Discussion

 RESPONSE #1

Three Components of Psychiatric Interview

   There are several evidence-based rating scales or assessment tools for diagnosing psychiatric and mental health disorders. However, a well-conducted psychiatric interview, history, and mental status examination (MSE) are crucial to the evaluation and care of a person suffering from mental illness ( Sadock, Sadock, & Ruiz, 2015). The components of a psychiatric interview (PI) includes but are not limited to the chief complaint, history of present illness, past psychiatric and medication history, substance use, abuse, and addiction, family history, developmental and social history, review of the system, mental status examination and (MSE), physical exam, For this week's discussion, three components of the psychiatric interview and rationale will be discussed. The psychometric properties of positive and negative symptoms scale (PANSS), which is widely used in a patient with schizophrenia. The three-component of the PI chosen are:

1. Chief complaint and history of present illness. The chief complaint is the reason why the patient is voluntarily or involuntarily seen by the PMHNP. It is the patient's word of his or her presenting psychiatric problem. Similarly, the patient's history is based on the subjective of the patient and perhaps, collateral reports from family members, caregivers, and other health care professionals. The rationale behind this component of PI is that the chief complaint enables the PMHNP to elicit information directly from the patient or indirectly from other caregivers or providers that have reliable information about the patient. Adam et al.(2015), states that about 50 to 90 percent of people with a chronic psychiatric illness such as schizophrenia live with their families and friends, thus, they can be a good source of reliable data collect during psychiatric evaluation

2. Past psychiatric history and medication. A vital component of a psychiatric interview is for the PMHNP to obtain information about past psychiatric diagnoses and treatment regimens. The reason why this element is critical is that it allows the PMHNP to formulate a differential diagnosis. Besides, knowing about the previous psychiatric and treatment can help the PMHNP determine which treatment options the patient has tried in the past including the patient response to such treatment regimen, side effects, and adherence (American Psychiatric Association, 2020). The PMHNP should give priority to issues of past suicidality intent, ideation, plan, and attempt mentioned by the patient or his or her family.

 3. Developmental and social History. Another component of a psychiatric interview is to obtain information about the developmental current psychosocial history of the patient such as where the patient was born, the status of pregnancy at birth, sexual history, substance abuse or recreational drug use, relationship and sexual history, abuse of any forms, current relationship with parents, grandparents and children, educational level, legal problems (arrest, jail time), cultural beliefs occupation, and economic status. This element is crucial has the potential to expose drug exposure during pregnancy and other developmental disorders. Also, obtaining developmental and psychosocial history allows the PMHNP to have a longitudinal and holistic view of the patient’s life, psychiatric, medication histories ( Scher, Fisher, & Summers, 2018).

The Psychometric Properties of PANSS

The positive and negative symptoms scale (PANSS) is a widely used rating scale for people with schizophrenia and other psychotic disorder with proven reliability and ease of administration. This rating tool is helpful for a PMHNP to track the severity of symptoms in their patient because its psychometric elements make it easy to use in a clinical setting (Sadock, Sadock, & Ruiz, 2015). The psychometric properties of PANSS are characterized by positive and negative symptoms. The psychometric properties of positive symptoms include hallucination, delusion, bizarre behavior such as agitation, inappropriate social and sexual behavior, inappropriate affect that are not blunt or simply flat, and formal thoughts disorder such as pressured speech, illogical and incoherence speech, tangentiality, clanging, and derailment. The psychometric elements for negative symptoms include blunt affects such as unchanging facial expression, poor eye contact, anhedonia such as little or no interest in activities previously enjoyed, alogia such as poverty of speech and content, avolition/apathy such inconsistency at work, poor grooming and hygiene and prolong sitting without spontaneous movement or activities, and social withdrawal or inattentiveness. Although positive symptoms are treated with antipsychotic medication, negative symptoms are difficult and may cause more prolong comorbid and functional impairment in a patient diagnosed with schizophrenia. However, the PANSS is greatly helpful to PMHNP in evaluating genuine treatment of negative symptoms as well as improving the patient positive symptoms (Leucht et al., 2019)

                                                                              References

Adam, G., Diana, R., Chris, M., Chloe, T., Linda, A.-W., Steven H., Z., & Carmen Galani, B. (2015). Assessing the Impact of Caring for a Person with Schizophrenia: Development of the Schizophrenia Caregiver Questionnaire. The Patient: Patient-Centered Outcomes Research, 8(6), 507–520. https://doi-org.ezp.waldenulibrary.org/10.1007/s40271-015- 0114-3

American Psychiatric Association. (2020). Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition. Retrieved from https://psychiatryonline.org/doi/full/10.1176 /appi.books.9780890426760.pe02

Leucht, S., Barabássy, Á., Laszlovszky, I., Szatmári, B., Acsai, K., Szalai, E., Harsányi, J., Earley, W., & Németh, G. (2019). Linking PANSS negative symptom scores with the Clinical Global Impressions Scale: Understanding negative symptom scores in schizophrenia. Neuropsychopharmacology, 44(9), 1589–1596. https://doiorg.ezp.waldenulibrary.org/10.1038/s41386-019-0363-2

 Sadock, B. J., Sadock, V. A., Ruiz, P. ( 2015). Kaplan & Sadock's synopsis of psychiatry. (11ed.). NY: New York, Wolter Kluwer.

Scher, L. M., Fisher, T. J., & Summers, S. M. ( 2018). Psychiatric Interview. Retrieved from https://emedicine.medscape.com/article/1941476-overview#a9

RESPONSE #2

Three Components of the Interview

The psychiatric interview is an important exercise used to assess and evaluate the patient's present and past mental health conditions. According to Sadock et al (2015), interview is the most valuable element of the evaluation and care of clients with mental illness. The first important component of the psychiatric interview is to establish a trusting rapport with the patient by using therapeutic communication. This helps to elicit the patient’s trust and cooperation. In other words, the Patient is more likely to open-up and honestly answer all questions asked by the clinician. The second component is to assess the patient’s history of present illness; it is important that the patients state in their own words, symptoms or concerns. Obtaining a thorough patient history is crucial in establishing a current psychiatric treatment, and other comorbidities affecting the client or their treatment.

The third component of the interview is completing a Mental Status Examination (MSE) which involves a series of questions and observations that provide a snapshot of a client's current mental, cognitive, and behavioral condition.  The MSE focuses on factors such as: appearance, behavior, motor activity, speech, mood, judgment, thought processes, level of consciousness, hallucination, and suicidality. According to Sadock, B.J. et al. (2015), the MSE is the psychiatric equivalent of a physical examination. The psychiatric examination is vital for clinicians to assess, diagnose and establish a treatment plan. According to Baker (2013), the MSE is a measure of biological, psychological, and social factors that predisposed, precipitated, and perpetuate the client's current functioning.

Psychometric Properties -- Patient Health Questionnaire

The assessment tool chosen is Patient Health Questionnaire (PHQ-9). It is a nine-item self-administered questionnaire used for diagnosing depression. According to Kroenke et al (2001), the PHQ-9 is a multipurpose assessment instrument used for screening, diagnosing, monitoring, and measuring the severity of depression. This screening tool asks nine questions of which some are as follows: Little interest or pleasure in doing things?, Feeling down, depressed or hopeless?, Trouble falling asleep, staying asleep, or sleeping too much?, Feeling tired or having little energy?, Poor appetite or overeating? As a severity measure, the PHQ-9 score can range from 0 to 27, since each of the 9 items can be scored from 0 (not at all) to 3 (nearly every day). If the score is 1-4, it means minimal depression, 5-9 means mild depression, 10-14 means moderate depression, 15-19 means moderately severe depression and 20-27 means severe depression. PHQ-9 is a helpful tool for the clinician as it helps to determine whether or not the patient’s depression is worsening or improving. It has been shown to have a positive outcome by helping nurse practitioners to detect, diagnose and monitor with depression with consistent and reliable tool. Simply put, this tool is valid and reliable to evaluate the severity of depression and suicidal ideation in patients using only nine questions.

  

References

 Baker, R. W. (2013). The psychiatric mental status examination. Oxford University Press.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.