NRNP 6635 – discussion

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

Alexis Renee Johnson

The Psychiatric Evaluation and Evidence-Based Rating Scales

Psychiatric Interview

There are multiple components to the psychiatric interview. While each one of the components is important, I am going to focus on the assessment, DSM-5 Diagnosis, and treatment plan. “The assessment should be a brief recapitulation of the overall clinical picture and a discussion of differential diagnosis.” (Carlat, D. J., 2017). Carlat also notes this is often the area other clinicians will focus on therefore it is important to capture all pertinent information here. In the assessment should include identifying data, current clinical picture, family, and medical history that may be associated with the current diagnosis. “The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the standard language by which clinicians, researchers, and public health officials in the United States communicate about mental disorders.” (Regier, D. A., Kuhl, E. A., & Kupfer, D. J., 2013). In the psychiatric interview, the DSM-5 is where the clinician will list all the diagnosis for the patient being interviewed. The treatment plan is where the clinician will document the plan of care for the patient. The treatment plan should include: any diagnostic testing planned (i.e., neuropsychological testing, laboratory tests), plans for medication, if you can prescribe, plans for therapy, if needed, referrals to other health care practitioners, if applicable, when you plan to see your patient again. (Carlat, D.J., 2017).

Psychometric Properties

There are multiple screening tools to diagnosis and determine the severity of depressive disorders. I chose to discuss the Beck Depression Inventory (BDI) scale. “The BDI was developed in the early 1960s to rate depression severity, with a focus on behavioral and cognitive dimensions of depression.” (Boland, R. & Verduin, M. L. & Ruiz, P., 2022). This screening tool consists of 21 questions the patient will answer based off their symptoms over the last 2 weeks. The scale is then scored and determines the severity of symptoms. The tool can be readministered to evaluate changes in symptoms over treatment. The screening tool can be administered anytime but would be most helpful and the beginning of the interview to help identify the severity of symptoms.

References:

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

Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th

ed.). Wolters Kluwer

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria

changes. World psychiatry: official journal of the World Psychiatric Association

(WPA), 12(2), 92–98. https://doi.org/10.1002/wps.20050

Mathew Ajemba

Hello professor and class,

The three important elements of the psychiatric interview are chief complaint and history of presenting illness (HPI), mental status examination (MSE), and family and social history. The CC offers direction on what kind of HPI (including onset, duration, symptom progression, alleviating, and triggering factors) to gather to understand the patient’s current mental health status (Sadock et al., 2017). By understanding the patient’s CC and HPI, the provider can gain valuable insight into their mental state and help formulate differential diagnoses and an appropriate treatment plan. The MSE helps gain insight into the patient’s mental status by assessing their appearance, behaviors, speech, thought content and process, mood and affect, cognition, perception, insight, and judgments, information fundamental to developing differential diagnoses by identifying specific abnormalities and patterns that indicate certain psychiatric illnesses and informing the development of a treatment plan (Newson et al., 2020). Family and social history is important considering it influence psychopathology. Information about the family’s mental illnesses, social practices (e.g. drinking, drug use, and smoking), and significant life events (e.g. divorce) can help understand the patient’s life and aid in identifying potential stressors and differential diagnoses (Sadock et al., 2017).

The screening tool assigned is the Overt Aggression Scale-Modified (OAS-M), a tool used to assess aggression in psychiatric patients, both inpatient and outpatient (Mistler & Friedman, 2022). According to Coccaro (2020), the OAS-M is a valid and reliable tool, with an alpha coefficient of 0.88 for OAS-M Global Anger and Aggression (GAA) and 0.78 for OAS-M aggression score (AGG), demonstrating internal consistency. The tool also has high inter-rate reliability with a Kappa coefficient of 0.84 and ICC value of 0.97; high temporal stability with an ICC of 0.55; and high face validity.

The OAS-M, as described by Coccaro (2020), is relevant for patients who present with aggressive behaviors such as a history of threats, violence, agitation, or irritability. It provides healthcare professionals with a structured and standardized approach to assessing the risk of overt aggression through the assessment of physical aggression, verbal aggression, hostility, and other aggressive behaviors. The tool also guides the development of appropriate intervention by informing on the severity and nature of the patient’s aggressive behaviors. For instance, helping identify specific triggers and developing targeted and individualized interventions for the management of aggressive behaviors (Mistler & Friedman, 2022). The OAS-M tool is also used to monitor the effectiveness of the intervention in which it is administered at regular interventions to track changes in severity and nature of aggregation, helping inform any change to treatment plans and making necessary adjustments to help attain therapeutic efficacy (Coccaro, 2020).

References

Coccaro, E. F. (2020). The Overt Aggression Scale Modified (OAS-M) for clinical trials targeting impulsive aggression and intermittent explosive disorder: Validity, reliability, and correlates. Journal of Psychiatric Research, 124, 50-57. https://doi.org/10.1016/j.jpsychires.2020.01.007Links to an external site.

Mistler, L. A., & Friedman, M. J. (2022). Instruments for measuring violence on acute inpatient psychiatric units: Review and recommendations. Psychiatric Services, 73(6), 650-657. https://doi.org/10.1176/appi.ps.202000297Links to an external site.

Newson, J. J., Hunter, D., & Thiagarajan, T. C. (2020). The heterogeneity of mental health assessment. Frontiers in Psychiatry, 11, 76. https://doi.org/10.3389/fpsyt.2020.00076

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. 39–52). Wolters Kluwer.

MY POST

Natalie Farquharson

Exploring Psychiatric Assessment and the Montgomery-Åsberg Depression Rating Scale (MADRS)

Components of the Psychiatric Interview

The key psychiatric interview components were rapport-building mental state analysis, and accurate diagnosing. Initial rapport-building fosters a therapeutic partnership that encourages patients to open up. This requires creating a sympathetic, nonjudgmental space for conversation. A comprehensive examination of cognitive, emotional, and perceptual functions reveals the patient’s mental health. Structured questions, observations, and open-ended inquiries help discover mental disorders in this complete examination (Carlat, 2017). Finally, a correct diagnosis is crucial. After the mental state exam, the diagnostic evaluation and formulation procedure synthesizes the data using DSM-5 criteria. This improves comprehension and helps create customized treatment programs.

Psychometric Properties of MADRS

The Montgomery-Åsberg Depression Rating Scale (MADRS) demonstrates robust psychometric properties, affirming its reliability and validity in assessing depressive symptoms. With good internal consistency, MADRS items exhibit high correlation, ensuring homogeneity in measuring depressive constructs. Inter-rater reliability is also notable, indicating consistent ratings across different assessors. Content validity is supported by the scale’s comprehensive coverage of various depressive aspects, and construct validity is evidenced by its effectiveness in measuring depressive symptoms (Borentain et al., 2022). MADRS exhibits sensitivity to change, crucial for tracking symptom severity changes over time in clinical trials. Its criterion-related validity is affirmed through significant correlations with other established depression measures. Furthermore, the one-factor structure of MADRS underscores its simplicity and efficiency in capturing the overall severity of depression.

Application of MADRS

It’s appropriate to use the scale as nurse practitioners during psychiatric interviews. The Montgomery-Åsberg Depression Rating Scale (MADRS) proves particularly valuable within nurse practitioners’ responsibilities. Employing MADRS during the initial psychiatric assessment allows nurse practitioners to gauge the severity of depressive symptoms, establishing a crucial baseline for informed treatment planning. As care progresses, the scale becomes an effective tool for ongoing monitoring, enabling nurse practitioners to track symptom changes and assess the effectiveness of therapeutic interventions (Ntini et al., 2020). MADRS also supports collaborative care models, facilitating standardized communication with other healthcare professionals involved in a patient’s mental health management. In research settings, nurse practitioners can utilize MADRS for data collection, contributing to a more comprehensive understanding of depressive symptomatology.

MADRS use in Nurse Practitioner’s Psychiatric Assessment

The Montgomery-Åsberg Depression Rating Scale (MADRS) significantly enhances a nurse practitioner’s psychiatric assessment by providing a structured and standardized method for evaluating the severity of depressive symptoms. Utilizing MADRS during the initial evaluation establishes a quantifiable baseline, enabling tracking changes in symptomatology over time and facilitating ongoing monitoring of treatment effectiveness (Ntini et al., 2020). The scale’s comprehensive nature ensures a systematic exploration of various depressive symptoms, contributing to a more accurate and holistic understanding of the patient’s mental state. MADRS also promotes consistency and effective communication in multidisciplinary care settings, enhancing collaboration with other healthcare professionals. In research contexts, MADRS serves as a valuable tool for data collection, contributing to evidence-based practice.

References

Borentain, S., Gogate, J., Williamson, D., Carmody, T., Trivedi, M., Jamieson, C., Cabrera, P., Popova, V., Wajs, E., DiBernardo, A., & Daly, E. J. (2022). Montgomery?Åsberg Depression Rating Scale factors in treatment?resistant depression at the onset of treatment: Derivation, replication, and change over time during treatment with esketamine. International Journal of Methods in Psychiatric Research, 31(4). https://doi.org/10.1002/mpr.1927Links to an external site.

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

Ntini, I., Vadlin, S., Olofsdotter, S., Ramklint, M., Nilsson, K. W., Engström, I., & Sonnby, K. (2020). The Montgomery and Åsberg Depression Rating Scale – self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy. Nordic Journal of Psychiatry, 74(6), 415–422. https://doi.org/10.1080/08039488.2020.1733077Links to an external site.

Please respond to Alexis and Mathew with 2 paragraphs with references

THE PSYCHIATRIC EVALUATION AND EVIDENCE-BASED RATING SCALES

EditEditAssessment 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.