Main Discussion Post
Examining, assessing, and diagnosing the client are all important aspects of being a psychiatric mental health nurse practitioner. Becoming skilled and confident in these areas helps providers to develop appropriate and effective treatment plans. One thing that has been emphasized in our reading this week and last week is the client-provider relationship. The initial assessment is where the provider lays the groundwork for a positive rapport to be developed. Sadock et al. (2015) stated one of the crucial aspects of the examination is showing empathy while retaining objectivity. Providing privacy, confidentiality, respect, and comfort are all significant factors of the assessment process as well. American Academy of Child and Adolescent Psychiatry (1995) recommended providers approach the interview with three things in mind: to obtain a diagnosis, determine if treatment will be indicated, and develop a treatment plan that will keep the client engaged. One of the objectives for this class is to feel confident with assessment tools and deciding which ones are appropriate for which clients. This post will discuss three important components of the psychiatric interview. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion I will also be discussing the Positive and Negative Symptom Scale (PANSS) and how the provider uses it to determine appropriate diagnoses and treatment.
The psychiatric interview, also referred to as an examination or assessment, is complex and time-consuming. With a cooperative client, the process can still take around an hour to complete. Three crucial components of the interview include the social history, family history, and past medical history NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. The social history gives the provider vital information about how the client functions and what kinds of coping skills they currently employ. This part of the interview also allows the provider to assess the client’s use and history with illicit drugs and alcohol. Sadock et al. (2017) recommended approaching this section of the interview carefully, as the provider will need honest information to get a clear picture of the client’s situation. Asking questions about substance use and abuse should be done without judgment. This tactic includes tone of voice, inflection, and body language. This information is critical in determining which symptoms could be related to substance abuse and what treatment would be most appropriate for each individual client. An example would be a client who presents with attention deficit disorder and reveals that they have a history of meth use. In this case, the provider would probably want to steer away from effective medications such as Adderall due to the possibility of abuse NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.
Many psychiatric disorders have a genetic component that can be assessed during the interview’s familial history portion. The provider can use this information to determine an accurate diagnosis and treatment. For example, if a client came in complaining of symptoms that seemed to align with anxiety and then stated her mom, sister, aunt, and grandmother all had been diagnosed with anxiety, it is very likely the client has a genetic predisposition for that particular disorder. Because genetics can also affect how successful treatment is, it could be useful to know how the client’s family responded to treatment. Another significant part of the family history is the history of suicide attempts and aggressive behaviors. American Psychiatric Association (2016) found that a family history of suicidal ideation and aggression puts the client at higher risk for the same behaviors. As a provider, I would use this information to focus a few more questions in these areas for a clearer picture of my client’s situation.
A client’s past medical history is important for a variety of reasons. A medical history can give the provider insight into possible risk factors for mental disorders. It also will affect how the provider develops a treatment plan. American Psychiatric Association (2016) stated that the provider would also need to determine how any current medical conditions could be affecting the presentation of symptoms and how that will influence the diagnosis. An example of this could be head injuries. The medical history is also important because it will cover any allergies or drug sensitivities the client may have had in the past. Providers use this information when developing their treatment plan if it includes medications. Another crucial component of the medical history is the current medications and supplements the client is taking. The provider will need to ensure that anything they propose to add to the client’s regimen wi
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