NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales

NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment 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.

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.

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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. NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales

Week 2 Discussion

Week 2 Discussion

The determination of safety should be the key element of the PMHNP’s interview to patient. In order to ensure patient safety, providers need to consider these three elements such as physical healthwell-being and ill-beingrelationships and belonging to be important components of the psychiatric interview.

First and foremost, screening physical health is crucial because it is the first clinical step in effective diagnosis and treatment of a patient. Poor physical health can lead to an increased risk of developing mental health problems. Similarly, poor mental health can negatively impact on physical health, leading to an increased risk of some conditions. Furthermore, some physical diseases are linked to psychotropic treatment. Consequently, people with serious mental illness experience heightened rate of preventable and treatable physical illnesses, comorbidities such as obesity, cardiovascular disease and diabetes. Thus, questions to ask may include for instance: What health concerns do you have?  How are your sleeping habits over the past 4 weeks?  Have you noticed any changes, difficulty sleeping? How would describe your current appetite? Have your eating habits altered in any way?

Next, asking patients about their Well- being or ill-being would allow the PMHNP to assess their quality of life, feelings of anxiety, distress, motivation, and energy. Sample questions could be: Have you had little pleasure or interest in the activities you usually enjoy over the past few months? Have you been concerned by low feelings, stress, sadness, and nervousness?  Besides, as safety remained a priority for the provider, questions about suicide, self-harm, homicide, domestic violence and abuse will not be omitted from the interview. NRNP 6635 Discussion The Psychiatric Evaluation and Evidence-Based Rating Scales

Moreover, it is import ant to ask during a psychiatric interview about a client ‘s relationships and belonging to know how client ‘s feelings and believes about his/her society and environments, to know if he/she feels accepted, supported, and possessed meaningful relationships. Possible questions that can be asked are: Do you have friends, family, or otherwise? How do you feel by others around you? Tell me about how you have been feeling about your relationships recently.

Explain the psychometric properties of the rating scale you were assigned.

My assigned rating scale is the Quick Inventory of Depressive Symptomatology (QIDS) or Quick inventory of Depressive Symptoms (QIDS-SR16), which is the only brief self-report instrument that assesses all of the clinical domains used in making a diagnosis of MDD based on DSM-IV-TR criteria. The QIDS-SR16 rates symptom domains during the prior 7 days. Each item is scored on a scale from 0 to 3 points. Total scores range from 0 to 27.

The Quick Inventory of Depressive Symptoms (QIDS-SR16) is a short and easy-to-use self-report instrument to assess depressive symptoms (Lako et al., 2014).

It is a new measure of depressive symptom severity derived from the 30-item Inventory of Depressive Symptomatology (IDS), which is available in both self-report (QIDS-SR(16)) and clinician-rated (QIDS-C(16)) formats. This report evaluates and compares the psychometric properties of the QIDS-SR(16) in relation to the IDS-SR(30) and the 24-item Hamilton Rating Scale for Depression (Rush et al., 2003)

The measure consists of 16 items, covering nine depressive symptom domains. These are sleep, sad mood, appetite/weight, energy, self-view, interest, psychomotor, suicidal thoughts, concentration (Rush et al., 2005)

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.

The QIDS-SR16 is sensitive to symptomatic change and its psychometric properties are good in patients with depressive disorders.

Although the Quick inventory of Depressive Symptoms (QIDS-SR16) may provide unique and clinically relevant information on depressive symptoms, this self-report instrument is not suitable for the use in patients with psychotic disorders (Lako et al., 2014)

The 16-item Quick Inventory of Depressive Symptomatology (QIDS), a new measure of depressive symptom severity derived from the 30-item Inventory of Depressive Symptomatology (IDS), is available in both self-report (QIDS-SR(16)) and clinician-rated (QIDS-C(16)) formats. This report evaluates and compares the psychometric properties of the QIDS-SR(16) in relation to the IDS-SR(30) and the 24-item Hamilton Rating Scale for Depression

the QIDS-SR16 is the only brief self-report instrument that assesses all of the clinical domains used in making a diagnosis of MDD based on DSM-IV-TR criteria.

The QIDS-SR16 rates symptom domains during the prior 7 days. Each item is scored on a scale from 0 to 3 points. Total scores range from 0 to 27 (Rush et al., 2005).

References;

Lako, I.M., Wigman, J.T., Klaassen, R.M., Slooff,J.C., Taxis, K., Velthuis,  A.B. (2014). Psychometric properties of the self-report version of the Quick Inventory of Depressive Symptoms (QIDS-SR16) questionnaire in patients with schizophrenia. BMC Psychiatry 14, 247 (2014). Retrieved from https://doi.org/10.1186/s12888-014-0247-2

Rush, J., Trivedi, M.H., Ibrahim, M.H., Carmody, T.J., Arnow, B., Klein, D. N., Markowitz, J. C., Ninan, P.T., Kornstein, S., Manber, R., Thase, M.E., Kocsis, J.H., Keller, M.B. (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Retrieved from

https://pubmed.ncbi.nlm.nih.gov/12946886/

Rush, J., Bernstein, H.J., Trivedi, M.H., Carmody, T.J., Wisniewski, S., Mundt, J.C., Shores-Wilson, K., Biggs, M.M., Woo, A., Nierenberg, A.A., and Fava, M. (2005). An Evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: A Sequenced Treatment Alternatives to Relieve Depression Trial Report. doi: 10.1016/j.biopsych.2005.08.022. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929841/

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!

Submission and Grading Information

RE: Week 2 Discussion

Hello Sika,

I think our scales are both tools that would likely be used in conjunction with each other. It seems that the QIDS-SR16 is used to monitor symptoms related to depression on a broader scale and can be completed quickly. The Quality of Life in Depression Scale (QLDS) in contrast is more specified to specifically the patient’s quality of life. Scenarios in which the QLDS would be used rather the QIDS would be when a broad understanding of the patient’s general depressive symptoms is had, but it is unclear if the patient is having an acceptable quality of day-to-day experience. The QLDS is described as developed in order to help resolve scenarios in which the counselor and patient have disagreement about the result of treatment (McKenna & Hunt, 1992). A scenario in which the provider may interpret the patient as having decrease in symptoms while the patient feels they have worsened may be a time when this tool in useful. In contrast the QIDS-SR16 seems to be a tool that would be repeated each visit in order to monitor for the progression of the patient’s depression symptoms. A situation in which the QIDS would be used would likely be involve a patient who is getting regular treatment for depression and is having monitoring to track the effectiveness of the medication (Rush, A., et al., 2003).

References

McKenna, S., & Hunt, S. (1992, October). The qlds: A scale for the measurement of quality of life in depression. Retrieved March 13, 2021, from https://pubmed.ncbi.nlm.nih.gov/10122730/

Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., Markowitz, J. C.,

Ninan, P. T., Kornstein, S., Manber, R., Thase, M. E., Kocsis, J. H., & Keller, M. B. (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological psychiatry, 54(5), 573–583. https://doi.org/10.1016/s0006-3223(02)01866-8

RE: Week 2 Discussion

Sika, you posted some important elements of the psychiatric interview such as finding out how the patient is doing by asking “How do you feel by others around you? Tell me about how you have been feeling about your relationships recently.” I would like to dig in here a bit. At this point the patient may disclose to you his or her relationship strains due to finances, chronic illnesses, or even homelessness. I believe that no matter the skill and personality of the provider if the provider is not sensitive to the immediate and pressing needs of the patient, the interview will go nowhere. Consider a patient becoming depressed because they have chronic pain. I think the patient would feel better if the pain was managed rather than completing the interview at that time. Additionally, symptoms of depression include hopelessness, worthlessness, helplessness, and loss of interest or pleasure in activities may manifest due to loss of employment. Mucedola (2015) Maslow  discussed that people are motivated to achieve certain needs and outlined “five stages (in ascending order: physiological, safety, social, esteem, and self-actualization) that individuals work to fulfill as they strive toward reaching their full potential” I strongly believe the practice of PMHNPs who care for patient with a nursing model, has full understanding of caring for the needs of the patients that they will interview and will carry the holistic way of practice to the psychiatric interview clinic.

References

Fincher, M., Coomer, T., Hicks, J., Johnson, J., Lineros, J., Olivarez, C. P., & Randolph, A. J. (2018). Responses to hunger on the community college campus. New Directions for Community Colleges, 2018(184), 51-59. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1002/cc.20327

Gomes, O. (2011). The hierarchy of human needs and their social valuation. International Journal of Social Economics, 38(3), 237-259. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1108/03068291111105183

Mucedola, M. S. (2015). Depression, suicide, and maslow’s hierarchy of needs: A preventive approach. Journal of Health Education Teaching Techniques, 2(3) Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fdepression-suicide-maslows-hierarchy-needs%2

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


What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 2, you will begin a systematic review of mental health disorders. You will apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information. You will also formulate differential diagnoses for patients across the lifespan using DSM-5 criteria.

Next Module

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.

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)

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)
Required Media (click to expand/reduce)

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

If you were to give a box of 100 different photographs to 10 people and ask them to sort them into groups, it is very unlikely that all 10 people would sort them into the exact same groups. However, if you were to give them a series of questions or a classification system to use, the chances that all 10 people sort them exactly the same increases depending on the specificity of the system and the knowledge of those sorting the photographs.Photo Credit: [Peter Polak]/[iStock / Getty Images Plus]/Getty Images

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.

Rubric Detail

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Name: NRNP_6635_Week2_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting:

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
40 (40%) – 44 (44%)
Thoroughly responds to the discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least 3 current credible sources.
35 (35%) – 39 (39%)
Responds to most of the discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least 3 credible references.
31 (31%) – 34 (34%)
Responds to some of the discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with fewer than 2 credible references.
0 (0%) – 30 (30%)
Does not respond to the discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only 1 or no credible references.
Main Posting:

 

Writing
6 (6%) – 6 (6%)
Written clearly and concisely.

Contains no grammatical or spelling errors.

Further adheres to current APA manual writing rules and style.
5 (5%) – 5 (5%)
Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.
4 (4%) – 4 (4%)
Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
0 (0%) – 3 (3%)
Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Posting:

 

Timely and full participation
9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation.

Posts main discussion by due date.
8 (8%) – 8 (8%)
Posts main discussion by due date.

Meets requirements for full participation.
7 (7%) – 7 (7%)
Posts main discussion by due date.
0 (0%) – 6 (6%)
Does not meet requirements for full participation.

Does not post main discussion by due date.
First Response:

 

Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic, may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
First Response:

Writing
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.
4 (4%) – 4 (4%)
Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.
0 (0%) – 3 (3%)
Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.
First Response:

Timely and full participation
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.

Posts by due date.
4 (4%) – 4 (4%)
Meets requirements for full participation.

Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)
Does not meet requirements for full participation.

Does not post by due date.
Second Response:

Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic, may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic, lacks depth.
Second Response:

Writing
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.
4 (4%) – 4 (4%)
Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.
0 (0%) – 3 (3%)
Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.
Second Response:

Timely and full participation
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation.

Posts by due date.
4 (4%) – 4 (4%)
Meets requirements for full participation.

Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)
Does not meet requirements for full participation.

Does not post by due date.
Total Points: 100
Name: NRNP_6635_Week2_Discussion_Rubric

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