Posted: December 13th, 2021
PEER RESPONSES WEEK 2
Week 2 Initial Post. Ostrander.
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NRNP 6635 Week 2/ Discussion Forum. Psychopathology and Diagnostic Reasoning
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.
3 Important Components of Psychiatric Interview
The psychiatric interview is an important component of assessing and evaluating the patient’s present and past mental health conditions. The first important component of the psychiatric interview is to use therapeutic communication to establish a trusting rapport with open-ended questions; identity the patient’s chief complaint in their own words. The second component is to assess the patient’s history of present illness; the patient states in their own words symptoms or concerns. Evaluate the patient’s psychiatric history such as diagnosis, current or past treatment plans. The patient should state and include any physical ailments/diseases including treatment therapies. The third is an important component of the interview is completing a mental status examination. According to Sadock, B.J. et al. (2015) the MSE is the psychiatric equivalent of a physical examination. The psychiatric examination is vital for practitioners to assess, evaluate, diagnose and establish a treatment plan. According to Voss and Das (2020) article, the MSE is key for detections of psychiatric signs and symptoms of mental and physical illness that includes categories of the patient appearance, behavior, motor activity, speech, mood, judgment, thought processes, perceptual disturbances, insight, and cognition. The mental status examination is a collection of subjective assessment and data by the practitioner.
Psychometric Properties of Patient Health Questionnaire
The psychometric properties of the patient health questionnaire, PHQ-9 is an assessment tool used to screen patients for mental health with depression. The American Psychological Association (2020) states the PHQ-9 is a patient health questionnaire used to help detect or assess for depression with high reliability and validity psychometric properties with supporting evidence if the patient score is between is greater than or equal to 10 the patient is 7 to 13.6 times likely to diagnose with depression, and scores 4 or less there is a 1 in 25 chance of a patient diagnosed with depression. The Journal of BMC Psychiatry (2020) reports the patient health questionnaire-9 this screening tool was developed for use in a primary care setting to help assess patients with depression due to the prevalence of depression to improve patient outcomes and decrease disability related to depression. The patient health questionnaire-9 form is an appropriate screening tool and scale to use within primary care physician office visits and among mental health providers during the MSE and interview to assess, evaluate and treat depression as applicable.
American Psychological Association (2021). Patient health questionnaire (PHQ-9 & PHQ -2): Construct Depressive Symptoms. Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health
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. https://doi.org/10.1046/j.1525Molebatsi, K., Motlhatlhedi, K. & Wambua, G.N. The validity and reliability of the Patient Health Questionnaire-9 for screening depression in primary health care patients in Botswana. BMC Psychiatry 20, 295 (2020). https://doi.org/10.1186/s12888-020-02719-5-1497.2001.016009606.x
Molebatsi, K., Motlhatlhedi, K. & Wambua, G.N.(2020, June, 12). The validity and reliability of the Patient Health Questionnaire-9 for screening depression in primary health care patients in Botswana. BMC Psychiatry 20, 295 Retrieved from https://doi.org/10.1186/s12888-020-02719-5
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Voss, R.M. and Das, J.M. (2020, October 13). Mental status examination. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546682/
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Main Discussion Post
Main Discussion Post
Three important components of the psychiatric interview are establishing a solid therapeutic alliance, obtaining a thorough psychiatric history, and involving the client is therapeutic decisions (Carlat, 2017). Establishing a therapeutic alliance develops a sense of trust and rapport between the practitioner and the client. The therapeutic alliance is formed by conveying emotional sensitivity, casting judgment aside, and projecting competence in the statements used and questions asked (DePue et al., 2020). Obtaining a thorough psychiatric history is crucial in establishing a clear overview of the client’s psychiatric history, current psychiatric treatment, and other comorbidities affecting the client or their treatment (Carlat, 2017). Involving the client in their treatment is crucial to optimize treatment adherence. The client is significantly more likely to be receptive to education and adhere to a treatment plan they helped negotiate and create (Etingen et al., 2019).
Psychometric components of the Patient Health Questionnaire (PHQ-9) include sensitivity and specificity to depressive symptoms within the diagnostic criteria (Mehra et al., 2021). The PHQ-9 tool assesses for DSM-5 depressive symptoms over the span of two weeks with the opportunity for the client to specify the frequency of each symptom’s occurrence. These properties aid in making this tool reliable, specific, and valid.
It is appropriate to use the PHQ-9 when initially assessing for symptoms of depression and as a tool to repeatedly measure the progress of depressive symptoms over a time period. The PHQ-9 is helpful to a nurse practitioner’s psychiatric assessment because it can assist in the identification of a client’s baseline of depressive symptoms or trend of depressive symptoms (Harrison et al., 2021). The client can intermittently complete the assessment throughout their treatment to assess whether or not the client’s depression is worsening or improving (Harrison et al., 2021). While the PHQ-9 is an excellent tool, further assessment of the client’s understanding of the questions and the answers they provide are necessary. The second question asks if the client has felt down, depressed, or hopeless over the past two weeks (Harrison et al., 2021). Determining which one the client is feeling is crucial because a hopeless client might be experiencing more abysmal lows.
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
DePue, M. K., Liu, R., Lambie, G. W., & Gonzalez, J. (2020). Examining the effects of the supervisory relationship and therapeutic alliance on client outcomes in novice therapists. Training and Education in Professional Psychology. http://dx.doi.org/10.1037/tep0000320
Etingen, B., Hill, J., Miller, L., Schwartz, A., LaVela, S., & Jordan, N. (2019). An exploratory pilot study to describe shared decision-making for PTSD treatment planning: The provider perspective. Military Medicine 184, 467-475. https://doi-org.ezp.waldenulibrary.org/10.1093/milmed/usy407
Harrison, P., Walton, S., Fennema, D., Duan, S., Jaeckle, T., Goldsmith, K., Carr, E., Ashworth, M., Young, A. H., & Zahn, R. (2021). Development and validation of the maudsley modified patient health questionnaire (MM-PHQ-9). BJPsych Open, 7(4) doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1192/bjo.2021.953
Mehra, A., Agarwal, A., Bashar, M., & Grover, S. (2021). Evaluation of Psychometric Properties of Hindi Versions of Geriatric Depression Scale and Patient Health Questionnaire in Older Adults. Indian Journal of Psychological Medicine, 43(4), 319–324. https://doi-org.ezp.waldenulibrary.org/10.1177/02537176211022159
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