NRNP 6635: Psychopathology and Diagnostic Reasoning
DISCUSSION RESPONSE THREE APA CTIATION EACH. THE RESPONSE SHOULD BE ONE PAGE
Discussion: 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.
- 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 one of your colleagues on a different day by comparing your assessment tool to theirs. Please reply to Irene’s post
WK 2 DISCUSSION
The Psychiatric Evaluation and Evidence-Based Rating Scales
The core purpose of conducting a psychiatric interview is to establish a therapeutic relationship between the patient and the medical practitioner. The relationship is vital since it facilitates data collection, organization, and synthesis to form the basis for the formulation, differential diagnosis, and treatment plan. Besides, establishing the relationship is fundamental in fostering a secured attachment between the doctor and the patient, thus facilitating open and mutual communication (Carlat,2017). The latter is needful in correcting misunderstandings and assisting the patient in building a cohesive narrative for their present and past situation. The key elements for the psychiatric interview are mental status examination, chief complaint, psychiatric and medical history, and behavioral observation. The chief complaint is usually presented through a direct quotation which is the core psychiatric concern from the patient. The patient is expected to be the chief complaint and not the spouse or a prior therapist (Barnhill, 2014). The medical history of the present illness is vital since it is the patient’s integrated narrative of the current psychiatric condition. The other important element is the past history of the psychiatric disorder. The collateral information is vital because the patient’s recall can seem fuzzy. Again, the history details are crucial because nonpsychiatric and psychiatric medical conditions tend to be frequently comorbid (American Academy of Child and Adolescent Psychiatry, 1995). Therefore, the medical practitioner needs to inquire concerning alternative, complementary and over-the-counter medications and the activities that can be therapeutic like meditation, yoga, and exercises. The mental status examination is crucial as it looks at speech, perception, thought form and content, general behavior, and appearance. The mentioned elements are essential because they go a long way in providing the patient with the best psychiatric care. They also inform the medical practitioner on the best practices that can be applied to prevent some symptoms’ re-occurrence.
Similarly, there are various rating scales, each having its unique psychometric properties. One of them is the NICH Vanderbilt Assessment Scale for children, used in screening, evaluating, and monitoring the signs and symptoms of attention deficit hyperactivity disorder (ADHD) in children. The Vanderbilt Assessment Scale is a brief scale created by teachers and parents that assesses ADHD symptoms of hyperactivity and inattention, anxiety, academic performance, oppositional defiance disorder, conduct disorder, and depression. The psychometric properties include good internal reliability with Cronbach’s alpha coefficient of >.90 (parent) and >.89 (teacher). Test-retest and interrater reliabilities are also between the two scales (Psych Tools, 2021). There is also a four-factor scale structure that confirms the validity of the inattention measure, hyperactivity, anxiety/depression, and oppositional/conduct disorder. The NICH Vanderbilt Assessment Scale has been applied in community and clinical samples of the population across American, Hispanic, African American, German, and Spanish children in urban, suburban, and rural areas with low and high risks of ADHD. The rating scale is appropriate for use in the psychiatric interview for children aged 6 to 12. It is a tool where the parents and teachers have versions that require the individual to fill in a form and rate the frequency of the patient’s behavior on a scale of 0 to 3. The scale helps the practitioner measure the score for the children and thus determine the diagnosis for the disorder. It also helps assess the degree of functional impairments that can result from the difficulties experienced by the child. According to (CDC, 2021), healthcare practitioners use the American Psychiatric Association’s Diagnostic and Statistical Manual guidelines to help diagnose ADHD.
American Academy of Child and Adolescent Psychiatry (1995). Practice parameters for the
assessment and treatment of children and adolescents.
Barnhill, J. W. (2014). The psychiatric interview and mental status examination. Arlington, VA:
American Psychiatric Publishing.
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Centers for Disease Control and Prevention (2021). Attention-Deficit/Hyperactivity Disorder (ADHD), https://www.cdc.gov/ncbddd/adhd/diagnosis.html
PsychTools, ( 2021). Vanderbilt Assessment Scales (VAS),
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
- Chapter 34, Writing Up the Results of the Interview
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
- Chapter 5, Examination and Diagnosis of the Psychiatric Patient
- Chapter 6, Classification in Psychiatry
- Chapter 31, Child Psychiatry (Sections 31.1 and 31.2 only)
American Academy of Child and Adolescent Psychiatry (1995). Practice parameters for the assessment and treatment of children and adolescents. https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Classification in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (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 Psychiatry (4th ed., pp. 9–15). Wolters Kluwer.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Medical assessment and laboratory testing in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed., pp. 16–21). Wolters Kluwer.