Assessment and Diagnosis of the Psychiatric Patient

A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.

This week, as you explore assessment and diagnosis of patients in mental health settings, you examine assessment tools, including their psychometric properties and appropriate uses. You also familiarize yourself with the DSM-5 classification system.

Reference: Bjorklund, P. (2013). Assessment and diagnosis. In K. Wheeler (Ed.), Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.) (pp. 95–168). Springer Publishing Company.

Learning Objectives

Students will:

•  Evaluate elements of the psychiatric interview, history, and examination

•  Analyze psychometric properties of psychiatric rating scales

• Justify appropriate use of psychiatric rating scales in advanced practice nursing

Learning Resources

https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.5555/appi.books.9780890425596.Section1

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.

   

Required Media (click to expand/reduce)

https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=20

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=39

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=53

https://ezp.waldenulibrary.org/login?qurl=https://video.alexanderstreet.com/watch/diagnostic-criteria

https://www.youtube.com/watch?v=U5KwDgWX8L8

https://www.youtube.com/watch?v=IRiCntvec5U

Getting Started With the DSM-5

This is not unlike what has occurred in the process of classifying mental disorders. A system that provides enough specificity to appropriately classify a large variety of mental disorders while also attempting to include all of the possible symptoms, many of which can change over time, is a daunting task when used by a variety of specialists, doctors, and other professionals with varied experience, cultures, expertise, and beliefs. The DSM has undergone many transformations since it was first published in 1952. Many of these changes occurred because the uses for the DSM changed. However, the greatest changes began with the use of extensive empirical research to guide the creation of the classification system and its continued revisions.

In order to assess and diagnose patients, you must learn to use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated as the DSM-5, to render a diagnosis. In this second week of the course, you will examine how DSM-5 is organized and how clinicians use it to render diagnoses. 

Review the Learning Resources this week, with special emphasis on viewing the Diagnostic Criteria video. This video explains the purpose and organization of the DSM-5 classification system, the purpose of the ICD-10 coding system, their relationship to one another, and the importance to the PMHNP role. 

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.

To Prepare:

• 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.

Diagnostic Tool

Beck Depression Inventory, 2nd Revision   

At least 3 citations

 Trade has been an integral part of society since prehistoric times. It exists not only as a basis for the economy in a global market but ingrained in culture. However, trade can pose controversies in global health as health organizations try to balance sustainable community health strategies in economically and culturally diverse communities. Do you think that global health policies on trade are necessary to build community capacity and ultimately support the health of the community? Assess how a populations needs are met by discussing how trade can positively impact a community’s health. Provide two examples of goods or services as support. In contrast, discuss how trade can negatively impact a community’s health, providing support using two examples of goods or services. 

Please provide at least two references

 

J.G. is a 42-year-old white man presenting with a 2-month history of intermittent midepigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. J.G. informs you that his doctor told him that he had an infection in his stomach 6 months ago. He never followed up and has been taking over-the-counter Zantac 75 for 2 weeks without relief. He takes no other medications. He is concerned because the pain is continuing. He has no other significant history except he is a 20 pack-year smoker and he drinks 5 cups of coffee a day. He eats late at night and goes to bed about 30 minutes after dinner. He is allergic to penicillin.

Diagnosis: Peptic Ulcer Disease: Answer the following questions in full sentences using APA citations. 

List specific goals for treatment for J.G.

What drug therapy would you prescribe for J.G.? Why?

Discuss specific patient education based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause you to change therapy.

What would be the choice for second-line therapy?

What lifestyle changes would you recommend to J.G.?

 

Assignment: Pharmacotherapy for Cardiovascular Disorders
…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…
—Murphy et al., 2018

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.  

Photo Credit: Getty Images/Science Photo Library RF

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

• Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

By Day 7 of Week 2

Write a 2- to 3-page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.