NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Saddock et al. (2015) state that the psychiatric interview is the most important element in evaluating and caring for persons with mental illness. How we obtain information will drive the criteria-based diagnosis and, ultimately, the care plan. From the beginning, the interview will establish the client-provider relationship, which can profoundly influence the outcome of treatment. Three important elements of the psychiatric interview include past psychiatric illness, mental status exam, and formulation.
Past Psychiatric Illness
The past psychiatric history should include all psychiatric illnesses, symptoms, and treatments over the patient’s lifespan. The symptoms should include when they occurred, how long they lasted, and the frequency and severity of episodes (Saddock, Saddock, & Ruiz, 2015) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales. Special considerations, such as suicidal or homicidal ideations and episodes of self-injury, should be assessed. Treatment episodes should include outpatient, inpatient, day, and voluntary/involuntary treatment. The practitioner should collect and review information about medication use and other modalities, such as electroconvulsive therapy (ECT), that have been used and the response experienced by the patient. Did the patient experience side effects or any other negative effects from the treatment? Finally, a diagnosis made in previous episodes should be considered now.
Mental Status Exam
The mental status exam (MSE) is intended to explore all areas of mental functioning and denotes evidence of signs and symptoms of mental illness (Saddock et al., 2015). The practitioner will begin the MSE upon initiation of the interview through observation, direct questioning, and cognitive screening. According to Sadock et al. (2015), components of the screening include appearance, behavior, motor, speech, mood, affect, cognition, abstract reasoning, and thought process. If suicidal ideations are present, intention, methods, motivation, reason for living, and the patient’s therapeutic alliance should also be assessed (American Psychiatric Association, 2016).
The formulation consists of the culmination of all the data collected, the diagnosis, recommendations, and treatment planning. The formulation should include a brief summary of the patient’s history, presentation, and current status (Saddock et al., 2015). Combined, these elements should lead to the differential diagnosis of the patient’s illness and the provisional diagnosis. The formulation should include a summary of the safety assessment, an estimate of the patient’s suicide risk, a rationale for treatment selection, and treatment-related preferences (American Psychiatric Association, 2016). All should be explained and collaborated with the patient; differential diagnosis, risks of untreated illness, treatment options, and benefits and risks of treatment (American Psychiatric Association, 2016). NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales.
Psychometric Properties of the Geriatric Depression Scale
The Geriatric Depression Scale has been tested and used extensively with the older population. The GDS is a self-report measure of depression in older adults. The response is in a yes/no format and was formulated because of their high correlation with depressive symptoms in previous validation studies (American Psychiatric Association, 2020). Of the 15 items on the assessment, 10 indicate the presence of depression when answered positively, while the other 5 indicate depression when answered negatively (short form).
American Psychiatric Association (2020). Geriatric Depression Scale (GDS). Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/geriatric-depression
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https//psychiatriconline.org/doi/pdf/10.1176/appi.books..9780890426760
Greenberg, Sherry A. (2020). The Geriatric Depression Scale (GDS). Hartford Institute for Geriatric Nursing. Retrieved from https://hign.org/consultgeri/try-this-series/geriatric-depression-scale-gds
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
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.
- 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.