What Comprehensive Psychiatric Assessment Actually Looks Like (When Your Doctor Cares About Your Whole Health)

The Appointment That Surprised Her

A few months ago, a new patient named Jennifer came to see me. She’d been referred by her primary care doctor for depression. She’d been to psychiatrists before, so she thought she knew what to expect.

Fifteen-minute appointment. Quick questions about symptoms. Prescription. Done.

When my scheduler told her the initial appointment was two hours, she was confused. “Two hours? What are we going to talk about for two hours?”

At the appointment, I started with the usual psychiatric questions. When did the depression start? What does it feel like? Sleep? Appetite? Energy? Thoughts of hurting yourself?

Then I kept going. Family history. Not just psychiatric history, but cardiovascular history. Who had heart attacks? Who had strokes? At what age?

Her father had a heart attack at 52. Her paternal grandfather died suddenly at 48.

“Wait,” Jennifer said. “I thought I was here for depression. Why are you asking about heart attacks?”

“Because your depression increases your cardiovascular risk by 30-50%,” I explained. “And with that family history, we need to know your complete cardiovascular picture. I’m not just treating your mood. I’m treating you as a whole person who has both a brain and a heart.”

I ordered lab work. Not just thyroid and basic metabolics that most psychiatrists order. Comprehensive lipid panel including Lp(a), inflammatory markers, metabolic markers, omega-3 index.

“My regular doctor checked my cholesterol last year,” Jennifer said. “It was fine.”

“I’m sure it was. But we’re looking deeper. Advanced cardiovascular testing catches things basic panels miss, especially in people with depression and strong family history.”

Two weeks later, we reviewed her results. Her basic cholesterol was indeed normal. But her Lp(a) was 168 (very high). Her hs-CRP was 4.8 (elevated inflammation). Her fasting insulin was 18 (early insulin resistance).

Jennifer stared at the results. “So my cholesterol is fine, but I’m still at risk?”

“Yes. And now we know that. We can address it. We can prevent you from following in your father’s footsteps.”

We created a comprehensive treatment plan. SSRI for depression (choosing one that would also help inflammation and cardiovascular risk). Therapy. High-dose omega-3s. Major diet overhaul. Exercise when she had energy. Close monitoring with her primary care doctor and a cardiologist.

Six months later, Jennifer told me: “When I first heard the appointment was two hours, I thought it was excessive. Now I realize no one’s ever actually looked at my whole health like this before. They just treated symptoms without understanding what was really going on.”

That’s what comprehensive assessment should look like. And that’s what I want to explain today.

Why Standard Psychiatric Evaluation Isn’t Enough

Don’t get me wrong. Standard psychiatric evaluation has its place. When someone is in crisis, you need to assess safety and start treatment quickly. Fifteen to thirty minutes might be all you have.

But for someone who’s not in immediate crisis, who wants to understand their health and prevent future problems, standard evaluation misses too much.

What Standard Psychiatric Evaluation Covers

Typically:

• Current symptoms (depression, anxiety, etc.)
• Duration and severity
• Past psychiatric history
• Medications tried before
• Family psychiatric history
• Substance use
• Safety assessment (suicidal thoughts, homicidal thoughts)
• Basic medical history
• Maybe some lab work (thyroid, sometimes)

This is fine for diagnosing depression or anxiety and starting treatment. But it tells you nothing about:

• Your cardiovascular risk
• Whether inflammation is driving your symptoms
• Your metabolic health
• Your autonomic nervous system function
• Nutritional deficiencies affecting your brain and heart
• Other medical factors contributing to your mental health

You get treated like a brain without a body.

The Problem with This Approach

When we only look at mental health symptoms without understanding the biological context:

We miss opportunities for prevention. Someone with depression and family history of heart disease needs aggressive cardiovascular risk reduction, not just an antidepressant.

We miss root causes. Sometimes depression is secondary to inflammation, metabolic dysfunction, or other medical issues. Treating just symptoms without addressing root causes leads to incomplete recovery.

We make suboptimal treatment choices. If you have both depression and elevated cardiovascular risk, some medications are better choices than others. But you need to know the cardiovascular risk first.

We don’t educate patients about connections. Most people don’t know their depression affects their heart. They should know. It empowers them to take treatment seriously.

What Comprehensive Assessment Includes

So what does it look like when a psychiatrist actually cares about your whole health? Let me walk you through what happens in my practice.

The Initial Interview (60-90 minutes)

This is longer than standard psychiatric intake because we’re covering more ground.

Standard psychiatric history:

• Current symptoms in detail
• How they affect your functioning
• When they started and how they’ve progressed
• Past episodes of depression, anxiety, or other mental health issues
• Past treatments and how they worked
• Current stressors and triggers

Comprehensive family history: Not just “does depression run in your family?” but:

• Who had heart attacks, strokes, or sudden cardiac death?
• At what ages?
• Who had diabetes, high blood pressure, high cholesterol?
• Who had dementia or Alzheimer’s?
• Any autoimmune conditions?
• Pattern of mental health issues across generations

This family history tells us your genetic cardiovascular risk and helps identify patterns.

Detailed personal medical history:

• Past medical problems
• Surgeries and hospitalizations
• Current medications (all of them, including over-the-counter)
• Allergies and adverse reactions
• Reproductive history for women (pregnancy, menopause affect cardiovascular risk)
• Any concerning symptoms (chest pain, shortness of breath, palpitations)

Lifestyle assessment:

• Sleep patterns and quality
• Exercise and movement
• Diet (detailed, not just “do you eat healthy”)
• Substance use (alcohol, tobacco, cannabis, others)
• Stress at work and home
• Social connections and support
• Trauma history (trauma affects both mental health and cardiovascular risk)

Review of systems: This is where we ask about symptoms in every body system, not just mental health. Sometimes we find important clues:

• Frequent infections (immune dysfunction)
• Digestive issues (gut health affects both brain and heart)
• Skin problems (can indicate inflammation)
• Joint pain (inflammation)
• Unexplained weight changes
• Temperature intolerance (thyroid)

By the end of this interview, I understand not just your mental health symptoms but your overall health picture and risk factors.

The Physical Exam

Many psychiatrists don’t do physical exams. I always do at least a basic one:

Vital signs:

• Blood pressure (both arms, sitting and standing)
• Heart rate
• Weight and BMI
• Sometimes waist circumference (indicator of metabolic health)

Cardiovascular exam:

• Listening to heart (checking for murmurs or irregular rhythms)
• Checking pulses
• Looking for signs of fluid retention or poor circulation

General appearance:

• Signs of thyroid problems
• Skin changes suggesting nutritional deficiencies
• Signs of substance use
• Overall level of distress and function

This isn’t as detailed as what your primary care doctor does, but it catches obvious problems and gives me baseline data.

The Lab Work

This is where comprehensive assessment really differs from standard psychiatry. I order labs that most psychiatrists don’t think about.

Standard psychiatric labs:

• Complete blood count (CBC)
• Comprehensive metabolic panel (electrolytes, kidney function, liver function)
• Thyroid function (TSH, sometimes Free T4 and T3)
• Vitamin B12
• Vitamin D

Advanced cardiovascular labs:

• Lipid panel: Not just basic cholesterol, but advanced testing: 
  • Standard lipid panel (LDL, HDL, triglycerides)
  • Lipoprotein(a) – that genetic risk factor I’ve written about
  • ApoB (particle number)
  • Sometimes LDL particle size if indicated
• Inflammatory markers: 
  • hs-CRP (high-sensitivity C-reactive protein)
  • Sometimes IL-6 or other cytokines if indicated
• Metabolic markers: 
  • Hemoglobin A1c (average blood sugar over 3 months)
  • Fasting insulin (catches insulin resistance early)
  • Fasting glucose
• Other cardiovascular markers: 
  • Homocysteine (if family history suggests it)
  • Omega-3 index (fatty acid status)
  • Sometimes fibrinogen or MPO (specialized inflammation markers)

Additional testing if indicated:

• Cortisol (if suspected cortisol dysregulation)
• Sex hormones (testosterone, estrogen, progesterone if symptoms suggest)
• Comprehensive nutrient panels
• Genetic testing (MTHFR, ApoE, others if family history suggests)

Yes, this is a lot of labs. Insurance doesn’t always cover everything. But the information is incredibly valuable for creating a comprehensive treatment plan.

The Follow-Up Discussion (30-45 minutes)

About two weeks after labs come back, we meet again to review everything and create a treatment plan.

I explain every result. Not just “your labs are fine” or “your cholesterol is high.” I walk through what each number means, why it matters, and how it affects both your mental health and cardiovascular health.

Then we create a comprehensive plan that addresses:

• Mental health symptoms
• Cardiovascular risk factors
• Inflammation
• Metabolic health
• Lifestyle factors
• Prevention strategies

This isn’t just “take this antidepressant and come back in six weeks.” It’s a roadmap for your whole health.

Real Examples: What Comprehensive Assessment Finds

Let me share three examples of patients where comprehensive assessment revealed critical information that standard evaluation would have missed.

Michael: The Hidden Inflammation

Michael came in for depression. Standard psychiatric history was unremarkable. Moderate depression, never treated before, no family psychiatric history.

Comprehensive assessment revealed:

• Father had heart attack at 49
• Grandfather died suddenly at 52
• Brother had early coronary artery disease at 45

His labs showed:

• Basic cholesterol: normal
• Lp(a): 178 (very high)
• hs-CRP: 8.1 (extremely elevated inflammation)
• Fasting insulin: 22 (insulin resistance)

Further investigation revealed possible celiac disease (gluten intolerance) causing chronic inflammation.

If I’d just treated his depression with standard approach, we would have missed:

• His sky-high cardiovascular risk
• The inflammation driving both depression and heart disease risk
• The possible celiac disease needing evaluation
• The opportunity to prevent him from following his family pattern

Instead, we:

• Treated his depression with an SSRI (anti-inflammatory)
• Got him to a gastroenterologist (diagnosed celiac, went gluten-free)
• Started aggressive cardiovascular risk reduction
• His hs-CRP dropped from 8.1 to 1.9 in six months
• His depression improved dramatically

We didn’t just treat depression. We potentially saved his life.

Sarah: The Thyroid Surprise

Sarah had been treated for “treatment-resistant depression” for three years. She’d tried four different antidepressants. Nothing worked well.

Her previous psychiatrist had checked her TSH (thyroid screening test) at some point. It was “normal.”

In my comprehensive evaluation, I checked not just TSH but Free T4 and Free T3. Her TSH was borderline. Her Free T3 was low-normal. Not technically hypothyroid, but suboptimal thyroid function.

I also found:

• Family history of autoimmune thyroid disease
• Positive TPO antibodies (Hashimoto’s thyroiditis)
• High cholesterol (related to thyroid)
• Fatigue, cold intolerance, constipation (thyroid symptoms)

We treated her thyroid. Her depression improved more in two months than it had in three years of trying different antidepressants.

Standard evaluation would have said “TSH is normal, not thyroid.” Comprehensive evaluation found the real problem.

David: The Metabolic Connection

David came in for depression and anxiety. He was 42, overweight, stressed at work. Pretty typical presentation.

Comprehensive labs showed:

• Prediabetes (A1c 5.9%)
• High fasting insulin (26)
• High triglycerides (245)
• Low HDL (38)
• Elevated inflammation
• Low testosterone (related to insulin resistance)

This is metabolic syndrome. It increases cardiovascular risk dramatically. And it was contributing to his depression and anxiety.

Standard psychiatric approach: prescribe an antidepressant, maybe one that causes weight gain, make the metabolic problems worse.

Comprehensive approach:

• SSRI that doesn’t worsen metabolism
• Major lifestyle overhaul (diet, exercise)
• Metformin (helps insulin resistance)
• Supplements (omega-3s, vitamin D, magnesium)
• Close monitoring of metabolic parameters

Six months later:

• A1c down to 5.4% (no longer prediabetic)
• Lost 35 pounds
• Triglycerides 120
• Depression significantly improved
• Anxiety much better

We didn’t just treat symptoms. We addressed root causes and prevented progression to diabetes and cardiovascular disease.

What This Costs (The Honest Discussion)

Let’s talk about money because I know that’s a concern.

Time Investment

Initial evaluation: 90-120 minutes (sometimes split across two appointments)

Lab review and treatment planning: 30-45 minutes

Follow-ups: Usually 30 minutes (not the 15-minute medication checks many psychiatrists do)

More time means higher costs if you’re paying out of pocket. But it also means better care and fewer wasted appointments trying things that don’t work.

Lab Costs

If insurance covers labs:

• Standard labs: usually fully covered
• Advanced lipids: often covered with appropriate diagnosis codes
• Lp(a): increasingly covered, sometimes $20-50 copay
• Specialty tests: variable coverage

If paying out of pocket:

• Standard psychiatric labs: $100-200
• Advanced cardiovascular labs: $100-300 additional
• Specialty tests: variable

Total lab costs: typically $200-500 if out-of-pocket, much less with insurance.

Is it worth it? If we find high Lp(a), catch prediabetes early, identify inflammation driving your symptoms, or discover a thyroid problem that’s been missed… absolutely yes.

The Value Proposition

Compare the costs of comprehensive assessment to:

• Years of trying different medications that don’t work well
• Missing a cardiovascular risk factor until you have a heart attack
• Not addressing root causes so symptoms keep recurring
• Treating depression while metabolic syndrome progresses to diabetes

Comprehensive assessment costs more upfront. But it often saves money and suffering long-term by getting it right the first time.

How to Find This Kind of Care

Not every psychiatrist practices this way. Most don’t, frankly. So how do you find someone who does?

What to Look For

Training in integrative psychiatry or functional medicine. Not everyone with this training practices comprehensively, but it’s a good sign.

Interest in medical aspects of psychiatric conditions. Check their website or bio. Do they talk about the mind-body connection? Comprehensive care? Preventive approaches?

Longer appointment times. If a practice advertises 15-minute medication checks as standard, they’re not doing comprehensive assessment.

Willingness to order labs beyond standard psychiatric screening.

Collaborative approach with other specialists (primary care, cardiology, endocrinology).

Questions to Ask When Calling

“How long is the initial evaluation?”

“What kind of lab work do you typically order?”

“Do you address cardiovascular health as part of psychiatric treatment?”

“Do you have experience with patients who have both mental health and medical concerns?”

Their answers will tell you if they practice comprehensively.

Alternative Models

If you can’t find a psychiatrist who practices this way:

Work with your primary care doctor who’s willing to order comprehensive labs and collaborate with your psychiatrist on a holistic plan.

See a functional medicine doctor for the comprehensive medical assessment and a psychiatrist for medication management.

Find a naturopathic doctor (ND) trained in mental health who can do comprehensive assessment and work with an MD for prescriptions.

The ideal is one provider who does it all, but collaborative care can work too.

What to Expect After Assessment

So you’ve done comprehensive assessment. Now what?

The Treatment Plan

You’ll get a detailed plan that addresses:

Mental health treatment:

• Medication if indicated (chosen based on your complete health picture)
• Therapy referral (specific type based on your needs)
• Lifestyle interventions

Cardiovascular risk reduction:

• Treatment of any identified risk factors
• Preventive strategies
• Monitoring plan

Metabolic optimization:

• Diet and exercise specifics
• Supplements if indicated
• Medication if needed (like metformin for insulin resistance)

Inflammation reduction:

• Addressing sources of inflammation
• Anti-inflammatory interventions
• Monitoring inflammatory markers

Other medical issues:

• Referrals to specialists if needed
• Treatment of thyroid, vitamin deficiencies, etc.

The Follow-Up Schedule

More frequent than standard psychiatry at first:

• 2-4 weeks after starting treatment (checking how you’re tolerating medications)
• 6-8 weeks (assessing initial response)
• 3 months (rechecking labs if needed)
• 6 months (comprehensive reassessment)

Then less frequent once stable (every 2-3 months).

This is ongoing care, not episodic “call me when you’re in crisis” medicine.

The Long-Term Approach

Comprehensive care isn’t just about treating current symptoms. It’s about:

• Preventing future problems
• Optimizing your overall health
• Catching changes early
• Adjusting treatment as you age or your life changes

It’s a partnership for your long-term health, not just a quick fix for current symptoms.

Frequently Asked Questions

Q: Do I need comprehensive assessment if my depression is mild?

A: It depends on your overall health and risk factors. If you have strong family history of heart disease, metabolic issues, or other concerns, comprehensive assessment makes sense even for mild depression. If you’re young, healthy, no risk factors, standard assessment might be fine.

Q: Will insurance cover this?

A: Most insurance covers psychiatric evaluation and standard labs. Advanced testing coverage varies. Many of the tests are increasingly covered, especially with appropriate diagnosis codes (like family history of heart disease). Ask ahead of time what’s covered.

Q: How is this different from what my primary care doctor does?

A: Your PCP does comprehensive medical assessment but may not deeply understand the mental health aspects or the mind-body connections. Comprehensive psychiatric assessment integrates mental health expertise with medical understanding. Ideally, your psychiatrist and PCP work together.

Q: What if I just want treatment for my depression and don’t care about cardiovascular stuff?

A: That’s your choice. But I’d encourage you to at least know your risk factors. You can’t make informed decisions without information. And the treatment we choose might be different if we know your complete picture.

Q: How long before I see results from this approach?

A: Some things improve quickly (weeks to months). Others are long-term prevention (years to decades). But the advantage is we’re not just putting band-aids on symptoms. We’re addressing root causes and preventing future problems.

Q: Do I need to keep doing all this monitoring forever?

A: Some things we check once (like Lp(a) – it’s genetic and doesn’t change). Others we monitor periodically (inflammation, metabolic markers). The intensity of monitoring decreases once you’re stable and optimized.

Q: What if comprehensive assessment doesn’t find anything?

A: Sometimes we don’t find medical issues contributing to mental health symptoms. That’s okay. At least you know your cardiovascular and metabolic health is good. We proceed with standard mental health treatment, but with peace of mind about your overall health.

Q: Is this “functional medicine” or “alternative medicine”?

A: It’s comprehensive, evidence-based medicine. Everything I’ve described is supported by mainstream medical research and guidelines. It’s just more thorough than what many psychiatrists do. It’s standard of care in cardiology and endocrinology, applied to psychiatry.

The Bottom Line

Comprehensive psychiatric assessment goes beyond standard evaluation to understand your whole health picture, not just your mental health symptoms.

It includes:

• Detailed personal and family history (psychiatric and medical)
• Physical examination
• Comprehensive lab work (cardiovascular, metabolic, inflammatory markers)
• Treatment planning that addresses both mental health and physical health
• Ongoing monitoring and prevention

This approach finds things standard evaluation misses:

• Hidden cardiovascular risk factors
• Medical causes of psychiatric symptoms
• Opportunities for prevention
• Root causes that need addressing

It costs more time and money upfront but often saves both long-term by getting treatment right and preventing future problems.

Not every psychiatrist practices this way, but if you have cardiovascular risk factors, strong family history, or have struggled to find effective treatment, comprehensive assessment might be exactly what you need.

Your brain and your heart are connected. Your care should reflect that.

Interested in Comprehensive Assessment?

If you want psychiatric care that considers your whole health, not just your mental health symptoms, my practice offers comprehensive evaluation and ongoing integrative treatment.

Initial evaluations are thorough (90-120 minutes) and include detailed assessment of cardiovascular risk, metabolic health, and other factors affecting both your mental and physical wellbeing.

Keep Reading

More about integrative psychiatric care:

• Why Your Psychiatrist Should Care About Your Heart
• Your Heart and Mind Are Connected: Complete Guide
• Advanced Cardiovascular Testing: What You’re Missing
• When Treating Depression Saves Your Heart

References & Research

This article describes clinical practice based on current medical guidelines:

1. Virani SS, et al. (2023). 2023 AHA/ACC Guidelines for Chronic Coronary Disease. Journal of the American College of Cardiology. 82(9):833-955. [Guidelines supporting comprehensive cardiovascular assessment]
   
2. Levine GN, et al. (2021). Psychological Health, Well-Being, and the Mind-Heart-Body Connection: AHA Scientific Statement. Circulation. 143(10):e763-e783. [Scientific basis for integrated mental health and cardiovascular care]
   
3. Wilson DP, et al. (2019). Use of Lipoprotein(a) in Clinical Practice. Journal of Clinical Lipidology. [Guidelines on Lp(a) screening]
   
4. Mensah GA, et al. (2025). Inflammation and Cardiovascular Disease: ACC Scientific Statement. Journal of the American College of Cardiology. [Guidelines on inflammation assessment]
   
5. Grundy SM, et al. (2019). 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Circulation. 139(25):e1082-e1143. [Comprehensive cholesterol assessment guidelines]
   
6. American Psychiatric Association. (2016). Practice Guideline for the Psychiatric Evaluation of Adults (Third Edition). [Standard psychiatric evaluation guidelines]
   
7. Lake J, Spiegel D. (2017). Complementary and Alternative Treatments in Mental Health Care. American Psychiatric Publishing. [Integrative psychiatry approaches]
   
8. El Baou C, et al. (2023). Psychological Therapies for Depression and Cardiovascular Risk. European Heart Journal. 44(18):1650-1662. [Evidence for integrated approach]
   
9. Apostolos A, et al. (2025). Depression and Coronary Artery Disease—Where We Stand? Journal of Clinical Medicine. 14(12):4281. [Current understanding of depression-CAD connection]
   
10. Noordzij R, et al. (2024). Practice Recommendations on the Management of Cardiometabolic Risk in Mental Healthcare. European Psychiatry. 67(1):e38. [Guidelines for metabolic monitoring in psychiatric patients] 

For verification: Current guidelines recommend screening for cardiovascular risk factors in patients with depression. Comprehensive lipid panels including Lp(a) are recommended for patients with family history of premature cardiovascular disease. hs-CRP and metabolic markers help identify inflammation and metabolic dysfunction contributing to both mental health symptoms and cardiovascular risk.

About Dr. Bliss Lewis

Dr. Bliss Lewis is a board-certified psychiatrist specializing in integrative medicine. Her practice emphasizes comprehensive assessment that addresses both mental health and physical health, recognizing that optimal psychiatric care requires understanding the whole person.

This article describes one approach to comprehensive psychiatric care. Different practitioners may have different approaches. Discuss your individual needs with healthcare providers.