NRNP 6635 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

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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. NRNP 6635 Week 2 Assessment and Diagnosis of the Psychiatric Patient

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

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.

Required Media (click to expand/reduce)

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

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. NRNP 6635 Week 2 Assessment and Diagnosis of the Psychiatric Patient

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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.

Read a selection of your colleagues’ responses.

Sample Discussion Approach – NRNP 6635 Week 2 Assessment and Diagnosis of the Psychiatric Patient

The 3 most important components of the psychiatric interview are building a therapeutic alliance, screening for general conditions, and interviewing for diagnosis (Carlat, 2017). Building a therapeutic relationship is important for the obvious reason; if your patients do not feel comfortable with you, they will be less likely to share personal information. Bolsinger et al., (2020) reports that the therapeutic relationship is essential for patient satisfaction, decreased rehospitalization rates, and clinical improvement. Screening for general conditions is important so the patient is not misdiagnosed. For example, a patient could be suffering from sleep apnea and not received adequate rest. This patient may appear flat or withdrawn but only due to exhaustion. When screening for general conditions you can also gather medication the patient may have forgotten to mention. Interviewing for the diagnosis will help the provider center their thoughts with all the information received. It allows the provider to ask more diagnosis centered questions.

            The scale I was assigned, NICH Vanderbilt Assessment Scale, is a tool used to diagnose ADHD in children.  Psychometric properties rose from 56% (parent using Vanderbilt Assessment alone) to 84% when clinical data was used instead of parent data alone (Silverstein et al., 2016). This scale should be used during the interviewing for diagnosis portion of the psychiatric interview. ADHD is not diagnosed on just an assessment. Diagnosis is determined if symptoms are present in 2 different settings: home and classroom or office visit and assessment scale (Carlat, 2017, pg. 246).

References

Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review. Frontiers in psychiatry, 10, 965. https://doi.org/10.3389/fpsyt.2019.00965

Carlat, D. J. (2017). The psychiatric interview (4^th ed.). Wolters Kluwer.

Silverstein, M., Hironaka, L. K., Feinberg, E., Sandler, J., Pellicer, M., Chen, N., & Cabral, H. (2016). Using Clinical Data to Predict Accurate ADHD Diagnoses Among Urban Children. Clinical Pediatrics, 55(4), 326–332. https://doi.org/10.1177/0009922815591882

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!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

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