NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales
NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales
NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales
INITIAL POST
Explain three important components of a psychiatric interview and why you consider these elements important.
Introduction
In the research according to (“The Psychiatric Interview and Mental State Examination” (n,d)), a psychiatric interview is a structured clinical conversation complemented by observation and mental state examination, supplemented by a physical examination which is the foundation of accurate psychiatric diagnosis through accurate history taking and assessment. The goal is to establish and build a therapeutic relationship with the patient of trust, and openness, in order to collect, organize, and synthesize detailed relevant information connected to the presenting problem, assess the personality of the patient, conduct a mental status examination, and assess psychopathology, write a diagnostic formulation, and list the differential diagnoses. In the research according to Savander et al (2021), the clinical goal of the psychiatric interview is to evaluate the patient’s problems and provide an evidence-based treatment grounded on the symptom-oriented diagnostic ICD-10/DSM-5 categories.
History of the present illness (HPI)
According to “The Psychiatric Interview and Mental State Examination” (n.d.) research, rapport and the agenda are established at the beginning of the interview between the patient and the provider. During HPI, circumstances leading to the current condition are accounted for. Details of the relevant events, sequence of the responses, and symptoms should be provided. Help-seeking behaviors, recent interventions, and treatments are assessed.
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Family history
The family history should encompass any history of psychiatric or physical health problems including established or suspected diagnoses, and treatments received. It is important to know the family history because there are shared traits that cannot be seen containing information on health conditions that tend to run in families. These traits may increase hereditary conditions and diseases. Therefore, knowing medical history will help the healthcare provider to take action to reduce the risks.
Suicide risk assessment
According to (Centers for Disease Control and Prevention), suicidal thoughts or actions are signs of extreme distress and should not be ignored, there the purpose of the interview is to prevent suicidal actions. In the research according to Oquendo & Bernanke (2017), 800,000 people die by suicide each year, and for each suicide, as many as 20 more individuals have attempted suicide. The assessment and management of suicide risk is considered a core competency for psychiatrists, yet guidelines diverge in their recommendations and there is no universally accepted model. Risk assessment and management are best conceptualized as a process and not a single event that includes structured evaluation, intervention, and re‐assessment. Some patients suffer transient but intense suicidal thoughts, which are not captured at the time of assessment. Numerous factors contribute to suicide risk and can be divided into distal and proximal factors. Distal factors may include genetics, personality characteristics such as impulsivity and aggression, prenatal and perinatal circumstances, childhood trauma, and neurobiological disturbances. Proximal risk factors may include mental illness, physical illness, psychosocial crises, substance use, availability of lethal means, and exposure to suicidal behavior (Ryan and Oquendo 2020).
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Explain the psychometric properties of the rating scale
Depression in earlier and later life stages is characterized by different factors and life events and it is a significant and common contributor to poor health, especially among older people. Geriatric Depression Scale (GDS) is a widely and frequently used scale developed specifically to assess, evaluate, and identify depression symptoms in the geriatric population (Nikmat et al., 2021). GDS is a mood-focused scale that can be used in any environment such as acute psychiatric or primary care, assisted living, or long-term care facilities. It was created for the elderly population depression testing, which helps PMHNP psychiatric assessment of affective and behavioral symptoms to rule out somatic and dementia illnesses.
When it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment
The rating scales are appropriately used during the research study and clinical practice to evaluate people with psychotic disorders, the HPI portion of the psychiatric interview/assessment, and ongoing monitoring of patient conditions. The scale is also an added tool for nurses to use in monitoring the effectiveness and outcome of both medical and nursing interventions. The PMHNP uses the scale to rank the severity of the symptoms which gives them an idea about how much the condition affects the patient and to track changes in the symptoms over time.
Conclusion
Psychiatric interview is crucial in the collection of critical information during the assessment, diagnosis, planning, treatment, and evaluation of patients with mental health conditions. The scales are designed to meet various needs including screening, diagnosis, and treatment monitoring. The geriatric population is vulnerable to depression related to age, socioeconomic status, low levels of neurotransmitters, family history of depression, and traumatic life events. According to Risal et al., (2020), GDS has been used in different cultures and it has proved to be a reliable and valid instrument for adult depression.
References
“Centers for Disease Control and Prevention.” “Risk and Protective Factors.” Www.cdc.gov, 2021, www.cdc.gov/suicide/factors/index.html
Risal et al., (2020). Nepali Version of Geriatric Depression Scale-15 – A Reliability and Validation Study. Journal of Nepal Health Research Council, 17(4), 506–511. https://doi.org/10.33314/jnhrc.v17i4.1984
Ryan and Oquendo (2020). “Suicide Risk Assessment and Prevention: Challenges and Opportunities.” FOCUS, vol. 18, no. 2, Apr. 2020, pp. 88–99, 10.1176/appi.focus.20200011.
Nikmat et al., (2021). Psychometric Properties of Geriatric Depression Scale (Malay Version) in Elderly with Cognitive Impairment. The Malaysian journal of medical sciences : MJMS, 28(3), 97–104. https://doi.org/10.21315/mjms2021.28.3.9
Oquendo & Bernanke (2017). Suicide risk assessment: tools and challenges. World Psychiatry. 2017 Feb;16(1):28-29. doi: 10.1002/wps.20396. PMID: 28127916; PMCID: PMC5269494.
Savander et al (2021). “The Patients’ Practices Disclosing Subjective Experiences in the Psychiatric Intake Interview.” Frontiers in Psychiatry, vol. 12, 10 May 2021, 10.3389/fpsyt.2021.605760.
“The Psychiatric Interview and Mental State Examination” (n,d). Clinical Gate, 24 May 2015, clinicalgate.com/the-psychiatric-interview-and-mental-state-examination/.
Your post is informative, Daniela. I acknowledge that BDI is one of the best assessment tools for determining the severity of depression in clients. As you noted, this tool provides a standardized measure, which facilitates a quantifiable assessment of the impact and severity of depression on the routine functioning of the patients. The information obtained can inform treatment decisions, help in the development of treatment goals, and assess changes in symptomatology over time. However, BDI is associated with limitations such as the risk of exaggerating or minimizing the scores by the person completing the assessment. Also, the manner of administering the instrument can cause effects on the final score (Upton, 2020). The alternative tool that can be used is the Beck Hopelessness Scale (BHS). This tool is a 20-item self-report inventory developed to measure three major aspects of hopelessness including lack of motivation, feelings about the future, and expectations (Sueki, 2022). It involves a true-false test and is suitable for adults between the ages of 17 and 80. This tool can be used as a pointer of suicide ideation in depressed individuals who have attempted suicide.
References
Sueki, H. (2022). Relationship between Beck Hopelessness Scale and suicidal ideation: A short-term longitudinal study. Death Studies, 46(2), 467-472. https://doi.org/10.1080/07481187.2020.1740833
Upton, J. (2020). Beck depression inventory (BDI). Encyclopedia of behavioral medicine, 202-203. DOI: 10.1007/978-3-030-39903-0_441
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
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To Prepare:
- Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
- Consider the elements of the psychiatric interview, history, and examination.
- Consider the assessment tool assigned to you by the Course Instructor.
By Day 3 of Week 2
Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature. NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales
Read a selection of your colleagues’ responses.
By Day 6 of Week 2
Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 2 Discussion Rubric
Post by Day 3 of Week 2 and Respond by Day 6 of Week 2
To Participate in this Discussion:
Week 2 Discussion
What’s Coming Up in Module 2?
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In Module 2, you will begin a systematic review of mental health disorders. You will apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information. You will also formulate differential diagnoses for patients across the lifespan using DSM-5 criteria.
Next Module
To go to the next module:
Module 2
Week 2: Assessment and Diagnosis of the Psychiatric Patient
A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.
—Pamela Bjorklund, clinical psychologist
Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.
This week, as you explore assessment and diagnosis of patients in mental health settings, you examine assessment tools, including their psychometric properties and appropriate uses. You also familiarize yourself with the DSM-5 classification system.
Reference: Bjorklund, P. (2013). Assessment and diagnosis. In K. Wheeler (Ed.), Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.) (pp. 95–168). Springer Publishing Company.
Learning Objectives
Students will:
- Evaluate elements of the psychiatric interview, history, and examination
- Analyze psychometric properties of psychiatric rating scales
- Justify appropriate use of psychiatric rating scales in advanced practice nursing
Learning Resources
Getting Started With the DSM-5
If you were to give a box of 100 different photographs to 10 people and ask them to sort them into groups, it is very unlikely that all 10 people would sort them into the exact same groups. However, if you were to give them a series of questions or a classification system to use, the chances that all 10 people sort them exactly the same increases depending on the specificity of the system and the knowledge of those sorting the photographs.Photo Credit: [Peter Polak]/[iStock / Getty Images Plus]/Getty Images
This is not unlike what has occurred in the process of classifying mental disorders. A system that provides enough specificity to appropriately classify a large variety of mental disorders while also attempting to include all of the possible symptoms, many of which can change over time, is a daunting task when used by a variety of specialists, doctors, and other professionals with varied experience, cultures, expertise, and beliefs. The DSM has undergone many transformations since it was first published in 1952. Many of these changes occurred because the uses for the DSM changed. However, the greatest changes began with the use of extensive empirical research to guide the creation of the classification system and its continued revisions.
In order to assess and diagnose patients, you must learn to use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated as the DSM-5, to render a diagnosis. In this second week of the course, you will examine how DSM-5 is organized and how clinicians use it to render diagnoses.
Review the Learning Resources this week, with special emphasis on viewing the Diagnostic Criteria video. This video explains the purpose and organization of the DSM-5 classification system, the purpose of the ICD-10 coding system, their relationship to one another, and the importance to the PMHNP role.
The Psychiatric Evaluation And Evidence-Based Rating Scales
The psychiatric interview comprises three crucial elements: the chief complaint, psychiatric history, and mental status examination (Gao et al., 2020). Including these elements is imperative for a thorough evaluation and determination of diagnosis, furnishing significant insights for developing treatment strategies.
First, the chief complaint allows the individual to articulate their principal apprehension or motive for pursuing psychiatric assessment. Gathering chief complaints concentrates the evaluation and directs subsequent inquiry, ensuring that the healthcare provider attends to the most urgent matters.
Secondly, obtaining a thorough psychiatric history is crucial in comprehending the patient’s background, prior mental health diagnoses, treatments, and psychosocial determinants (Gao et al., 2020). This aids in the identification of prior psychiatric episodes, familial history of mental illness, substance abuse, or traumatic events. Using psychiatric history is crucial in developing an accurate diagnosis, devising a suitable treatment plan, and identifying possible risk factors or contraindications.
Finally, the Mental Status Examination (MSE) assesses the individual’s present cognitive, emotional, and behavioral performance (Dietrich & Tamas, 2020). The assessment evaluates various aspects of the individual’s presentation, including their physical appearance, verbal communication, cognitive functioning, emotional state, perceptual experiences, and level of self-awareness. The Mental Status Examination (MSE) furnishes impartial information regarding the patient’s mental condition, thereby assisting in distinguishing between various diagnoses and tracking alterations in the patient’s condition over a period. This aids healthcare professionals in evaluating the magnitude of symptoms, ascertaining the degree of functional impairment, and pinpointing any particular areas of interest.
Regarding the psychometric characteristics of the designated rating scale, the Beck Depression Inventory (BDI) is a frequently employed self-report survey instrument utilized for evaluating the intensity of depressive symptoms. According to Georgi (2019), the Beck Depression Inventory (BDI) exhibits good internal consistency and test-retest reliability, indicating high levels of reliability and validity. The assessment tool comprises a total of 21 distinct indicators that correspond to particular manifestations of depression. These indicators are evaluated using a four-point Likert scale. The aggregate score indicates the gravity of depressive symptoms, encompassing a spectrum from mild to severe depression.
The Beck Depression Inventory (BDI) is a suitable tool to employ in a psychiatric interview to evaluate indications of depression in clients. The utilization of screening tools can aid in the detection of depression, facilitate the monitoring of treatment efficacy, and enable the evaluation of responses to interventions. The utilization of a scale in psychiatric assessment is of great assistance to nursing practitioners, specifically in evaluating depressive symptoms. This is because it provides a standardized measure, which enables a quantifiable assessment of the severity and impact of depression on the patient’s daily functioning. This data can provide direction for treatment decisions, assist in formulating treatment objectives, and monitor alterations in symptomatology across time.
To sum up, the primary grievance, psychiatric background, and mental state assessment are integral elements of the psychiatric assessment. The provided information offers a comprehensive comprehension of the patient’s present issues, history, and psychological condition. The Beck Depression Inventory (BDI) is a dependable and accurate assessment tool that can be employed during clinical interviews to evaluate the intensity of depressive symptoms. The Beck Depression Inventory (BDI) is a valuable tool for nurse practitioners to assess depressive symptoms, track treatment efficacy, and support informed decision-making in treating individuals with depression.
References
Georgi, H. S., Vlckova, K. H., Lukavsky, J., Kopecek, M., & Bares, M. (2019). Beck Depression Inventory-II: Self-report or interview-based administrations show different results in older persons. International Psychogeriatrics, 31(5), 735-742. Beck Depression Inventory-II: Self-report or interview-based administrations show different results in older persons | International Psychogeriatrics | Cambridge CoreLinks to an external site.
Gao, L., Xie, Y., Jia, C., & Wang, W. (2020). Prevalence of depression among Chinese university students: a systematic review and meta-analysis. Scientific reports, 10(1), 1-11. https://link.springer.com/content/pdf/10.1038/s41598-020-72998-1.pdfLinks to an external site.
Dietrich, Z. C., & Tamas, R. L. (2020). Mental status Examination. Psychiatry Morning Report: Beyond the Pearls E-Book, 9. Psychiatry Morning Report: Beyond the Pearls – Tammy Duong, Rebecca L. Tamas, Peter Ureste – Google BooksLinks to an external site.
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| Main Posting:Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. |
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| Main Posting:Writing |
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| Main Posting:Timely and full participation |
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| First Response:Post to colleague’s main post that is reflective and justified with credible sources. |
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| First Response:Writing |
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| First Response:Timely and full participation |
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| Second Response:Post to colleague’s main post that is reflective and justified with credible sources. |
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| Second Response:Writing |
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| Second Response:Timely and full participation |
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| Total Points: 100 | ||||||
I decided to choose the Columbia Suicide Severity Rating Scale (C-SSRS), The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), supports suicide risk assessment through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. Users of the tool ask people (Interian A, et al 2017). Suicidal is a global public health problem and a leading cause of death across age groups worldwide. Suicide is also a major public health concern in the United States, with suicide ranking as the second leading cause of death among young people ages 10-24. According to the Centers for Disease Control and Prevention (CDC), more than 47,000 individuals killed themselves in 2019, they were identified as deaths related to suicide. In my workplace, we lost two people due to suicide in one year, in the community where I reside three young adults in one year for suicide. Every time I take my kids for immunization or just check with their pediatrician the registration clipboard always comes with the sheet that has this questionnaire, asking these questions Have you thought of hurting yourself? • Have you wanted to die? • Have you thought of killing yourself? • Have you tried? • How, when, and what led up to your attempt? • If you have not tried, what led you to hold back? • Do you feel safe to go home? •. What arrangements can be made to increase your safety and to decrease your risk of acting on suicidal feelings, (Interian A, et al 2017). always I used to answer those questionnaires for my kids because I thought that answering those questions about suicide would give them suicidal ideas. However, I was wrong, The question they are not promoted suicidal ideation these tools to diagnose possible suicidal. The Ask Suicide-Screening Questions (ASQ) tool is a brief validated tool for use among both youth and adults. The Joint Commission approves the use of the ASQ for all ages (Horowitz, L. M., et al. 2020). The Suicide Risk Screening clinical pathway material was generated by the American Academy of Child and Adolescent Psychiatry (AACAP) Pathways for Clinical Care (PaCC) workgroup to assist hospitals, emergency departments, and inpatient medical/surgical units with the implementation of suicide risk screening pathways for pediatric patients (Roaten, K., et al 2019). These pathways can assist healthcare providers in identifying youth at elevated risk for suicide and connecting individuals to the appropriate level of mental healthcare, It always is necessary to address the possibility of suicide to all ages when assessing them in the healthcare facility. Even though the chief complaint may be something else, the interviewer must discover as much as possible about how the patient thinks and feels. During the clinical interview, information is gathered from what the patient tells the interviewer; critically important clues also come from how the history unfolds. Suicide is a leading cause of death that is often preventable. The provider should find effective ways to deal with patient hesitancy. When patients need help in elaborating, a simple statement provider may ask a question like “Tell me more about that.” Repeating or reflecting on what patients say also encourages patients to open up and may mention what triggers suicidal thoughts. Sometimes comments that specifically reflect the provider’s understanding of the patient’s feelings about events may help the patient to elaborate. This approach provides confirmation for both the interviewer and the patient that they are on the same wavelength. To achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. Acute intervention should start immediately to keep the patient alive (Roaten, K., et al. 2021). Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioral therapy including dialectical behavior therapy and problem-solving therapy in preventing suicidal behavior and other psychological treatments. A secure home, public, and hospital environment, without access to suicidal means, is a necessary strategy in suicide prevention. Each treatment option, prescription of medication, and discharge of the patient from the hospital should be carefully evaluated against the involved risks ( Rihmer Z, et al. 2019). Multidisciplinary treatment teams including psychiatrists and other professionals such as psychologists, social workers, and occupational therapists are always preferable, as integration of pharmacological, psychological, and social rehabilitation is recommended especially for patients with chronic suicidality (Wasserman D et al. 2021). Not only the healthcare workers are responsible for suicide prevention. All members of our society including the community, political leaders as well as religion leaders.
REFERENCES
Centers for Disease Control and Prevention Links to an external site., National Center for Injury Prevention and Control
Links to an external site. Last Reviewed: May 8, 2023
Horowitz, L. M., Snyder, D. J., Boudreaux, E. D., He, J. P., Harrington, C. J., Cai, J., Claassen, C. A., Salhany, J. E., Dao, T., Chaves, J. F., Jobes, D. A., Merikangas, K. R., Bridge, J. A., Pao, M. (2020). Validation of the Ask Suicide-Screening Questions (ASQ) for adult medical inpatients: A brief tool for all ages.
Links to an external site. Psychosomatics, 61(6), 713-722.
Interian A, Chesin M, Kline A, Miller R, St Hill L, Latorre M, Shcherbakov A, King A, Stanley B. Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to Classify Suicidal Behaviors. Arch Suicide Res. 2018 Apr-Jun;22(2):278-294. doi: 10.1080/13811118.2017.1334610. Epub 2017 Jul 17. PMID: 28598723.
Roaten, K., Horowitz, L. M., Bridge, J. A., Goans, C. R. R., McKintosh, C., Genzel, R., Johnson, C., & North, C. S. (2021). Universal pediatric suicide risk screening in a health care system: 90,000 patient encounters.
Links to an external site. Journal of the Academy of Consultation-Liaison Psychiatry.
Rihmer Z, Németh A, Kurimay T, Perczel-Forintos D, Purebl G, Döme P. [Recognition, care and prevention of suicidal behaviour in adults]. Psychiatr Hung. 2019;32(1):4-40. Hungarian. PMID: 28424378.
Wasserman D, Rihmer Z, Rujescu D, Sarchiapone M, Sokolowski M, Titelman D, Zalsman G, Zemishlany Z, Carli V; European Psychiatric Association. The European Psychiatric
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