NRNP 6635: Psychopathology and Diagnostic Reasoning 1.Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. A.Identification and Chief Symptom

 

There are many points in the initial psychiatric assessment that are important, with the hierarchy tending to be the symptoms or behaviors resulting in the patient receiving a psychiatric evaluation. Obtaining the patient’s present symptoms and a history of psychiatric care are two specific areas this writer feels are important.  In the initial interview, one can learn much about the patient.  The patient may not be forthcoming in saying why he is present for an interview or assessment. This behavior could be because he is paranoid, ashamed, fearful of reprisal, or wishing to hold his feelings inside to hide what he has plans to do if suicidal.  To determine a correct diagnosis, it is essential to identify the symptomology, which will build a case for the diagnosis (Kaplan and Sadock, 2015). The use of open-ended questions facilitates communication of what the patient feels is necessary.

A second concept of the interview includes others in the development of a diagnosis and treatment plan. To obtain a patient’s history of psychiatric treatment and another’s view or perceptions of the patient’s behavior, collaboration with family members, caregivers, teachers, and other significant people who frequently see the patient may be needed.  (American Academy of Child and Adolescent Psychiatry,1995).  Without the accurate and complete present presentation of symptoms, past diagnoses, and treatment received, the ability to develop a treatment plan that meets the patient’s needs becomes difficult.  When working with geriatrics, the patient may not know why they are being assessed.  The patient being unclear is an example of why a Mini-Mental Exam is useful when doing a systematic review.  The geriatric depression scale should be given during the systematic review as well because depression may not always be manifested blatantly or overtly in geriatric patients.  Symptoms of depression and early dementia can overlap. Difficulty concentrating, trouble sleeping, forgetfulness is just a couple of symptoms seen in both disorders.  When depression can be detected and treatment initiated while mild or moderate, there is a greater prognosis. The Geriatric Depression Scale (GDS) is a scale made up of thirty questions that have been developed into a fifteen-question scale.  “The GDS-15 scale is the most widely psychometric tool designed specifically for measuring depression in the elderly” (He et al., 2018, Sjoberg et al., 2017; Tsoi et al., 2017; Yesavage et al., 1982 as cited by Merkin, Medvedev, Sachev, Tippett, Krishnamurthi, Mahon, Kasabov, Parmar, Crawford, Doborjeh, Doborjeh, Kang, Kochan, Bahrami, Brodaty, Feigin (2020). The MMSE and GDA-15 would be essential in examining a geriatric patient and easily incorporated into the systems review.  The questions of the GDS-15 INCLUDE 1) Are you basically satisfied with your life? 2) Have you dropped many of your activities and interests? 3) Do you feel that your life is empty? 4) do you often get Bored? 5) Are you in good spirits most of the time? 6) Are you afraid that something bad is going to happen to you? 7) Do you feel happy most of the time? 8) do you often feel helpless? 9) Do you prefer to stay at home at night, rather than going out and doing new things? 10) Do you feel you have more problems with memory than most? 11) Do you think it is wonderful to be alive not? 12) do you feel pretty worthless the way you are not? 13) Do you feel full of energy? 14) Do you feel that your situation is hopeless? 15) Do you think that most people are better off than you are? (Merkin et al., 2020).

Another area this writer believes is essential is obtaining the past medical history and labs to determine the patient’s present state of health.  This writer has seen many geriatric patients admitted with increased confusion and behavioral issues with a severe urinary tract infection. Their behavior and confusion cleared with the treatment of the urinary tract infection.

References

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

Merkin, A.G., Medvedev, O. N., Sacdev, P. S., Tippett, L., Krishnamurthi, R., & Mahon, S., et al., (2020), Mew avenue for the geriatric depression scale:  Rasch transformation enhances reliability of assessment, Journal of Affective Disorders, 264(2020. [[7-14

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., pp9-15), Wolter Kluwer