6635Non.Wk2Res
Jane,
Please post a response to each of these 2 posts. The instructor asks “As you are writing your discussion, please ensure you properly support your posts with current (past 5 years) sources and the appropriate number of sources. Peer posts should not just be post agreeing, they should critique, offer alternative viewpoints, critical analysis, etc.” The goal of the post is to compare to the Overt Agression Scale to the scales they used. Just do your best. You always post great work. As long I have something to post I will be alright
THANKS!
Post 1 (AM)
There is a lot of information that needs to be considered and completed in a psychiatric interview. A skilled provider is able to get the answers to the questions that need to be asked through casual conversation. By doing so, the provider puts the patient at ease and the patient is willing to open up more about what brought them in, which is their chief complaint. Therapeutic rapport building is essential in the initial interview to ensure reliable information is gathered put the patient at ease, and determine the patient’s potential for risk ("Psychiatric Interviewing: the Art of UNDERSTANDING. a Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals, 2nd Edn," 2000).
Though all of the parts of the psychiatric interview are important, there are three components of the interview that I consider to be the most important. These three components are chief complaint, family history, and mental status exam. The chief complaint helps the provider determine what the patient’s presenting issue is and can be used to incorporate other parts of the psychiatric interview (Thagard & Larocque, 2018). Discussing the patient’s chief complaint opens the door to all of the other parts of the psychiatric interview that could be contributing to the presenting issue or concern.
Understanding the dynamics of a patient’s family history will help shed light on relationships, trauma, psychiatric history with-in the family, and the provider can direct therapies based on this gained knowledge. There may be psychiatric or medical diseases that have been inherited and could contribute to the patient’s presenting chief complaint. The mental status exam (MSE) is an assessment of the patient that the provider conducts while interviewing the patient. Through conversation, the provider assesses the patient’s general appearance, behavior, attitude, eye contact, and speech. This assessment tool helps the provider assess the patient’s behaviors.
For this discussion question, I was assigned the abnormal involuntary movement scale (AIMS). The AIMS was developed by the United States National Institute of Mental Health to measure the involuntary movements that patients may exhibit as a side effect for taking antipsychotic medication (Citrome, 2018). A provider should be observing the patient for abnormal movements throughout their interview with the patient. An AIMS should be conducted if any abnormal movements are noted during the interview process, or the patient complains of abnormal movements, or the family has witnessed abnormal movements by the patient. The AIMS evaluation tool takes about ten minutes to complete and rates the patient’s involuntary movements in twelve different areas of the patient’s body (Citrome, 2018). There are other rating scales that can be used, but the AIMS has been approved by the United States Food and Drug Administration (FDA) and provides a comprehensive view of a patient’s progress over months and years. The provider can talk to the patient and family about conducting an AIMS by a trained professional.
The twelve different areas of the body are divided into five main categories. The five categories of the body that are observed are facial and oral movements, extremity movements, trunk movements, global judgments, and dental status. The AIMS tool uses a scale of 0 to 4 to describe the level of movement seen. Zero is considered no movement and four is considered severe movement. If the patient has a total score of two or above the patient is considered as having tardive dyskinesia and options should be discussed (Hauser & Truong, 2018). The AIMS is a helpful tool for providers, patients, and families to help monitor the long-term effects of neuroleptic medications.
References
Citrome, L. (2018). Reprint of: Clinical management of tardive dyskinesia: Five steps to success. Journal of the Neurological Sciences, 389, 61–66. https://doi.org/10.1016/j.jns.2018.02.037
Hauser, R. A., & Truong, D. (2018). Tardive dyskinesia: Out of the shadows. Journal of the Neurological Sciences, 389, 1–3. https://doi.org/10.1016/j.jns.2018.02.009
Psychiatric interviewing: The art of understanding. a practical guide for psychiatrists, psychologists, councellors, social workers, nurses, and other mental health professionals, 2nd edn. (2000). Australian and New Zealand Journal of Psychiatry, 34(2), 347–348. https://doi.org/10.1046/j.1440-1614.2000.0716d.x
Thagard, P., & Larocque, L. (2018). Mental health assessment: Inference, explanation, and coherence. Journal of Evaluation in Clinical Practice, 24(3), 649–654. https://doi.org/10.1111/jep.12885
Post 2 (JG)
Three important components of the psychiatric interview. Why these elements are vital.
Therapeutic alliance, patient and family history, and the history of present illness are three imperative portions of any psychiatric interview (Carlat, 2017). A therapeutic alliance sets the tone and success for the client and provider relationship during the entirety of the treatment. Trust is the basis of this professional relationship. Projecting competence, reassuring confidentiality, exhibiting nonjudgement, portraying empathy, reducing guilt, and practicing normalization may enhance trust (Carlat, 2017, p. 17-32). The second imperative psychiatric interview technique is the collection of patient and family history (American Psychiatric Association, 2016, p.4-6). The interviewer will access valuable patient data through an in-depth medical, psychiatric, substance abuse, and social patient and family history. For example, a patient may present with depressive symptoms. During the interview, the provider discovers the patient has a history of substance abuse and gambling addiction. The client then divulges a family history of bipolar disorder and substance abuse. The clinician’s initial impression of general depressive disorder needs further evaluation based on the history provided. With the knowledge that mental illness often has a genetic or familial component (Smoller, 2019), providers must know the patient’s family history. In addition, the patient should always undergo a physical examination to rule out any compounding pathologies. A third vital part of the psychiatric interview is the history of the present illness (Sadock et al., 2015, p.197-198). Mental illness, like physical illness, may be chronic or acute. A mental disorder can have a distinct pattern or be erratic. Patients may show a rapid deterioration of symptoms or remain stable. A mental health prescriber must understand the course, severity, and symptoms of the patient’s disease before prescribing medications and therapies.
The psychometric properties of the Quality of Life in Depression Scale
The Quality of Life in Depression Scale (QLDS) quantifies the influence and power of depression on a patient’s quality of life (Mckenna et al., 2001). Clinicians use this tool to connect the severity and frequency of depressive symptoms to their effects on the patient’s day to day experiences. The psychometric properties of the QLDS point to the reliability and validity of the scale. The differing versions for multiple countries give the QLDS high generalizability and transferability (Berle & Mckenna, 2004). The Norwegian scale proved high construct validity and internal consistency (Berle & Mckenna, 2004). European studies showed the QLDS had an adequate internal consistency (0.94) and content validity (0.79) (Tuynman-Qua et al., 1997).
When it is appropriate to use this rating scale with clients during the psychiatric interview
Some mental health care providers believe the quality-of-life measurements outweigh symptom management (Connell et al., 2014). If this is true, patients will benefit from a QLDS score with every psychiatric assessment. At the least, practitioners should monitor a client’s quality of life before changing a medication, dosage, or treatment plan.
How the scale is helpful to a nurse practitioner’s psychiatric assessment.
The QLDS gives the practitioner insight into a client’s perception of their daily life. With this measurement, providers can access the tactical effects of patient symptoms on their daily living. The prescriber may adjust medications and dosages based on depressive symptoms. With the use of this tool, the prescriber can further understand the effectiveness of medications and the impact of symptoms. For example, a patient’s depressive score may stagnate with a specific dosage of medication. If the patient’s quality of life is improving, the provider is reassured, despite symptoms. On the other side of the spectrum, if a patient’s symptoms improve and quality of life does not, the provider will seek further answers.
References
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.).
https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
Berle, J. Ø., & McKenna, S. P. (2004). Quality of Life in Depression Scale (QLDS): adaptation and evaluation of the psychometric properties of the Norwegian version.
Nordic Journal of Psychiatry, 58(6), 439–446. https://doi.org/10.1080/08039480410006070
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Connell, J., O'Cathain, A., & Brazier, J. (2014). Measuring quality of life in mental health: Are we asking the right questions? Social Science & Medicine 120, 12–20.
https://doi.org/10.1016/j.socscimed.2014.08.026
McKenna, S. P., Doward, L. C., Kohlmann, T., Mercier, C., Niero, M., Paes, M., Patrick, D., Ramirez, N., Thorsen, H., & Whalley, D. (2001). International development of the
Quality of Life in Depression Scale (QLDS). Journal of Affective Disorders, 63(1-3), 189–199. https://doi.org/10.1016/s0165-0327(00)00184-1
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th. ed.). Wolters Kluwer.
Smoller, J.W. (2019). Psychiatric genetics begins to find its footing. American Journal of Psychiatry, 176(8), 609-614. https://doi.org/10.1176/appi.ajp.2019.19060643
Tuynman-Qua, H., de Jonghe, F., & McKenna, S.P. (1997). Quality of Life in Depression Scale
(QLDS). Development, reliability, validity, responsiveness and application, European Psychiatry, 12, 199-202.