Psychiatric SOAP Note

Running head: INTERVIEWING TECHNIQUES

Interviewing Techniques

Author's Name

Institutional Affiliation

INTERVIEWING TECHNIQUES

Assignment

https://youtu.be/3hJ11kJ6f7s

1. Please watch this entire YouTube video interview.

2. Complete a SOAP note on this client using the attached template (3-5 pages). Make

sure you complete a thorough diagnostic assessment using the DSM 5 and create a

comprehensive treatment plan based on your assessment.

3. Write a 3-page essay (1) discuss the interviewing techniques used by the interviewer,

(2) identify the corresponding therapeutic intervention (CBT, DBT, MBT, MI….) and (3)

conclude with your observations about the skills of the interviewer.

Psychiatric SOAP Note Template

There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment,

and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of

SOAP in the psychiatric practice setting. Refer to the Psychiatric SOAP Note PowerPoint for further detail

about each of these sections.

Criteria Clinical Notes

Subjective

Include chief complaint,

subjective information

from the patient, names

and relations of others

present in the interview,

and basic demographic

information of the

patient. HPI, Past

Medical and Psychiatric

History, Social History.

Objective

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This is where the “facts”

are located. Include

relevant labs, test

results, vitals, and

Review of Systems (ROS)

– if ROS is negative,

“ROS noncontributory,”

or “ROS negative with

the exception of…”

Include MSE, risk

assessment here, and

psychiatric screening

measure results.

Assessment

Include your findings,

diagnosis and

differentials (DSM-5 and

any other medical

diagnosis) along with

ICD-10 codes, treatment

options, and patient

input regarding

treatment options (if

possible), including

obstacles to treatment.

Plan

Include a specific plan,

including medications &

dosing & titration

considerations, lab work

ordered, referrals to

psychiatric and medical

providers, therapy

recommendations,

holistic options and

complimentary

therapies, and rationale

for your decisions.

Include when you will

want to see the patient

next. This

comprehensive plan

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should relate directly to

your Assessment.

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Clinical interviewing is one of the vital skills required in the field of psychiatry. Essentially

psychiatrists interview patients to gain an understanding of his or her problem in order to come

with appropriate medical intervention. The quality of the interview process significantly affects

the formulation of diagnosis and the development of treatment plans. For this reason,

psychiatrists and psychologists must possess effective interviewing skills in order to develop

effective treatment plans for patients. In this particular intervening, the psychiatrists demonstrate

effective interviewing skills as she attempts to gain deeper insights into the possible cause,

extent, and nature of the patient's mental health problem.

Clinical interviewing is an essential part of the assessment and treatment process in healthcare,

especially in the field of mental health. Here are some of the reasons why clinical interviewing is

important:

Collecting Comprehensive Patient Information: Clinical interviewing helps healthcare providers

gather information about a patient's current health status, including their medical and

psychiatric history, symptoms, and other important details. This information is essential to

develop a comprehensive diagnosis and treatment plan.

Building a Therapeutic Relationship: Clinical interviewing is an opportunity for healthcare

providers to build a therapeutic relationship with their patients. Establishing rapport and trust

is critical for effective treatment and helps patients feel more comfortable and open to sharing

personal information.

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Assessing Mental Status and Risk: Clinical interviewing helps healthcare providers assess a

patient's mental status, including their mood, thought processes, and overall functioning.

Additionally, clinical interviewing can help identify any potential risk factors, such as suicidal or

homicidal thoughts, which may require immediate intervention.

Tailoring Treatment Plans: Clinical interviewing allows healthcare providers to gather

information that can be used to develop personalized treatment plans that address the

patient's specific needs and goals. The information gathered during clinical interviewing can

also be used to monitor the patient's progress and make adjustments to the treatment plan as

needed.

Promoting Patient Empowerment: Clinical interviewing can help patients feel empowered by

giving them a voice in their own healthcare. It allows patients to share their concerns, goals,

and preferences, and helps healthcare providers work collaboratively with patients to develop a

treatment plan that is tailored to their unique needs.

Overall, clinical interviewing is an important tool for healthcare providers in the assessment and

treatment of patients, as it helps to build a therapeutic relationship, gather comprehensive

patient information, assess mental status and risk, tailor treatment plans, and promote patient

empowerment.

Identifying Underlying Issues: Clinical interviewing allows healthcare providers to identify

underlying issues that may be contributing to the patient's current symptoms or conditions. For

example, a patient with depression may be experiencing social isolation, financial stress, or a

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history of trauma. By identifying these underlying issues, healthcare providers can develop a

more effective treatment plan that addresses the root causes of the patient's symptoms.

Screening for Co-occurring Disorders: Clinical interviewing can help healthcare providers

identify co-occurring disorders, such as substance abuse or eating disorders, that may be

contributing to the patient's mental health issues. Screening for these disorders is important, as

they can impact the effectiveness of treatment and require specialized care.

Preventing Misdiagnosis: Clinical interviewing helps prevent misdiagnosis by providing

healthcare providers with a complete picture of the patient's symptoms and history. This helps

to avoid making assumptions based on incomplete or inaccurate information, which can lead to

incorrect diagnoses and ineffective treatments.

Monitoring Treatment Progress: Clinical interviewing is an ongoing process that allows

healthcare providers to monitor the patient's progress and adjust treatment plans as needed.

Regular check-ins can help healthcare providers track changes in symptoms, identify areas

where additional support may be needed, and make modifications to the treatment plan to

optimize outcomes.

In summary, clinical interviewing is an essential tool for healthcare providers in the assessment,

diagnosis, and treatment of patients. By gathering comprehensive patient information, building

a therapeutic relationship, tailoring treatment plans, and monitoring progress, healthcare

providers can provide patients with the best possible care and support for their mental health

and overall well-being.

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Establishing a Diagnosis: Clinical interviewing helps healthcare providers establish a diagnosis

by gathering information on the patient's symptoms, medical history, and current mental

status. This information is used to differentiate between different mental health conditions,

which can be critical in determining the most effective treatment approach.

Providing Education and Support: Clinical interviewing provides an opportunity for healthcare

providers to educate patients on their condition, treatment options, and self-care strategies.

This can empower patients to take an active role in their own care and can help to improve

treatment outcomes.

Addressing Stigma: Clinical interviewing can help to address stigma associated with mental

health issues by creating a safe and non-judgmental space for patients to share their

experiences. By promoting open and honest communication, healthcare providers can help to

reduce the shame and isolation that many individuals with mental health issues may feel.

Identifying Cultural and Social Factors: Clinical interviewing helps healthcare providers identify

cultural and social factors that may impact the patient's mental health and treatment. This

includes factors such as social support, socioeconomic status, and cultural beliefs about mental

health and treatment. By taking these factors into account, healthcare providers can develop a

more culturally sensitive and effective treatment plan.

In conclusion, clinical interviewing is a crucial component of mental health assessment and

treatment. By gathering comprehensive patient information, building a therapeutic

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relationship, establishing a diagnosis, and providing education and support, healthcare

providers can help patients achieve optimal mental health and overall well-being.

Addressing Trauma: Clinical interviewing can help healthcare providers identify and address

past traumatic experiences that may be contributing to the patient's current mental health

issues. By acknowledging and validating the patient's experiences, healthcare providers can

help them to develop coping strategies and reduce the impact of trauma on their mental

health.

Improving Communication: Clinical interviewing promotes open and honest communication

between healthcare providers and patients, which is critical for effective treatment. By

providing patients with a safe space to share their thoughts and feelings, healthcare providers

can better understand the patient's needs and tailor their approach to treatment accordingly.

Enhancing Treatment Adherence: Clinical interviewing helps to enhance treatment adherence

by involving patients in the treatment planning process and helping them to understand the

benefits of treatment. This can help to increase motivation and commitment to the treatment

plan, leading to better outcomes.

Promoting Patient Safety: Clinical interviewing helps to promote patient safety by identifying

potential risk factors, such as suicidal or homicidal thoughts, and taking appropriate action to

address them. This may include hospitalization, medication management, or referrals to

specialized care.

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Overall, clinical interviewing plays a vital role in mental health assessment and treatment. By

gathering comprehensive patient information, establishing a diagnosis, building a therapeutic

relationship, and addressing underlying issues and cultural factors, healthcare providers can

provide patients with the best possible care and support for their mental health and overall

well-being.

Supporting Patient Autonomy: Clinical interviewing supports patient autonomy by involving

patients in the treatment planning process and respecting their values and preferences. By

working collaboratively with patients, healthcare providers can help them to take an active role

in their own care and make informed decisions about their treatment.

Fostering Resilience: Clinical interviewing can help to foster resilience by promoting adaptive

coping strategies and building on the patient's strengths and resources. By focusing on the

patient's resilience and ability to overcome challenges, healthcare providers can help to instill

hope and promote positive outcomes.

Promoting Long-Term Mental Health: Clinical interviewing can help to promote long-term

mental health by identifying and addressing factors that may contribute to future relapse or

recurrence of mental health issues. This includes addressing environmental stressors,

promoting healthy lifestyle habits, and developing a relapse prevention plan.

In summary, clinical interviewing is a multifaceted tool that has many benefits in mental health

assessment and treatment. By providing patients with a safe and supportive environment,

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gathering comprehensive patient information, promoting open and honest communication, and

tailoring treatment plans to the patient's individual needs, healthcare providers can help

patients achieve optimal mental health and overall well-being.

Monitoring Treatment Progress: Clinical interviewing helps healthcare providers monitor the

patient's progress throughout the course of treatment. By regularly checking in with patients

and adjusting the treatment plan as needed, healthcare providers can ensure that the patient is

receiving the best possible care and support.

Addressing Comorbid Conditions: Clinical interviewing helps healthcare providers identify and

address comorbid conditions that may be impacting the patient's mental health. This includes

physical health conditions, substance use disorders, and other mental health issues. By

addressing these conditions in a comprehensive treatment plan, healthcare providers can help

patients achieve better outcomes.

Building Trust: Clinical interviewing helps healthcare providers build trust with patients by

creating a safe and non-judgmental environment. This can help patients feel more comfortable

sharing sensitive information and can improve the therapeutic relationship.

Identifying Treatment Barriers: Clinical interviewing helps healthcare providers identify

potential barriers to treatment, such as financial or logistical challenges, and develop strategies

to overcome these barriers. This can improve treatment adherence and help patients receive

the care and support they need to achieve optimal mental health.

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Promoting Recovery: Clinical interviewing helps healthcare providers promote recovery by

addressing the underlying issues that contribute to the patient's mental health issues and

developing a comprehensive treatment plan that addresses these issues. By focusing on

recovery, healthcare providers can help patients achieve long-term mental health and overall

well-being.

In conclusion, clinical interviewing is a critical component of mental health assessment and

treatment. By providing patients with a safe and supportive environment, gathering

comprehensive patient information, monitoring treatment progress, and promoting recovery,

healthcare providers can help patients achieve optimal mental health and overall well-being.

One of the major interview techniques employed by the interviewer in this particular interview is

behavioral questioning. Essentially, behavior interviewing entails asking the client to describe

how he or she handled a past experience and how they went about making decisions. The

interviewer employs behavioral questioning by asking the client to describe his past experiences

on how he began his substance abuse, factors that led to his addiction, etc. The interviewer uses

behavioral questioning to get into the patient's head and learn his thought processes that

accompany his decisions and actions. This enables the interviewer to understand the interval

cues that led him to indulge in drugs and substance abuse.

The second important technique used in this interview is active adaptive questioning. These are

guided questionings that the interviewer use to encourage patients to fully communicate without

interrupting the flow of their story or narrative. The second interviewer effectively employs this

interviewing technique by starting with more general questions but making them more specific

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as the interview progresses. Also, both interviewers' questioning style elicits graded responses

versus closed-ended (yes or no) reply. The third interview technique used by both interviewers

is nonverbal communication. According to Lippincott & Wilkin (2008), nursing assessment

requires interviewers to be in tune with their clients' nonverbal communications such as eye

contact, facial expressions, and general body language. The two interviewers are in tune with the

patients' nonverbal cues in order to better understand their problems.

Several therapeutic interventions can be employed in treating these patients of their substance

abuse disorders. The first major intervention is Cognitive Behavioral Therapy. According to the

American Addiction Centers (2018), "CBT addresses harmful thought patterns, which help

clients recognize their ability to practice alternative ways of thinking and regulates distressing

emotions and harmful behavior." Noteworthy, CBT would be a very effective therapeutic

intervention for these patients because it would help the healthcare provider to recognize the

patients' destructive and negative thought patterns, and thus devise effective strategies to

overcome them. CBT, as stated by the American Addiction Centers (2018), "CBT is present-

oriented, problem-focused, and goal-directed hence it can assist the healthcare provider to

formulate coping strategies to help the patient handle potential stressors.

The second therapeutic intervention that should be considered is dialectical behavior therapy

(DBT). Ideally, DBT involves identifying and changing negative thinking patterns for guides the

patient towards positive behavioral changes (McHugh et al. 2010). According to American

Addiction Centers (2018), "individual therapy sessions for the client are typically held on a

weekly basis with the therapist. In the sessions, the therapist and client work together to increase

the client's motivation to change certain aspects of thinking and behavior." Using DTB, the

healthcare providers will help the patient transition from out of control to in control. However,

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there are several other therapeutic interventions that should be considered including

Mentalization-based treatment (MBT), and motivational interviewing (MI).

Addressing Stigma: Clinical interviewing can help healthcare providers address the stigma

associated with mental health issues by providing patients with a safe space to share their

experiences and emotions without fear of judgment or discrimination. This can help patients

feel more comfortable seeking treatment and can improve their overall mental health

outcomes.

Enhancing Cultural Competence: Clinical interviewing helps healthcare providers enhance their

cultural competence by understanding the unique needs and perspectives of patients from

different cultural backgrounds. This includes understanding how cultural factors can impact

mental health, as well as addressing potential cultural barriers to treatment.

Improving Patient Satisfaction: Clinical interviewing can improve patient satisfaction by

providing patients with a personalized and collaborative approach to treatment. By involving

patients in the treatment planning process and addressing their individual needs and

preferences, healthcare providers can help patients feel more invested in their own care and

improve overall satisfaction with treatment.

Improving Healthcare Outcomes: Clinical interviewing can improve healthcare outcomes by

providing healthcare providers with comprehensive patient information that can inform

diagnosis, treatment planning, and overall care. This can lead to better outcomes for patients

and improve overall healthcare quality.

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Improving Provider Satisfaction: Clinical interviewing can improve provider satisfaction by

providing healthcare providers with a rewarding and fulfilling experience that comes from

helping patients achieve optimal mental health and well-being. This can lead to increased job

satisfaction, reduced burnout, and improved retention rates among healthcare providers.

Overall, clinical interviewing is an essential tool in mental health assessment and treatment. By

providing patients with a safe and supportive environment, gathering comprehensive patient

information, addressing underlying issues and cultural factors, and promoting recovery,

healthcare providers can help patients achieve optimal mental health and overall well-being,

while also improving healthcare outcomes and provider satisfaction.

Reducing Healthcare Costs: Clinical interviewing can help to reduce healthcare costs by

improving treatment outcomes and reducing the need for more intensive and costly

interventions. By addressing the underlying issues that contribute to the patient's mental

health issues and promoting recovery, healthcare providers can help to prevent

hospitalizations, emergency room visits, and other costly interventions.

Improving Coordination of Care: Clinical interviewing can improve the coordination of care

among healthcare providers by providing a comprehensive picture of the patient's mental

health status and treatment needs. This can help to ensure that patients receive the right care

at the right time and can prevent potential gaps in care that can lead to poor outcomes.

Enhancing Patient Safety: Clinical interviewing can enhance patient safety by identifying

potential risks, such as suicidal ideation, and developing appropriate treatment plans to address

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these risks. By providing a safe and supportive environment, healthcare providers can also help

to reduce the risk of harm to patients and improve overall patient safety.

Addressing Health Disparities: Clinical interviewing can help to address health disparities by

understanding the unique needs and perspectives of patients from underserved populations. By

addressing social determinants of health, such as poverty, discrimination, and lack of access to

care, healthcare providers can help to reduce health disparities and improve overall health

equity.

Promoting Public Health: Clinical interviewing can promote public health by improving the

mental health and well-being of individuals, which can have positive impacts on families,

communities, and society as a whole. By promoting mental health and preventing mental

illness, healthcare providers can help to improve overall public health outcomes.

In summary, clinical interviewing is a powerful tool that has many benefits in mental health

assessment and treatment, including improving treatment outcomes, enhancing patient safety

and satisfaction, addressing health disparities, and promoting public health. By using a patient-

centered approach that involves active listening, empathy, and collaboration, healthcare

providers can help patients achieve optimal mental health and overall well-being.

One of the outstanding interviewing skills demonstrated by interviewers is the common

language. Given that some patients may find it difficult to share their intimate lives, interviewers

must employ a language that gets the client more comfortable to share their experiences,

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opinions, and feelings. Additionally, the interviewers' ability to use common language helps to

reduce tensions that may affect the clients' comfort and willingness to share vital details of their

lives. The other interviewing skills demonstrated by the interviewer is active listening. In any

form of interviewing, active listening is a centerpiece of psychiatry because it enables healthcare

providers to learn more from what patients say and do (Lippincott & Wilkins, 2008). The two

interviewers have demonstrated their active listening through techniques such as maintaining eye

contact with the clients, nodding their heads appropriately to encourage the clients to continue

sharing their experiences and feelings. For instance, the first interviewer occasionally uses short

phrases such as "wow", Oh, and okay" to express their concerns and a good understanding of the

patients' conversation. More importantly, both interviewers have avoided passing judgments

through their statements and expressions in order to encourage the clients to feel free when

sharing their feelings and opinions.

The other important interviewing skills are the use of probing questions. Essentially, these are

questions that follow up with the answers given by the clients for precious questions. The two

interviews constantly ask probing questions such as "how did you feel?" to search and clarify the

reason behind certain decisions and actions and establish inconsistencies. These interviewing

skills have helped to improve the quality of the interview, and the reliability of the outcomes.

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References

American Addiction Centers (2018). "Cognitive Behavioral Therapy (CBT)." Retrieved from

https://americanaddictioncenters.org/cognitive-behavioral-therapy

American Addiction Centers (2018). "When to Use Dialectical Behavior Therapy." Retrieved

from https://americanaddictioncenters.org/therapy-treatment/dialectical-behavioral-

therapy

Lippincott Williams & Wilkins. (2008). Medical-surgical nursing made incredibly easy!.

Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for

substance use disorders.BPsychiatric Clinics,B33(3), 511-525.

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What were the highlights of this week's clinical? Describe a particular patient, patient

interaction, or disease process that stood out to you.ADHD

The highlight of this week is the successful treatment of a 25-year-old Caucasian male with

Attention-Deficit/Hyperactivity Disorder (ADHD). The main reason for the patient seeking

medical attention overcome difficulties at school and work that is closely tied to his ADHD.

What made the treatment of this particular patient particularly successful is the combination of

appropriate medications and psychotherapy. Research has established individually-tailored

treatment -- a combination of psychotherapy, drug therapy and psychotherapy-may provide

better results. The patient's condition greatly improved after 36 hours of treatment and close

monitoring.

Reflect on a situation or a patient presentation that you were unfamiliar with during

clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe

how you handled this unfamiliar situation/case.

One of the challenging situations encountered this week is attending a 36-year old female with

Major depressive disorder (MDD). Being the first time toe counter such a serious case of MDD, I

was quite anxious about how to attend the unfamiliar condition. As a result, I consulted my

preceptor who immediately recognized the condition and led us through successful diagnosis and

treatment. One of the vital lessons to learn about MDD is associated with several complications

that make its treatment challenging. These complications, as observed in this particular patient,

include panic disorder, suicidal feelings, and self-mutilation.

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Describe a situation or encounter from this week that led you to a new understanding of a

specific mental health condition.

The successful treatment of ADHD led to gain a better understanding of ADHD as a major

health condition affecting many individuals from different age groups. One of the vital

revelations from my preceptor's treatment of the patient is that appropriate nutrition, play, and

exercise are important tools to improve the patient with ADHD. For younger people, these

coping skills can help to significantly improve the individual's performance at school and to

bolster their interpersonal relationships with others. Moreover, these coping skills can help the

individual to overcome stress and frustration.

Discuss any interactions with patients that you observed, either in therapy or a medication

management session that were missing some of the concepts you have been learning about

regarding therapeutic relationships and communication.

During the week, I encountered a patient 10-year old male with ADHD. From the record, I

learned the patient had been to the facility severally in the previous 6 months. While the child

suffered from inattentiveness, he was not hyperactive or impulsive. This led to the

understanding that children with ADHD may be inattentive but not necessarily hyperactive or

impulsive. In addition, children with this condition may be hyperactive and impulsive but also

able to pay attention. ( HelpGuide 2019).

How did you apply the content learned in your online courses to your clinical setting this

week?

The content learned in our online courses was instrumental because firstly, it helped me enhance

the accuracy and reliability of assessment and diagnosis. The information learned from these

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materials imparted new insights and understanding of the interpretation of various conditions,

and more importantly, strategies of overcoming dilemmas. Additionally, this information and

findings from the online materials helped to correct my old misunderstandings and pave the way

for new better treatment protocols, which in turn helped improve the quality of care and improve

patient outcomes.

How did you apply the content learned in your online courses to your clinical setting this

week?

The chief complaints by patients were to trouble concentrating and remembering details and

events. The patients revealed that they have has trouble focusing on various tasks, especially at

work or school. The other major complaint by most patients were impulsiveness and trouble in

coping with stressful situations in life. The development of preliminary differential diagnosis

lists for each specific patient was somewhat challenging because various individuals too had

other complex symptoms.

Given the most frequent psychiatric disorders you encountered in your clinical rotation

this week, what is the most useful set of guidelines (i.e., depression guidelines, Beer's

criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?

Just like the previous week, depression was the most common psychiatric disorder encountered

this week. In order to gain more in-depth information about prescribing or psychotherapy for

depression patients, I consulted the depression guidelines. Essentially, these are guidelines

developed for the management of depression and are very useful for health care providers

especially those who may have challenges in prescribing and or psychotherapy. The rationale

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for choosing depression guidelines over the other sets of guidelines is that the former provides

specific, clear, and easy-to-understand guiding procedures.

Thinking about the common mental health conditions you saw in your clinical this week

(see question #7), did you feel that you had adequate knowledge to discuss these diagnoses

with your preceptor? If not, what preparation work do you have planned to help you feel

more confident for the upcoming clinical week?

Personally, I believe I possessed adequate knowledge and skills to discuss the diagnoses with my

preceptor. All the knowledge and skills learned in class coupled with information obtained from

our online courses was adequate for me to discuss each of the diagnoses with my preceptor.

However, I believe I still have a lot of potentials to improve my knowledge in order to enhance

my preparedness. This could be achieved by constantly practicing and consulting a wide variety

of sources in order to gain all-rounded knowledge and competence.

List a brief plan of care for one of the patients you saw this week. Include your preceptor's

plan, too. Discuss, briefly, whether or not you agree with your preceptor's plan of care. If

not, describe what you would have done differently and why.

Assessment Data Expected Outcomes Nursing

Interventions

Rationale

Irritability, fatigue,

restlessness,

insomnia, suicidal

Improve sleeping patterns

Overcome suicidal

thoughts, irritability, guilt,

Collaborate

and closely

work with

Stabilization

and

normalization

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thoughts, difficulties

concentrating and

making decisions,

loss of interest in

important activities,

and feelings of guilty

and intense sadness.

and sadness.

Improve concentration and

focus on important

activities in life.

Improve decision making

Return to the previous

level of work functioning.

the patient on

a one-to-one

basis.

Implement

cognitive

restructuring,

cognitive

behavior

therapy

(CBT),

Implement

activity

scheduling

Prescribe

medications.

of the

patient’s

thought

patterns,

emotions, and

feelings.

Help improve

the

individual’s

understanding

of their

conditions.

 Psychotherap

y help to help

identify

cognitive

distortions.

What situation or patient presentation did you see in your clinical setting this week that has

not yet been covered in your online psychiatric courses?

One of the challenging encounters this week were two patient with Somatoform disorders. These

two patients exhibited symptoms that were unfamiliar to me such as abnormal movements and

complained about extreme pain in their bodies. At first, it appeared as though each of these two

patients was pretending, however, I later learned these are some of the major symptoms of

Somatoform disorders. What made attending these two patients difficult for is because this

disorder has not yet been covered in class hence I did not possess the knowledge and experience

to effectively offer help to them.

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Reference

HelpGuide (2019). "ADHD in Children." Retrieved from

https://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-in-children.htm

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Sean Wiest

The mental status examination (MSE) is one of the most important assessments that

the psychiatric mental health nurse practitioner must complete with each patient,

especially if he or she is new to the provider. The MSE evaluates the patient’s current

cognitive and emotional state (Carlat, 2017). There are several different considerations

that should be focused on when conducting a MSE since what the patient says may not

be line with how he or she presents. Additionally, a patient’s culture can impact the

examination. “Its interpretation in culturally distinct groups and among immigrant

populations requires caution, as it may be culturally biased” (Sadock, Sadock, & Ruiz,

2014, p.141). The way a patient dresses or grooves themselves are just a few of the

differences that may vary between cultures5(Sadock, Sadock, & Ruiz, 2014). In addition,

there may be language and educational barriers that can impact the patient’s treatment

outcome. Providers should not assume that the patient understands the information that

the provider is discussing. Being cognitively impaired (CI) is another concern when

completing a MSE. Patel and Singh (2018) found that there can be serious clinical and

public health consequences when completing mental health examinations and

screening when individuals are cognitively impaired. For these reasons, I do believe that

a patient’s treatment outcome can be impacted due to ethical considerations and

classifications.5

Manic Patient Mental Status Exam:

A mental status exam (MSE) for a manic patient may include the following observations:

Appearance and Behavior:

The patient may have a flamboyant or overly colorful appearance.

They may engage in impulsive or risky behaviors, such as spending sprees or sexual promiscuity.

They may speak rapidly and excessively, interrupting others and going off on tangents.

They may have a high level of energy and may be pacing, fidgeting, or engaging in other

hyperactive behaviors.

Mood and Affect:

The patient may be extremely euphoric or irritable, with a heightened sense of self-confidence or

grandiosity.

Their affect may be labile, with rapid shifts from elation to anger or agitation.

They may be easily distractible and have difficulty focusing on one topic.

Thought Content:

The patient may have racing thoughts or experience flight of ideas, making it difficult for them to

complete a coherent thought.

They may exhibit poor judgment and decision-making, with impaired insight into the consequences of

their actions.

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They may have delusions of grandeur, such as believing they have special powers or abilities, or that

they are on a mission to save the world.

Cognition:

The patient may have difficulty with attention and concentration, and may exhibit poor judgment and

decision-making.

They may have impaired memory and recall, making it difficult for them to remember important

information or complete tasks.

Overall, an MSE for a manic patient would focus on identifying symptoms of mania, such as elevated or

irritable mood, hyperactivity, and racing thoughts, while also assessing for potential psychotic features,

such as delusions or impaired insight. It is important to approach the patient with empathy and

understanding, while also maintaining a focus on safety and appropriate treatment interventions.

Additionally, it is important to assess for any potential risk to the patient or others. This may include

asking about any history of suicidal or homicidal ideation, as well as assessing for any current intent or

plans to harm themselves or others. Safety planning and interventions may need to be put in place to

ensure the patient's safety and the safety of those around them.

It is also important to assess the patient's current medications and any past history of medication

compliance or noncompliance. Manic episodes may require medication adjustments or additional

medications to help stabilize the patient's mood and behavior.

The MSE for a manic patient may also include a brief cognitive screening, such as the Mini-Mental State

Examination (MMSE), to assess for any potential cognitive deficits or impairments.

Finally, it is important to take a holistic approach to the assessment and treatment of a manic patient.

This may include assessing for any co-occurring medical conditions, such as thyroid disorders or

substance use disorders, which may be contributing to the patient's symptoms. Collaborating with other

healthcare providers, such as primary care physicians or specialists, can help to ensure that the patient

receives comprehensive and coordinated care.

In addition to the clinical interview and MSE, it is important to obtain collateral information from family

members or other individuals who may have observed the patient's behavior during the manic episode.

This information can help to confirm the diagnosis of mania, identify potential triggers for the episode,

and provide additional insight into the patient's behavior and functioning.

Treatment for a manic episode typically involves a combination of pharmacotherapy and psychotherapy.

Medications such as mood stabilizers, antipsychotics, or benzodiazepines may be used to help stabilize

the patient's mood and behavior. Psychotherapy, such as cognitive-behavioral therapy (CBT), may also

be beneficial in helping the patient to identify and manage triggers for the manic episode, improve

coping skills, and reduce symptoms of anxiety and depression.

Overall, the MSE for a manic patient is an important tool in the assessment and treatment of bipolar

disorder. By identifying key symptoms of mania, assessing for potential risks and comorbid conditions,

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and developing a comprehensive treatment plan, mental health professionals can help to improve

outcomes for patients with bipolar disorder.

It is important to note that in some cases, a manic episode may be part of a larger pattern of bipolar

disorder, which includes both manic and depressive episodes. In such cases, the MSE may need to be

modified to assess for symptoms of depression, such as sadness, hopelessness, and decreased energy

and interest in activities.

It is also important to maintain a non-judgmental and empathetic stance when working with patients

with bipolar disorder. Manic episodes can be distressing and confusing for both the patient and their

loved ones, and it is important to provide support and education to help the patient and their family

members understand the condition and its treatment.

In addition to pharmacotherapy and psychotherapy, lifestyle modifications such as maintaining a regular

sleep schedule, engaging in regular exercise, and avoiding drugs and alcohol can also help to stabilize

mood and reduce the risk of relapse.

Overall, the MSE for a manic patient is a critical component of the assessment and treatment of bipolar

disorder. By accurately identifying symptoms and assessing for potential risks and comorbid conditions,

mental health professionals can develop a comprehensive treatment plan that helps patients to manage

their symptoms and improve their quality of life.

It is important for mental health professionals to monitor the patient's progress during treatment and

adjust the treatment plan as needed. This may involve regular follow-up appointments to assess

symptom severity, medication adherence, and side effects, as well as monitoring for potential

complications such as medication toxicity or substance abuse.

In some cases, hospitalization may be necessary if the patient is at risk of harm to themselves or others

or if their symptoms are severe and require close monitoring and intensive treatment. Inpatient

treatment may involve a combination of medication management, psychotherapy, and supportive care

to help stabilize the patient's mood and reduce symptoms.

It is also important to involve family members and loved ones in the treatment process, as they can

provide valuable support and assistance in helping the patient to manage their symptoms and adhere to

their treatment plan. Family therapy and education can also help to improve communication and reduce

stress and tension within the family system.

In summary, the MSE for a manic patient is a critical tool in the assessment and treatment of bipolar

disorder. By accurately identifying symptoms and assessing for potential risks and comorbid conditions,

mental health professionals can develop a comprehensive treatment plan that helps patients to manage

their symptoms, improve their quality of life, and reduce the risk of relapse. Ongoing monitoring and

adjustment of the treatment plan, as well as involving family members and loved ones in the treatment

process, can also help to ensure the best possible outcomes for patients with bipolar disorder.

Additionally, it is important for mental health professionals to recognize that not all patients

will respond equally well to all treatments, and that some patients may require more intensive

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or specialized care. For example, some patients may have co-occurring substance use disorders

or other comorbid conditions that require additional treatment.

It is also important to provide patients with education and resources to help them manage their

symptoms and maintain their mental health over the long term. This may include providing

information about community resources such as support groups, peer networks, and mental

health clinics, as well as offering guidance on lifestyle modifications and self-care strategies.

Finally, it is important to recognize the impact that bipolar disorder can have on a patient's life

and relationships, and to provide emotional support and empathy throughout the treatment

process. By working collaboratively with patients and their loved ones, mental health

professionals can help patients with bipolar disorder to achieve and maintain stability, improve

their quality of life, and achieve their goals.

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Mary is a Caucasian female being see for an inpatient follow up visit. Patient’s hygiene

appears to be well kept with feathered hair and mismatched clothing. Patient states that

she “went off on my husband last night and beat him up.” The patient presents with a

positive attitude, increased energy, and an elated mood stating she is “on top of the

world” and “it’s just going to be one great day.” The patient is loud at times with extreme

happiness and laughing outbursts that are incongruent and at inappropriate times.

Patient has difficulty focusing and has frequent loose associations bouncing between

loving the outdoors to how she met her spouse. Patient exhibits poor concentration and

was unable to answer questions without incorporating disconnected thoughts. Patient

states “I am a spy. My mission is to fight for the American way.” When asked what the

means, the patient was unable to elaborate and simply stated “the Statue of Liberty.”

Patient additionally endorses delusions of grandeur stating that she can “bring up the

wind, bring the rain, I can bring the sunshine through Jesus Christ who strengthens me.”

Patient appears to have an oral fixation and would chew gum and blow bubbles

throughout the session. Full family/social history his currently unknown at this time with

the exception of her husband and deceased mother. Patient’s laugh was with

inappropriate affect when talking about her mother. She was easily distractible and

asked “am I stilled focused” which was followed by more inappropriate laughter. Patient

states that she can get drunk on coffee, water, Kool-Aid, and other things when she is

“high” and in her current euphoric state. Patient enjoys her current state except when

she is unable to sleep. Patient states that she is able to concentrate and complete tasks

even without sleep. When outside of the facility, the patient believes that she would

engage in risky sexual behaviors. Patient endorses auditory hallucinations but states

what they say are “none of my business.” Patient identifies as a “morphodite” having

both female and male reproductive organs, which she believes is how God is. 5

References

Carlat, D. J. (2017).5The Psychiatric Interview5(4th5ed.). Philadelphia, PA: Wolters Kluwer

Patel, R., & Singh, U. (2018). Prevalence study of cognitive impairment and its

associated sociodemographic variables using mini-mental status examination among

elderly population residing in field practice areas of a medical college.5Indian Journal of

Community Medicine. 43(2), 113-116.

doi:5http://dx.doi.org.regiscollege.idm.oclc.org/10.4103/ijcm.IJCM_102_175

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).5Synopsis of psychiatry(11th ed.).

London, England: Lippincott, Williams, and Wilkins.

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Responses:

Tasha, I agree with you that labeling a person with mental illness poses psychological and social

consequences, such as shame, blame, secrecy, exclusion, danger, and discrimination, leading to

isolation and rejection of that person in all aspects of their lives. A prognosis is based on a

number of factors to include the type of problem your teen is struggling with, the duration of the

problem, your teen's personal strengths and weaknesses, and the availability of support systems.

Parents may hear this term used in the early stages of therapy or entry into a treatment program.

For example, a psychiatrist might say the prognosis for a specificBteen suffering from

depressionBis good since the teen is motivated to stick with a program of medication and

psychotherapy and has strong family support. People often confuse the terms prognosis

andBdiagnosis. The difference between the two is that while a prognosis is a guess as to the

outcome of treatment, a diagnosisBis actually identifying the problem and giving it a name, such

asBdepressionBorBobsessive-compulsive disorder (Kathryn, 2019)B

Major mental illnesses such as schizophrenia or bipolar disorder rarely appear “out of the blue.”

Most often family, friends, teachers or individuals themselves begin to recognize small changes

or a feeling that “something is not quite right” about their thinking, feelings or behavior

beforeBan illness appears in its full-blown form. Learning about developing symptoms, or early

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warning signs, and taking action can help. Early intervention can help reduce the severity of an

illness. It may even be possible to delay or prevent a major mental illness altogether.

References:

Kathryn R, 2019; “Prognosis and Diagnosis in Mental Health” retrieved from

https://www.verywellmind.com/prognosis-defined-2610393

Ranna P, 2018; “Warning Signs of Mental Illness” retrieved from

https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness

Sean, basically the-mental state examination (MSE)Bis a structured way of observing and

describing aBpatient’s current state ofBmind, under the domains of appearance, attitude, behavior,

mood, and affect, speech, thought process, thought content, perception, cognition and insight.

The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient’s

mental state, which when combined with the biographical and historical information of

theBpsychiatric history, allows the clinician to make an accurateBdiagnosis andBformulation.

Below is a framework that demonstrates the type of information that the mental state

examination hopes to gain (Lewis, 2018).

The mental status examination, in many respects, lends itself less well to a systematic and

structured approach than other portions of the examination of the patient. On the one hand,

because mental status testing can be threatening to the patient and requires much cooperation on

the part of the patient, it is desirable to leave the mental status testing to the end of the overall

evaluation when the patient can be placed most at ease and when some degree of rapport has

been established between the examiner and the patient. On the other hand, the mental state of the

patient colors the accuracy and sensitivity of the entire medical history, and from this standpoint,

the physician wishes he or she could perform a mental status examination as a prelude to the rest

of the medical history in order to have the assessment as a template against which to measure the

accuracy of the rest of the history. The successful clinician must develop a style in which much

of the mental status examination is performed through relatively unstructured observations made

during the routine history and physical. The way in which the patient relates the history of the

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present illness will reveal much about general appearance and behavior, alertness, speech,

activity, affect, and attitude. A primary technique, then, in mental status testing is the imposition

of some structure on these observations and raising them from the level of subliminal

impressions to clinically useful descriptions of behavior (Strub, Black; 2013).

References:

Lewis P, 2018; “MENTAL STATE EXAMINATION (MSE) – OSCE GUIDE” Retrieved from

https://geekymedics.com/mental-state-examination/

Strub RL, Black FN. The mental status examination in neurology. 2nd ed. Philadelphia: FA

Davis, 2013

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