Discussion: Week 2 The Psychiatric Evaluation and Evidence-Based Rating Scales
Discussion: Week 2 The Psychiatric Evaluation and Evidence-Based Rating Scales
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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Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
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.
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.
QUSHANIA (150 W0RDS, 2 RESPONSES)
Main Post
Understand the significance of conducting a thorough psychiatric interview, which is a fundamental part of the assessment process for individuals with mental health concerns. Here are three important components of the psychiatric interview and their importance, followed by an explanation of the SLUMS rating scale and its appropriate use:
Chief complaint and presenting problem: The chief complaint is the primary reason the patient seeks psychiatric evaluation. This component is essential because it sets the stage for the interview and helps identify the specific issues that need attention. Understanding the presenting problem provides insight into the patient’s subjective experience and allows the clinician to prioritize and tailor the assessment accordingly (American Psychiatric Association, 2016). By actively listening to the patient’s narrative, the nurse practitioner can establish rapport and gather valuable information about the patient’s emotional state, triggers, and concerns.
Mental status examination (MSE): The MSE is a systematic assessment of a patient’s cognitive, emotional, and behavioral functioning. It encompasses elements such as appearance, behavior, mood, affect, thought content, perception, cognition, insight, and judgment (American Psychiatric Association, 2016). Conducting a comprehensive MSE is crucial because it helps detect subtle or overt signs of mental illness, assess the patient’s level of distress, and monitor changes in mental status over time. The MSE aids in formulating an accurate diagnosis and treatment plan by providing objective data to complement the patient’s subjective report.
Psychosocial history and social support: Gathering information about a patient’s psychosocial history, including family dynamics, educational and occupational history, substance use, trauma history, and social support network, is vital for a holistic assessment (Sadock et al., 2017). Understanding these factors is important because they can influence the onset, course, and prognosis of psychiatric conditions. Assessing social support is particularly critical, as it can impact treatment planning and outcomes. A patient with strong social support is more likely to have better treatment adherence and recovery rates.
The SLUMS rating scale:
SLUMS (Saint Louis University Mental Status Examination) is a brief cognitive screening tool designed to assess various cognitive domains, including attention, memory, language, and executive function (Sadock et al., 2017). Its psychometric properties make it a valuable tool in psychiatric assessments:
Reliability: The SLUMS scale has brought back some good test-retest results, showing it will prove consistent results when given to the same patient on different occasions. Reliability ensures that changes in cognitive functioning can be accurately tracked over time (Sadock et al., 2017).
Validity: The SLUMS scale has shown concurrent validity with other established cognitive assessment tools like the Mini-Mental State Examination (MMSE). This suggests that it measures what it intends to measure cognitive impairment (Sadock et al., 2017).
Sensitivity and Specificity: The SLUMS scale is sensitive to mild cognitive impairment and can differentiate between normal cognitive functioning and cognitive deficits associated with various psychiatric and neurological condition (Sadock et al., 2017).
Ease of Use: Its brevity and ease of administration make it a practical choice in a clinical setting, especially when time is limited.
The SLUMS rating scale is good to use with patients during the psychiatric interview when there are concerns about cognitive impairment, such as in cases of dementia, delirium, or cognitive symptoms associated with psychiatric disorders (Carlat, 2017). It helps nurse practitioners to assess the cognitive status of the patient and aids in differential diagnosis. Additionally, for patients with comorbid cognitive disorders and psychiatric issues, the SLUMS scale provides valuable information for treatment planning and monitoring cognitive changes over time.
In conclusion, the psychiatric interview components of chief complaint and presenting problem, mental status examination, and psychosocial history are essential for a comprehensive assessment of individuals with mental health concerns (Carlat, 2017). The SLUMS rating scale, with its reliable and valid psychometric properties, is a valuable tool for assessing cognitive functioning during the psychiatric interview, particularly when cognitive impairment is suspected. This comprehensive approach aligns with evidence-based practice in psychiatric nursing and enhances the quality of care provided to patients.
References:
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adultsLinks to an external site.
Links to an external site. (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Classification in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical PsychiatryLinks to an external site.
Links to an external site. (4th ed., pp. 1–8). Wolters Kluwer.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In Kaplan and Sadock’s Concise Textbook of Clinical PsychiatryLinks to an external site.
Links to an external site. (4th ed., pp. 39–52). Wolters Kluwer.
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TAMARA (150 W0RDS, 2 RESPONSES)
Week 2 Discussion
The psychiatric interview is a foundational component of mental wellness assessments, allowing medical professionals, especially nursing professionals, to collect essential data for accurate evaluation and therapy planning. Rapport-building, evaluating psychological status, and compiling a full biopsychosocial history are crucial for this interview. In psychiatric examinations, rapport-building is a cornerstone of successful communication. Rapport fosters trust, empathy, and a comfortable environment where patients can share sensitive information (Ameel et al., 2019). Additionally, establishing a strong therapeutic connection encourages patient cooperation and improves the reliability of the data gathered. Once individuals feel understood and valued, they are more inclined to communicate their thoughts, feelings, and worries.
Another critical component involves evaluating mental status. Nursing professionals must assess their patients’ emotional, cognitive, and perceptual capacities. The nurse must fully assess a patient’s mood, cognitive functions, and thought content during this evaluation. Detecting psychiatric diseases or cognitive challenges and guiding therapeutic decisions can be aided by recognizing abnormal mental status (Hartley et al., 2020). Under biopsychosocial history, it is necessary to obtain details about the patient’s medical, mental, and psychosocial history. This history contains information about one’s family history, prior traumas, substance usage, and current pressures. A comprehensive history assists nurse practitioners in understanding the patient’s background and the circumstances contributing to their mental health concerns.
The Hamilton Depression Rating Scale (HDRS) is a common diagnostic tool in psychiatric evaluations. It assesses the intensity of depressive symptoms and supports therapeutic planning and evaluation (Carrozzino et al., 2020). The HDRS includes measures that assess mood, guilt, sleeplessness, agitation, and other factors. It is a useful tool for monitoring changes in an individual’s status over time. When evaluating patients with probable depression, nursing professionals should use the HDRS. This tool objectively evaluates the severity of symptoms, which aids in diagnosis and treatment selection. The HDRS can also monitor therapy advancement and alter interventions as needed. Quantifying depressive symptomatology provides a more comprehensive assessment of the individual’s mental health.
The scale is available and has two forms which have 17 (more common) or 24 items and is each scored between 0 and 4 points. The first 17 items measure how severe the symptoms of depression are. The scoring is based on the 17-item scale and scores of 0–7 are considered as being normal, 8–16 suggest mild depression, 17–23 moderate depression and scores over 24 are indicative of severe depression; at most, a client can score 52 on the 17-point scale. The HAM-D has been used extensively to evaluate a change in response to pharmacologic and other interventions and thus offers the advantage of the comparability across a broad range of treatment trials (Boland et al., 2022).
In summary, the fundamental elements of the psychiatric interview, such as rapport-building, mental status evaluation, and detailed history-taking, serve as the foundation for reliable psychiatric evaluations. The Hamilton Depression Rating Scale improves the capacity of nursing professionals to evaluate and manage depression by providing a standard and reliable measure of symptom intensity. The above elements and tools work together to provide a comprehensive and effective examination of a person’s psychological well-being, enabling targeted and evidence-based interventions.
References
Ameel, M., Kontio, R., & Välimäki, M. (2019). Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review. Journal of Psychiatric and Mental Health Nursing, 26(9-10), 301–322. https://doi.org/10.1111/jpm.12543
Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Carrozzino, D., Patierno, C., Fava, Giovanni A., & Guidi, J. (2020). The Hamilton Rating Scales for depression: A critical review of clinimetric properties of different versions. Psychotherapy and Psychosomatics, 89(3), 133–150. https://doi.org/10.1159/000506879
Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102(1). https://doi.org/10.1016/j.ijnurstu.2019.103490