According to Saddock, Saddock, and Ruiz (2015), the psychiatric interview is the most important element in the evaluation and care of persons with mental illness. It is how we obtain information that will drive the criteria-based diagnosis and ultimately, the plan of care. From the beginning, the interview will establish the client-provider relationship which, can have a profound influence on the outcome of treatment. Three important elements of the psychiatric interview include past psychiatric illness, mental status exam, and formulation NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.
Past Psychiatric Illness
The past psychiatric history should include all psychiatric illnesses, symptoms, and treatment over the patient’s lifespan. The symptoms should include, when they occurred, how long they lasted, and the frequency and severity of episodes (Saddock, Saddock, & Ruiz, 2015) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. Special considerations, such as, suicidal or homicidal ideations, and episodes of self-injury should be assessed. Treatment episodes should include outpatient, inpatient, day, and voluntary/involuntary treatment. The practitioner should collect and review information about medication use and other modalities such as electroconvulsive therapy (ECT) that have been used and the response experienced by the patient. Did the patient experience side effects or any other negative effects from the treatment? Finally, was a diagnosis made in previous episodes that should be considered now.
Mental Status Exam
The mental status exam (MSE) is intended to explore all areas of mental functioning and denotes evidence of signs and symptoms of mental illness (Saddock et al, 2015). The practitioner will begin the MSE upon initiation of the interview through observation, direct questioning, and the cognitive screening. According to Sadock et al (2015), components of the screening include appearance, behavior, motor, speech, mood, affect, cognition, abstract reasoning, and thought process. If suicidal ideations are present, intention, methods, motivation, reason for living, and the patient’s therapeutic alliance should also be assessed (American Psychiatric Association, 2016) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.
Formulation
Formulation consists of the culmination of all the data collected, the diagnosis, recommendations, and treatment planning. The formulation should include a brief summary of the patient’s history, presentation, and current status (Saddock et al, 2015) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. Combined, these elements should lead to the differential diagnosis of the patient’s illness as well as the provisional diagnosis. The formulation should include a summary of the safety assessment, an estimate of the patient’s suicide risk, rationale for treatment selection, and treatment related preferences (American Psychiatric Association, 2016). All should be explained and collaborated with the patient; differential diagnosis, risks of untreated illness, treatment options, and benefits and risks of treatment (American Psychiatric Association, 2016). NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.
Psychometric Properties of the Geriatric Depression Scale
The Geriatric Depression Scale has been tested and used extensively with the older population. The GDS is a self-report measure of depression in older adults. The response is a yes/no format and was formulated because of their high correlation with depressive symptoms in previous validation studies (American Psychiatric Association, 2020). Of the 15 items on the assessment, 10 indicate the presence of depression when answered positively while the other 5 are indicative of depression when answered negatively (short form) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.
American Psychiatric Association (2020). Geriatric Depression Scale (GDS). Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/geriatric-depression
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https//psychiatriconline.org/doi/pdf/10.1176/appi.books..9780890426760
Greenberg, Sherry A. (2020). The Geriatric Depression Scale (GDS). Hartford Institute for Geriatric Nursing. Retrieved from https://hign.org/consultgeri/try-this-series/geriatr
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