Walden NRNP 6635 Week2 Discussion

Week 2: 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.}

Walden NRNP 6635 Week2 Discussion 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

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Learning Resources

Required Readings (click to expand/reduce)

American  Psychiatric Association. (2013). Section I: DSM-5 basics. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 5–29). Author.

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. Walden NRNP 6635 Week2 Discussion

Required Media (click to expand/reduce)

Classroom Productions. (Producer). (2015). Diagnostic criteria [Video]. Walden University.

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00:00:00BEGIN transcript: 

00:00:00DIAGNOSING MENTAL DISORDERS 

00:00:00DSM-5® AND ICD-10 

00:00:05DIAGNOSTIC CRITERIA 

00:00:10Dr. Matthew Macaluso, D.O. 

00:00:10ABPN Board Certified 

00:00:10MATTHEW MACALUSO There’s not a single lecture that I give that doesn’t have DSM criteria imbedded into it. So because it’s the gold standard for diagnosis, that’s what we teach medical students in residence. Walden NRNP 6635 Week2 Discussion

00:00:20Dr. Tracie Collins, MD, MPH 

00:00:20Professor, Practising Physcian 

00:00:20TRACIE COLLINS As a primary care position, you see a lot of depression, generalized anxiety disorders, uh… adjustment disorders with depressed mood. And the DSM is very helpful for understanding how to accurately diagnose a patient as far as put them into a certain category. 

00:00:40MATTHEW MACALUSO You know, I think that there are aspects of the billing and coding system that a little clunky. Umm… And I think physicians need to be well educated on them. And I think that’s one of the purposes of this video series is to help doctors understand the differences between DSM and ICD and how they cross-walk and how they can understand the DSM criteria, how they can use those codes in their practice and how those codes apply to their billing. 

00:01:10SIOBHAN DOHERTY Every year, nearly one in five American adults, or 42.5 million people, experience a mental illness. A mental illness or mental disorder can be defined as a clinically important syndrome, that is, it’s a collection of symptoms, these can be behavioral or psychological that causes the person disability or distress in social, personal or occupational functioning. This definition helps to convey the scope of these mental disorders, as they cover a wide range of symptoms, with no two individual’s experiences exactly alike. While some may experience a lower depressed mood, others could be easily excitable or agitated. And there are those that can swing back and forth from one set of symptoms to another. The symptoms can manifest in physical compulsions or could be relegated to the individual’s internal life, with the individual experiencing racing thoughts or hallucinations. And well there are individuals that may find their symptoms completely debilitating, others may find them to be a mild but still problematic facet of their lives, which nonetheless causes a degree of functional impairment. Each set of symptoms can require its own mode of treatment, and so the first step in beginning that treatment process is evaluating these symptoms, in order to diagnose the patient with a specific mental disorder. Because of this, it is crucial for a clinician to have both an effective diagnostic method and set of diagnostic criteria. In the United States, the gold standard for diagnosing a mental disorder is the Diagnostic and Statistical Manual of Mental Disorders, or DSM. 

00:02:50MATTHEW MACALUSO DSM is a necessity in psychiatry because we’re operating on a syndromic level. And so psychiatric illnesses are different from illnesses elsewhere in medicine, in that we don’t have to discreet biomarkers to diagnose them. For example, if someone comes in with signs and symptoms of kidney failure, there are lab tests that can be done to confirm that diagnosis. In psychiatry, no such lab tests or brain imaging exists as of today that can definitively confirm a diagnosis. So because of that we’re operating on a syndromic level. 

00:03:25SIOBHAN DOHERTY Since the same tests or biomarkers may not be available to diagnose a mental disorder as when diagnosing a physical condition. DSM can provide the clinician with the standardized method of identifying a patient’s disorder. This allows for the disorder to be treated or even communicated to another clinician during the treatment process. However, it is not the only diagnostic criteria used both in the United States and throughout the world. The World Health Organization’s International Classification of Diseases, or ICD, is used in concert with DSM in the United States. It is also considered the standard throughout the rest of the world. Because of this, it is vital for the clinician to be familiar with these two classification systems, their role in the current medical landscape and their use in the field, so that the clinician can better guide the patient along their path to recovery. Walden NRNP 6635 Week2 Discussion

00:04:25CLINICIANS 

00:04:30SIOBHAN DOHERTY To better understand that DSM, ICD and their use in various healthcare or academic settings, we consulted with two experts in the field, Dr. Tracie Collins, MD, MPH and Dr. Matthew Macaluso, D.O.. 

00:04:40TRACIE COLLINS I first came into contact with the DSM and ICD when I was a medical student. The DSM was really emphasized during my psychiatry rotation, umm… and during that time I learned about the various umm… codes and how to diagnose a patient based on their symptoms and signs. DSM was very helpful to categorize patients as being either major, umm… where’s they having either major depression or other symptoms, umm… other diagnosis. 

00:05:10MATTHEW MACALUSO DSM has been a major part of my professional life since the time when I was a resident and I learned the DSM criteria. I was tested on DSM when I became Board Certified as a psychiatrist. And in clinical practice, I used DSM to document patient diagnosis and for billing purposes. 

00:05:35TRACIE COLLINS As far as my practice… So after medical school in residency, I practiced General Internal Medicine. As a primary care position you see a lot of depression, generalized anxiety disorders, uh… adjustment disorders with depressed mood. And the DSM is very helpful for understanding how to accurately diagnose a patient as far as put them into a certain category. And so in my practice, it has been helpful as far as communicating with other practitioners about what I believe is going on with the given patient. 

00:06:05MATTHEW MACALUSO Although, I teach it to medical students and residence umm… and it’s the gold standard within the profession and so use DSM everyday, have a copy of it on my desk. 

00:06:15SIOBHAN DOHERTY Before delving into the current use of DSM and ICD, it is important to understand their history in the larger context of psychiatry. 

00:06:25HISTORY OF ICD AND DSM 

00:06:30MATTHEW MACALUSO Umm… So are there other diagnostic manuals that I use? At present no, but historically there have been a number of other schools of thought in terms of diagnosis. In fact, the first diagnostic manual in psychiatry came out of Washington University in St. Louis. And it had far fewer diagnosis than the DSM. The DSM has gone through multiple iterations stating back to the 1950s and 60s. I mean, it’s expanded and contracted over time. There’s a working group that sits down and looks at the DSM codes and DSM diagnosis and brings an expert consensus into the development of those criteria. Walden NRNP 6635 Week2 Discussion

00:07:10SIOBHAN DOHERTY Since antiquity, people have been working on classification systems from mental disorders. Hippocratic system was based on imbalances in the four humors. Later, in the 1600s, Thomas Sydenham focused more on clinical observation and defined the idea of syndromes that would be used for centuries. Throughout the 18th century, (inaudible ), William Cullen, Pinel and Esquirol contributed to psychiatric noselogy in that century, as they tried to revise previous taxonomic classifications into basic classes or types. In the 19th century, the term psychiatry was coined by Johann Christian Reil and the terms psychosis and neurosis began to be used. During this time, an anatomical clinical approach to classification became preferred over the prior taxonomic classifications of mental disorders. As the 19th century progressed, so to did the additional definitions and explanations of mental disorders. In 1949, ICD-6 was the first include mental disorders. DSM developed out of a US army manual, as well as from systems for collecting census and psychiatric hospital statistics. With the publication of ICD-6 and it’s newly included mental and behavioral disorders, the APA was tasked with developing a version specifically for use in the US. Thus, DSM-1 was born in 1952. ICD has since gone through four other versions leading to the current standard ICD-10 in 1992. The World Health Organization is currently revising ICD towards ICD-11. The final draft of the ICD-11 system is expected to be submitted to WHO’s World Health Assembly, WHA, for official endorsement by 2017. However, new iterations of ICD are adopted in the United States at a much slower rate, as we’ll cover in more detail later in this program. There have been five major versions of DSM. DSM-II 1968 was similar to DSM-I but eliminated the term reaction. And in the reprint of DSM-II in 1974, homosexuality was removed as a disorder, and the decision was made to create a new revision to the DSM. DSM-III 1980 was designed to make nomenclature consistent with the ICD and to improve uniformity and validity of psychiatric diagnosis. DSM-4, in 1994, brought clinical significance to almost half of the categories, requiring that symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The current version of DSM is DSM-5. 

00:10:15MATTHEW MACALUSO But I have been a member of the American Psychiatric Association Assembly for a couple of years now and the assembly voted unanimously to accept DSM-5 in 2013 and DSM-5 then went into effect in May of 2013. DSM, you know, it’s sold nationwide, it’s sold worldwide and it’s the gold standard for the diagnosis of mental illness. 

00:10:40SIOBHAN DOHERTY However, for clinicians used to using DSM-4TR, there are some key differences. 

00:10:50DSM-4® and DSM-5® 

00:10:55TRACIE COLLINS From my perspective, from a primary care physicians perspective, the big difference between DSM-4 and DSM-5 is more detail in DSM-5. 

00:11:00MATTHEW MACALUSO DSM-5 tried to place more of an emphasis on dimensional diagnosis rather than categorical. So for example, umm… in most DSM-4 diagnosis, you need a certain number of criteria in order to meet… uh… In order to be diagnosed with the given disorder. But what happens with the people who have, you know, one or two, umm… one or two fewer criteria than needed. You know, they still have a burden of illness, but they may not meet the full criteria for a disorder. Well, DSM-5 is using more of a dimensional approach, where certain disorders exist along more of a spectrum. 

00:11:40TRACIE COLLINS The DSM-4 allowed you to, to categorize a patient as saying major depressive disorder. Well, the DSM-5 allows you the same thing, but now it has sort of additional components, mild, moderate, severe, uh… duration. So instead of saying only cyclothymia or a dysthymia, you now can put a length of time to someone’s depression and how long they have it. And so the categories are pretty similar, but their additional modifiers that you can add on to those diagnosis that actually provide more information to either their personal reimbursing the, uh… company reimbursing you as well as communicating with your colleagues about a persons, about a patients diagnosis. 

00:12:25MATTHEW MACALUSO The best example of the, the differences between DSM-4 and DSM-5 is in the personality disorder of a class. That DSM-5 actually has two conventions for making personality disorder diagnosis, one which is categorical, which is essentially the same as DSM-4, and the other which is dimensional. And that dimensional uh… approach looks at different personality trades and characteristics over dimensions and the clinician assesses the patient accordingly. The old categorical approach says, well, if you have a certain number of criteria, you meet the diagnosis. If you don’t have that number of criteria, you don’t meet the diagnosis. So it, it leaves some people in limbo to where they may not have enough criteria, so they can’t be diagnosed with the given condition, they may then wind up without a diagnosis or could wind up with or not otherwise specified diagnosis. So these are the problems with having a, with operating on a syndromic level and not having definitive biomarkers that can help people finalize or confirm a diagnosis. Walden NRNP 6635 Week2 Discussion

00:13:35SIOBHAN DOHERTY DSM-5, also has a different organizational system than DSM-4 for some classes of disorders. 

00:13:40MATTHEW MACALUSO The, the bread and butter diagnosis in psychiatry are gonna be your mood disorders and your anxiety disorders. Now those who are discreet classes in DSM-4, but they have been broken up into separate classes in DSM-5. And so I’m referring to the depressive disorders class in DSM-5, as well as the bipolar and related disorders class in DSM-5. You also have several classes that used to be listed in the anxiety disorders class in DSM-4 including umm… obsessive-compulsive and related disorders and some of the trauma uh… disorders in DSM-5. Those are very common disorders in psychiatric practice. 

00:14:25DSM-5® and ICD-10 IN THE UNITED STATES 

00:14:30SIOBHAN DOHERTY While DSM-5 went into effect in 2013 as previous mentioned. ICD-10, wasn’t adopted until October 2015 in the United States. As you will remember, ICD010 was introduced internationally in 1992. This marks a separation between the United States and the rest of the world, one that is not without some controversy. 

00:14:50MATTHEW MACALUSO I believe physicians have been given a grace period on implementing ICD-10. The American Medical Association had lobbied to CMS and other third party payers to allow physicians a grace period in adopting ICD-10. Well, that being said, the rest of the world adopted ICD-10 more than 20 years ago and the United States actually put off that adoption. The rest of the world also doesn’t use ICD-10 for billing purposes. The rest of the world is using ICD-10 to capture a data on the incidents and prevalence of disorders, which is used for epidemiological purposes. So we have a very unique use of ICD in this country. So 20 some odd years ago, when ICD-10 was released in the rest of the world. The United States and the United States Congress chose not to adopt it. And the US has put off the adoption of ICD-10 until this year. In fact, ICD-10 was supposed to be adopted last year, but that adoption was put off for a variety of reasons, mainly because, you know, third party payers and physicians just weren’t ready for it. At this point, the rest of the world is ready to bring in ICD-11. And so the United States is again a little bit behind the curve in that adoption. Uh… The United States is also a little different in that. We use DSM as the gold standard for the diagnosis of mental illness, uh… which again crosswalks over to ICD-10. 

00:16:15SIOBHAN DOHERTY Now that we have covered the larger historical and international context of DSM-5 and ICD, we can begin to look more into their use in the field. 

00:16:25USING DSM-5® 

00:16:30SIOBHAN DOHERTY The DSM-5 text is broken up into over 20 chapters, organized by classes of disorders. Throughout this series, we will be covering each chapter in more detail and exploring the diagnostic criteria for most disorders within these chapters. Most disorders covered in DSM-5 are organized into specific chapters. These disorders are made up of diagnostic criteria, which lists the symptoms required for a diagnosis of a given disorder. A list of specifiers or additional features the clinician can indicate when giving their diagnosis. Differential diagnosis, or other conditions for the clinician to consider when making their diagnosis. And comorbidity or other disorders that can co-exist with the disorder in question. The clinicians familiarity with these disorders will be vital in making a diagnosis. Walden NRNP 6635 Week2 Discussion

00:17:25MATTHEW MACALUSO My process for diagnosing and subsequently treating kind of depends on the setting I’m in. So if I’m in a restart setting, I may be doing a very structured diagnostic interview like a skid or a mini for example that asks a structured set of questions from a script. And depending on the patient’s “Yes or No” answers to those questions, they may have one or, or other different diagnosis. If I’m in clinical practice, I do a much less structured interview which more or less resembles a conversation with the patient. And then based on that conversation and my clinical judgment I’ll come up with a diagnosis using DSM-5 as a guide. 

00:18:05TRACIE COLLINS My process for diagnosing and subsequently treating a mental order, is to obtain a detailed history and physical. And from the symptoms that the patient describe in his/her own words, synthesize that into a list of symptoms and from that list, referred to the DSM-5 to see what diagnose is best matches or diagnosis best match this patient symptoms. 

00:18:35MATTHEW MACALUSO If I’m seeing a patient, you know, at the end of my note when I get into the diagnosis, I’m gonna give a DSM-5 diagnosis. Throughout that note I’m gonna give supporting criteria that’s say, why I’m making that diagnosis. So it plays a very big role in everything I do. 

00:18:55CODING 

00:19:00SIOBHAN DOHERTY Every disorder in DSM-5 is given its own diagnostic code. 

00:19:00MATTHEW MACALUSO Many people who do a lot of clinical work have some of these codes memorized. And when they are coming up with a list of diagnosis, they will not only list the diagnostic terms but they will also list the diagnostic codes. Usually in psychiatry we’re listing the DSM-5 codes and DSM-5 terms in our, our documentation. And there are some type of electronic health record system or coder who will convert it over to ICD, because all of those codes will crosswalk to one another. In fact, if you look throughout DSM, you will see listings of ICD-9 codes, ICD-10 codes, as well as DSM codes. 

00:19:45SIOBHAN DOHERTY In DSM-5, each disorder is first linked to the coding system from ICD-9, with the codes for ICD-10 listed in parenthesis. This is what is meant when we say all of the DSM codes crosswalk to the ICD codes. For instance, obsessive-compulsive disorder is a sign to the code 300.3 in ICD-9 and F42.0 in ICD-10 listed in parenthesis. This is because as previously mentioned, ICD-9 was still in use in the United States when DSM-5 was released. However, because ICD-9 is no longer the standard in the United States, for this series, we will be listing the newer code from ICD-10 first, followed by ICD-9s coding in parenthesis. Additional specifiers maybe added to these codes depending on the disorder. In many ways, DSM and ICD compliment each other, though they do have differences in both their content and their application. 

00:20:45DSM-5® AND ICD-10 

00:20:50MATTHEW MACALUSO DSM and ICD crosswalk to one another and so there’s a conversion from the DSM code to the ICD code which is the main convention for billing in the United States. 

00:21:05TRACIE COLLINS The DSM is for clinician to clinician communication. The ICD is for clinician to reimburse her communication. 

00:21:15MATTHEW MACALUSO Well, in clinical practice psychiatrists are using DSM-5 and DSM codes which crosswalk over at ICD. So most commonly a psychiatric would have an electronic health record or a coder of some kind who would make that conversion for them. 

00:21:30TRACIE COLLINS In my practice as a primary care position, the DSM-5 is what I use when I want to figure out from the list of symptoms I have. What’s the best diagnosis for this patient? And if there’s another clinician with whom I’m gonna communicate, they can easily glean from my diagnosis, what’s going on with this patient. The ICD-10 allows for me to adequately uh… be reimburse, so that I can get the actual diagnosis in to the medical record. And so when I submit for reimbursement, it’s clear to the reimburser what the diagnosis is for a given patient. It also allows for uh… going back and reviewing registries and looking at sort of the population health perspective because you’ve got these codes and these large databases that you can use. 

00:22:20SIOBHAN DOHERTY There are organizational differences between DSM-5 and ICD-10. We will highlight these for specific classes of disorders throughout the series. Highlighting these differences, is useful not only in understanding the diagnostic and coding differences between DSM-5 and ICD-10, but it also helps to illuminate some of the similarities and differences between various conditions. Walden NRNP 6635 Week2 Discussion

00:22:50EVALUATING FUNCTIONALITY 

00:22:55SIOBHAN DOHERTY DSM also makes it possible to evaluate the patient’s level of functioning. This can be useful in marking the patient’s progress overtime. Assessing level of functioning has changed from DSM-4-TR to DSM-5. 

00:23:05MATTHEW MACALUSO In the DSM-4, we were focused on the GAF, the Global Assessment of Functioning. And personally I like the GAF and we still use it in some research protocols. However, a lot of clinicians weren’t using it properly and weren’t focusing on the anchor points which would tell you definitively where someone scored on the GAF. So the GAF became a bit of a moving target in clinical practice. The other piece of the GAF, is the score was often dictated by the patient’s admission status. So someone was admitted to a psychiatric hospital versus a partial hospital, their GAF was often dictated by their level of care. Uh… So clinicians often work backwards in that way. DSM-5 tried to remedy this by adopting something called the WHODAS or World Health Organisation Disability Assessment Scale. Umm… And WHODAS is something that can be done by the clinician or it can be patient raided. And it actually gives you a sense of their level of functioning and the level of disability that they have as a result of their illness. Only time will tell if that will be a better system than the GAF or not. It’s certainly will take a little bit more time for clinicians to administer because it’s lengthier than the GAF, but it may provide more useful information among multiple dimensions. 

00:24:30COMORBID CONDITIONS 

00:24:35MATTHEW MACALUSO It’s very common that you see patients with recurrent major depressive disorder. Uh… And those patients could have mild, moderate or severe illness. Those with severe major depressive disorder could have psychotic features as well. These patients often have associated anxiety disorders or substance abuse disorders. That type of patient would be very common in clinical practice. 

00:25:00SIOBHAN DOHERTY As mentioned briefly before, some patients will have more than one comorbid or coexisting disorder. If this is the case, when diagnosing the patient, first list the disorder that prompted the patient’s evaluation or why they saw treatment in the first place. If another disorder is subsequently discovered, list it following the initial disorder. 

00:25:25CULTURAL INFLUENCES 

00:25:30SIOBHAN DOHERTY Throughout the text, DSM-5 makes it clear that the clinician should consider the patient’s societal and cultural norms when making a diagnosis. How these cultural factors impact the clinicians diagnosis may differ from patient to patient and clinician to clinician. Walden NRNP 6635 Week2 Discussion

00:25:45MATTHEW MACALUSO There’s actually a whole section in DSM-5 on the cultural formulation which guides clinicians in this area. And so someone’s background their culture can actually play a big role and how their symptoms present and how they understand their symptoms and the DSM aims to help clinicians with that. In DSM-4, there is actually a section on culture-bound syndromes. I mean, several of those are still talked about in clinical practice as well. 

00:26:10TRACIE COLLINS So the role that cultural influences play when I’m considering a diagnosis is really… It’s more of my skill set to actually take a patient’s complaints and their symptoms and understand how they translate into the language that’s used in the DSM-5 and ICD-10 to categorize these patients. So those two approaches to diagnosing mental health disorders, they are not culturally sensitivity or culturally tailored. The tailoring comes from the clinician. 

00:26:45SIOBHAN DOHERTY An example of a cultural factor to consider can be found with a disorder, schizophrenia. A feature of this disorder maybe hallucinations. However, auditory hallucinations of a religious nature, such as an individual, believing that they hear the voice of God, maybe a normal aspect of certain cultures. Thus, they may not be a marker that contributes to a diagnosis of schizophrenia from an individual coming from that culture. 

00:27:15TRACIE COLLINS Those differences and their impact on how I make a diagnosis and the use of the DSM-5 or ICD-10 to make that diagnosis, it’s really my effort and digesting and interpreting what a patient has just told me and taking that language and then applying it to what I think is the language of the DSM-5, so making them compatible. So as the clinician I have to do the work to translate what a patient has said and then look at DSM-5 to say, oh, here is the diagnosis that fits for this patient. But the DSM-5 again is not culturally tailored. It, there is not a section in there or component of the diagnosis that says, For a patient who’s of this advancity or this culture, they may describe this list of symptoms. The symptoms are very uh… descriptive and very standardize. 

00:28:10SIOBHAN DOHERTY Having a standard criteria, allows the clinician to translate the patient’s behavior and verbiage into a diagnosis. This gives the patient and the clinician a greater sense of the patient’s symptoms and puts them on the path to recovery. 

00:28:25MATTHEW MACALUSO I think this video series is a nice one for people learning DSM-5 because it reviews the diagnostic criteria. And so clinicians need to realize that the diagnostic criteria were not handed down by Moses on stone tablets, they are manmade. And so they are fallible to some degree and they will not, can’t necessarily capture every patient’s umm… uh… symptomatology. DSM even cautions that it’s system be used as a guide. It is the best guide we have and it is our definitive language for communicating the symptoms that patients have in terms of mental disorders. And so I hope people will take a look at this video series and use it to learn the criteria and also learn the diagnostic codes and how they crosswalk with ICD. Walden NRNP 6635 Week2 Discussion

00:29:15Produced by 

00:29:15Classroom Productions, INC. 

00:29:15Technical Advisors 

00:29:15Dr. Tracie Collins, MD, MPH 

00:29:15Dr. Matthew Macaluso, D.O. 

00:29:15Mary Llenell Paz, MS 

00:29:15Directed by 

00:29:15Sean Harrigan 

00:29:15Written by 

00:29:15Sean Harrigan 

00:29:15Siobhan Doherty 

00:29:15Script Editor 

00:29:15Pandora Suderman 

00:29:15Production Coordinator 

00:29:15Siobhan Doherty 

00:29:15Field Production 

00:29:15Amanda Buffington 

00:29:15Hannah Huff 

00:29:15Merlin Huff 

00:29:15Featured Cast 

00:29:15Anatasha Blakely 

00:29:15Ross Crain 

00:29:15Siobhan Doherty 

00:29:15Brett Duggan 

00:29:15Abbey Grace 

00:29:15Zach Hallett 

00:29:15Jim Harrigan 

00:29:15Sean Harrigan 

00:29:15Kristen Henley 

00:29:15Hannah Huff 

00:29:15Merlin Huff 

00:29:15Dennis Hurley 

00:29:15Jason Ko 

00:29:15Matt Koenig 

00:29:15Amy Landon 

00:29:15Maribel Martinez 

00:29:15Marissa Moosekian 

00:29:15Bree Murphy 

00:29:15Alan Ramos 

00:29:15Diana Sanchez-Vega 

00:29:15David Santana 

00:29:15Jennifer Shaevitz 

00:29:15Bette Smith 

00:29:15Eddie Smith 

00:29:15Lindsay Smith 

00:29:15Miller Tai 

00:29:15Narration 

00:29:15Siobhan Doherty 

00:29:15Post-Production 

00:29:15Sean Harrigan 

00:29:15Robert Suderman 

00:29:15Property of 

00:29:15Classroom Productions, Inc. 

00:29:15Copyright 2016 

00:29:15All Rights Reserved 

00:29:40END transcriptION 

MedEasy. (2017). Psychiatric history taking and the mental status examination | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=U5KwDgWX8L8

Psychiatry Lectures. (2015). Psychiatry lecture: How to do a psychiatric assessment [Video]. YouTube. 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

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. Walden NRNP 6635 Week2 Discussion

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!