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Discussion post #1
Brandon J
Psychiatric Evaluation and Evidence-Based Rating Scales
The psychiatric interview is a vital information-gathering process to help providers gain an understanding of the current mental health status of a patient. This interview can include cognitive, emotional, and behavioral assessments and a mental status examination. The mental status examination is an integral part of the psychiatric interview. This includes different sections, including the patient’s appearance, behavior, activity, speech, mood, affect, thought process, thought content, cognition, insight, and judgment, which allow a provider to have information on the patient’s current mental status (Voss & Das, 2022). Another essential component of the psychiatric interview includes creating and building a therapeutic relationship and rapport. This allows the patient, who is often in distress and experiencing challenging conditions, to feel comfortable and trust the provider to be opening up about specifics (Lenouvel et al., 2022). Lastly, an important part of the psychiatric interview involves reviewing substance use and/or addictions which can be gathered and included in the patient’s health history. This is important as individuals which a substance use disorder account for around 20% of all patients with a mental illness (Iqbal et al., 2019). Gathering this information will help a provider know if a co-occurring disorder exists.
The PHQ-9 is a patient health questionnaire to help determine if a patient is experiencing, and to what extent they are experiencing, depression. One property of this scale is that it allows for a quick screening for depression and an idea of the changes in symptoms over time (Aslan et al., 2020). This questionnaire includes questions about the patient being bothered by the following, “little interest or pleasure in doing things, feeling down, depressed, or hopeless, troubling falling or staying asleep, or sleeping too much, etc.” (National HIV, 2015). This interview is appropriate to use when a patient has suspected depression and can be given verbally by the provider or given to the patient as a questionnaire to fill out (Ford et al., 2020).
Discussion post #2
Joshua D
The presenting compliant is why the patient is seeking help and it is vitally important to hear the patient’s interpretation of symptoms and for the provider to notice any outward facing symptoms that may give hints into diagnosing. The patient may explain that they are hearing voices and that may lead us to believe that schizophrenia could be a possibility (Psychiatry lectures, 2015).
The history of the illness is another particularly important component of the psychiatric interview. It can tell the duration of the illness and help us understand why something may be occurring. Hearing voices can also occur from out of traumatic experiences and may be treated slightly different from another diagnosis. We must establish what the patient’s baseline functions is and if the past medications/interventions have helped or hurt the situation. We need to understand what impact the patient’s diagnosis has on his or her functioning, living situation and what common comorbidities may be occurring (Psychiatry lectures, 2015). Family history is important due to the genetic disposition that may put a patient at an increased risk for a disease process like depression or schizophrenia. A strong family history, along with a solid assessment of how the patient is currently living can help us understand what may possibly occur later on in the patient’s life (Sadock, Sadock, Ruiz, 2017). A person’s suicide risk is now believed to be 45% to 55% genetic and the risk can be further examined by understanding the how the patient views their life and personal struggles (Genetic discovery, n.d.).
The PTSD Checklist (PCL) is a 20-item self-reporting checklist of symptoms associated with a patient’s PTSD (Posttraumatic Stress Disorder. Patients rate each item from 0 to 4 to indicate the extent to which they are disturbed by a certain symptom over the past month or week. ) being the least amount disturbed and 4 being very bothered by the symptom (PTSD checklist n.d.). The respondent’s setting, as well as the goal of the assessment should be considered when using this tool. To monitor a patient’s progress this tool can be used more than once after the start of treatment. If a treatment has started for a month, the score is expected to go down. A 5 to 10 point change is considered a reliable number after starting treatment. A 10 to 20 point changed is a significant jump that may infer that it is not reliable and further insight may be needed (PTSD checklist n.d.). PCL can be used when assessing for PTSD, especially when assessing patients already diagnosed with depression or schizophrenia. Childhood trauma can often be associated with these diagnoses, as well trauma that occurs due to experiencing the symptoms that occur with these diagnoses (Sadock, Sadock, Ruiz, 2017).
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