaints. The main thing is to behave completely calmly at the reception and not be afraid of the wrong answers.

If the psychiatrist does not like the answers to his questions, the commission may be denied

Inspection results

When a person has passed all the examinations, the medical commission draws up the results on a special strict recording form. The decision is made based on the opinion of the majority of votes.

The document is prepared within 20 days from the date of inspection and 10 days from the date of drawing up the conclusion.

The person signs it upon receipt, which shows his agreement with the decision. At the same time, the results of the examination are entered into the medical record.

The decision of the medical commission

The final document is a medical certificate with a seal and signatures of the specialists who examined the patient, the chief physician (or therapist). If everything went well, it will contain a positive conclusion that the person is suitable for work in the chosen position, or is allowed to drive a vehicle or carry a weapon.

If the commission sees grounds for refusal, the person is given a referral for additional examinations or treatment.

Validity period of the received certificate:

• The license is valid for 10 years, but every 2 years the inspection must be repeated.
• To carry a weapon – 6 months.
• For employment – ​​5 years.

Possible problems during inspection

Difficulties with the decision or a negative response from the commission appear if the person has been registered with a psychiatric patient or is still on it. This happens with chronic or long-term disorders: severe depression, psychosis, etc.

They are deregistered only after 3 years of stable remission. If they have not yet passed, they may refuse to issue a positive certificate.

The conclusion can be challenged and the psychiatrist’s commission can be repeated and additional diagnostics can be requested. If the diagnosis is not confirmed, the first document is considered invalid. If a person’s mental state is unstable, a new decision on labor restrictions will be issued, which will be valid for 5 years.

Appealing a medical opinion

The Decrees of the Government of the Russian Federation (1604 and 143) indicate contraindications to driving and carrying weapons. A ban can only be given on the basis of these documents. If a person does not agree with the result of the examination, considers the diagnosis to be incorrect or his rights have been infringed, he may not sign the document and file a protest in court. This is regulated by the Code of Civil Procedure of the Russian Federation, Art. 3, part 1.

Procedure for appealing:

1. Go through separate examinations with doctors in other medical institutions.
2. Make copies of the received certificates and have them certified by a notary.
3. Write an application to the psychoneurological dispensary for deregistration.
4. If they refuse, write a complaint to the administration. Next - to the Ministry of Health: in person, by mail or through the website. Attach certificates, application, sick leave, test results, copy of passport. The request will be reviewed within 30 days.
5. If this does not produce results, go to the prosecutor's office or court. The statement of claim is drawn up under Article 131 of the Civil Law Code of the Russian Federation. In court you need to ask for an independent medical examination. If she shows that there are no contraindications to work, driving or carrying weapons described by the medical board, the court will make a decision in favor of the plaintiff. The conclusion will be canceled and the necessary certificate will be issued.

Responsibility for refusing inspection

By law, a person visits a psychiatrist voluntarily. Forced under Art. 213 of the Labor Code of the Russian Federation, this is done only by persons who work in conditions of increased danger. Their list is indicated in 377 Decree of the Government of the Russian Federation dated April 28, 1993. This happens at the expense of the company.

Many enterprises do not ask employees for certificates every 5 years, but if there is an inspection and the person refuses the request to undergo a medical examination, he is reprimanded. Next comes a fine - 15-25 thousand rubles, and from the company to the state - up to 130. This is indicated in the Code of Administrative Offenses, Art. 5.27.1, part 3. If the person refuses again, the person is fired.

Other situations:

• To obtain a driver's license or a concealed weapon permit, a psychiatric evaluation is required.
• You can refuse and not bear responsibility for this only during a child examination: according to the law, psychiatric care is provided to a child with the consent of the parents.