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Respond to at least two of your colleagues by comparing your assessment tool to
Respond to at least two of your colleagues by comparing your assessment tool to theirs. Please make sure to use at least 2 CURRENT Scholarly resources from outside and 1 from the school material. 1) Post by Tarshe Gre
To reduce the distress associated with assisting individuals in mental crisis to achieve favorable outcomes with treatment modalities and care, psychiatric mental health nurse practitioners (PMHNPs) utilize a patient-centered approach while conducting comprehensive psychiatric interviews. Effective interviewing encompasses several key elements: rapport-building, the development of a therapeutic alliance, and the elicitation of a patient’s narrative to gather, structure, and devise a precise diagnosis and course of treatment (Savander et al., 2021). The following are the three critical components of a psychiatric interview.
Background of the presenting issue: The interview procedure elicits the patient’s mental health history, including previous hospitalizations, medical/psychological issues, and providers. Additionally, by conducting an assessment, the NP can enhance their comprehension of the patient’s symptomatology and the potential factors contributing to their present condition.
The mental status examination: An essential element of the interview procedure, the mental status examination must be tailored to the patient and his or her circumstances. This fundamental data is required for the diagnostic process and the customization of treatment recommendations. Safety concerns are also evaluated during the mental status examination, including the possibility of self-injury and the ability to cause harm to others. An interview may be influenced by various factors, such as circumstances, communication styles, cultural disparities between the interviewer and the patient, and cultural differences that may arise between the two parties (Kung et al., 2023).
Treatment Options: Acquiring relevant data and subjective information from patients can facilitate the development of a comprehensive framework for determining the most effective course of treatment. The clinician’s objective during psychiatric interviews is to assess the patient’s issues and propose a treatment plan supported by evidence and based on symptom-oriented diagnostic ICD-10/DSM-5 categories (Savander et al., 2021). By developing treatment options, both the healthcare provider and the patient can tailor an approach that is most beneficial for the patient.
Mini-Mental State Examination’s psychometric features (MMSE)
Screening tests facilitate the detection of suspected cognitive decline. Screening tests must be comprehensive, encompassing all cognitive functional areas, and possess sufficient sensitivity to detect cognitive decline, even in cases where impairment is confined to a single area. Cognitive decline suspicions can be identified using the Mini-Mental State Examination (MMSE), a simple screening tool used to evaluate five cognitive domains (orientation, immediate memory, attention, delayed memory, and language) with a 0 to 30-point assessment.to test the level of dementia (Korsnes, 2020). Utilizing this criterion to guide subsequent cognitive evaluations, it identifies cognitive decline in incoming patients of 65 years or older. Nevertheless, it is essential to mention that low MMSE scores do not automatically imply cognitive decline. For instance, individuals who have intellectual developmental delays or other conditions that cause chronic cognitive impairment may inherently exhibit low scores. High test-retest reliability signifies that MMSE scores exhibit consistency and stability across administrations.
Sensitivity is more critical than specificity for screening incoming patients for dementia. When sensitivity and specificity are near their maximum levels, overlap is acceptable for cost-effectiveness and may be utilized to identify dementia patients. Thus, aging and illness comorbidity may affect MMSE scores differently (Korsnes, 2020). Age affects test results more since cognitive decline is a natural part of aging. Any combination of these variables may cause cognitive deterioration. Cultural characteristics, including ethnicity, gender, and education, may also misconstrue dementia screening in cognitive tests (Korsnes, 2020).
Justify using this rating scale with clients during psychiatric interviews and explain how it helps a nurse practitioner evaluate them. Proven research should support your plan.
When assessing cognitive impairment during a psychiatric interview, the MMSE is a suitable instrument for the nurse practitioner to utilize for dementia determination in those 65 years and older. Orientation (10 points), registration (3 points), attention and calculation (5 points), recall (3 points), language (8 points), and replicating (1 point) are the six categories comprising the MMSE (Myrberg et al., 2019). The possible MMSE scores are between 0 and 30. The MMSE scores were interpreted using widely accepted thresholds for defining cognitive impairment: none (ranging from 27 to 30), which denotes normal cognitive function; mild (ranging from 23 to 26), which indicates moderate cognitive impairment; and severe (ranging from 0 to 22), which corresponds to dementia (Myrberg et al., 2019). An individual completes the evaluation by memorizing three items from a list, drawing a clock, and then recalling the three items from the list. Practitioners in primary care may find the Mini-Cog beneficial due to its simplicity of interpretation and the fact that it requires no training (Porsteinsson et al., 2021). Using these initial neurocognitive assessments, individuals can implement treatment plans before the deterioration of their cognitive states. In addition to tracking the efficacy of cognitive therapies such as cognitive-behavioral therapy or medications, it furnishes the nurse practitioner with vital data regarding the patient’s cognitive functioning. It facilitates the identification of potential mental health issues. Since clinicians frequently have limited time with patients, nurse practitioners must utilize the diagnostic process of detecting, assessing/differentiating, diagnosing, and treating. In this regard, training is crucial for accurately recognizing early signs and symptoms.
The MMSE is an essential nursing intervention in acute inpatient mental health settings; without valid and practical assessment, nurses cannot provide “reliable and valid nursing care.” When comparing alterations in the mental condition of patients, subjective experiences and objective observations are crucial as a point of reference and baseline (Volcevska et al., 2023). By utilizing the MMSE, nurse practitioners have the opportunity to acquire and apply competencies associated with psychopathology knowledge, such as effective engagement and observational abilities, as well as the capacity to establish a constructive therapeutic alliance while maintaining cultural sensitivity (Volcevska et al., 2023).
An investigation into brief cognitive screening instruments revealed that the MMSE is one of the most utilized cognitive screening instruments in primary care, and can enable early detection of depression in community-based older individuals (Kim, 2022). According to the study, it is capable of tracking cognitive changes over time with depression. The MMSE is valuable for evaluating cognitive functioning during a psychiatric interview. It provides practitioners with important information about a patient’s cognitive abilities and aids in detecting potential mental health problems. 2) Post by Josep K Mar Mood Disorders Scales:
Hamilton Depression Rating Scale (HAM-D)
Boland et al. (2022) state that the psychiatric interview—which tries to acquire information to help diagnose mental health disorders—is crucial to the evaluation and treatment of people with mental illnesses. Developing a relationship with the patient, ensuring the interview is patient-centered, and reviewing the patient’s family and medical history are three crucial aspects of the psychiatric interview. The therapeutic relationship between the patient and the healthcare professional is essential to the psychiatric interview, which calls for mutual respect and trust. Patients may conceal information or feel uncomfortable disclosing personal details if a rapport is not built, compromising proper diagnosis and treatment compliance. The interview must also be patient-centered to fully understand the patient and allow them to share their narrative.
According to Carlat (2017), every patient has a different mental health illness, and every version of the disease calls for a different strategy. It is significant to remember that every patient has another presentation and description of their depression and that everyone will need a customized treatment approach depending on their symptoms and particular circumstances. A comprehensive health and family history is essential to the psychiatric interview. This information will benefit medical professionals when formulating a treatment plan, selecting diagnostic resources, and posing inquiries. Healthcare professionals must carefully investigate patients’ medical and family histories to correctly identify and treat patients, as many mental health illnesses are inherited, and patients frequently have several comorbidities.
For patients who have already been diagnosed with a depressive condition, the most popular clinician-rated diagnostic instrument for determining the severity of depression is the Hamilton Rating Scale for Depression (HAM-D) (Carrozzino et al., 2020). This scale comes in multiple forms, ranging from 6 to 24 questions. Trained lay administrators or mental health professionals administer it. It assesses melancholy mood, guilt, suicidal thoughts, sleeplessness, anxiety, restlessness, job and hobbies, physical symptoms, weight changes, and insight, among other symptoms. In the 21-item version, questions can have 0–2 or 0–4 points depending on the evaluated symptom. The patient’s score is determined using the first 17 answers. Based on observation and the patient interview, the healthcare provider assigns a rating to the patient. Individuals with less than eight points are not deemed to be depressed; mild depression is defined as 8–13, moderate depression as 14–18, severe depression as 19–22, and very severe depression as 23 and above. Healthcare practitioners can analyze a wide range of therapy trials with the HAM-D, a valuable tool for assessing how pharmacologic and other therapies impact depression (Boland et al., 2022).
This measure might be used in conjunction with a discussion of the patient’s depression and would be suitable for individuals who have already received a diagnosis of depression. With this scale, the healthcare professional can assess the efficacy of the present treatment strategy and contrast it with other experimental interventions to ascertain the most beneficial course of action for each patient. While the six-item HAM-D is superior at differentiating between active therapy and placebos, Carrozzino et al. (2020) suggest using the 17-item HAM-D to rate the severity of depression since it more sensitively distinguishes between the various depression levels. When utilizing this diagnostic tool on elderly or medically unwell patients, care should be taken because depression may not be the source of their physical symptoms (Boland et al., 2022).
The HAM-D instrument helps follow a patient’s progress, assessing the efficacy of pharmacologic and other therapies and assessing the degree of the patient’s depression, even if it is not used to diagnose depression. By comparing previous and present interventions and their effects on the patient’s depression, healthcare providers can use this information as a reference to determine what has and has not worked for their patients. The HAM-D will guide future healthcare providers and may help the practitioner decide if a prior intervention was more successful than the present course of treatment. The Patient HealthQuestionnaire-9 (PHQ-9) includes the Diagnostic and Statistical Manuel of Mental Health Disorders-VI algorithm, which is used to diagnose depression and rate its severity, according to some researchers, who contend that the HAM-D is out of date and should be replaced. The PHQ-9 self-rating diagnostic instrument is more economical, avoids administrator bias, shortens treatment times, and saves medical expenses, claim Ma et al. (2021). To guarantee correct diagnosis and treatment, healthcare providers must choose which available mental health diagnostic instruments to utilize based on the most recent evidence, reliability, validity, and pertinence to the patient (Ma et al., 2021). LEARNING RESOURCES
Required Readings
American Psychiatric Association. (2022). Section I: DSM-5 basics. In Diagnostic and statistical manual of mental disorders Links to an external site.(5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.5555/appi.books.9780890425787.Section_1Links to an external site.
American Psychiatric Association. (2022). Classification. In Diagnostic and statistical manual of mental disorders Links to an external site.(5th ed., text rev., pp. xiii-xl). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.5555/appi.books.9780890425787.Section_1Links to an external site.Review Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.Chapter 34, Writing Up the Results of the Interview
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.Chapter 1, “Examination and Diagnosis of the Psychiatric Patient”
American Academy of Child and Adolescent Psychiatry (1995). Practice parameters for the assessment and treatment of children and adolescentsLinks to an external site.. https://www.aacap.org/App_Themes/AACAP/docs/practi…
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adultsLinks to an external site. (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi….
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Classification in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical PsychiatryLinks to an external site. (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 PsychiatryLinks to an external site. (4th ed., pp. 39–52). 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 PsychiatryLinks to an external site. (4th ed., pp. 16–21). Wolters Kluwer.
Required MediA
MedEasy. (2017). Psychiatric history taking and the mental status examination | USMLE & COMLEXLinks to an external site. [Video]. YouTube. Psychiatry Lectures. (2015). Psychiatry lecture: How to do a psychiatric assessmentLinks to an external site. [Video]. YouTube.
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