Christina Diglaw
Week 2
Purpose Statement
The purpose of this discussion board post is to explain three important components of the psychiatric interview and why these elements are considered important. I will then explain the Brief Psychiatric Rating Scale, including 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 Psychiatric Interview
The psychiatric interview is different from a medical SOAP note. The documentation is less on the physical and more on the mental. The interview is where information will be gathered to formulate a diagnoses and treatment plan. There are still similar aspects such as subjective and objective portions, as well as a history. The three important components of the psychiatric interview include any previous psychiatric illnesses, a mental status exam, and the formulation section.
It is important to be thorough as not to miss any previously diagnosed psychiatric disorders or any tried and failed medications. Previous psychiatric illness shed a light on why the client presents, whether it is for a second opinion, to treat a condition that was treated in the past, or new or worsening symptoms. Part of this is a complete review of medications. If a client reports taking several medications in the past and cannot remember names, a genecyte test may be appropriate. Genecyte testing is a blood test that provides data specifying which medications would be best for the patient based on their genetic makeup.
Mental status exam consists of the following elements: appearance and behavior, motor activity, speech, mood, and affect (Sadock et al., 2017). These findings are typically objective, though some can be subjective such as mood, and can be used with each assessment to determine the efficacy of treatment. These finding can aide in formulating a diagnosis.
Formulation brings together all the pieces of the interview process and is used to formulate a diagnosis, differential diagnoses, and a plan. This portion of the interview could also include a cultural assessment if needed (Lim et al., 2016). Another part of this component is a safety assessment that will determine the level of care that is recommended for the client.
Brief Psychiatric Rating Scale
Psychiatric rating tools are used to help diagnose disorders as well as assess the efficacy of an implemented treatment. The Brief Psychiatry Rating Scale (BPRS) is a tool administered by a clinician and is used to measure psychiatric symptoms. Psychiatric illnesses including schizophrenia, bipolar disorder, and major depressive disorder are similar through cognitive dysfunction and can be evaluated through the BPRS (Zhu et al., 2019). The BPRS is comprised of 18 questions, each scored from 0-7 in severity, with a score of 0 equating to the quality not being assessed. The assessed symptoms include somatic concerns, anxiety, emotional withdrawal, conceptual disorganization, feelings of guilt, tension, mannerisms and posturing, grandiosity, depressive mood, hostility, suspicion, hallucinatory behavior, motor retardation, uncooperativeness, unusual thought content, blunted affect, excitement, and disorientation. The calculations are based on the interview as well as observation of symptoms. This tool can be used to evaluate the formal thought disorder for schizophrenic patients (Park et al., 2018). It would be appropriate to utilize the assessment tool if the client is complaining for symptoms and exhibiting outward signs of potential psychosis. The tool takes about 30 minutes to complete depending on the level of cooperation from the client, therefore it can be completed in session.
Conclusion
Complete and thorough documentation is vital in assessing and treating clients. The more information gathered in an organized manner, the more accurate the diagnosis will be. Utilizing the appropriate tools is also a key factor in client assessment, reevaluation of symptoms and diagnosis/treatment. As providers we have a duty to the clients to utilize the resources available for the best treatment outcomes.
References
Lim, R.F., Díaz, E., & Ton, H. (2016). Cultural competence in psychiatric education using the Cultural Formulation Interview. In: Lewis-Fernández R, Aggarwal NK, Hinton L, Hinton DE, Kirmayer LJ, eds. DSM-5® Handbook on the Cultural Formulation Interview.American Psychiatric Publishing, Inc.; 2016:253-266. Accessed June 9, 2022. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=psyh&AN=20 15-37696-023&site=eds-live&scope=site
Park, Y. C., Kanba, S., Chong, M. Y., Tripathi, A., Kallivayalil, R. A., Avasthi, A., & Park, S. C. (2018). To use the brief psychiatric rating scale to detect disorganized speech in schizophrenia: Findings from the REAP-AP study. The Kaohsiung journal of medical sciences, 34(2), 113-119.
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2017). Classification in psychiatry. In Kalpan and Sadock’s Consice Textbook of Clinical Psychiatry(4th ed., pp. 47) Wolters Kluwer.
Zhu, Y., Womer, F. Y., Leng, H., Chang, M., Yin, Z., Wei, Y., … & Wang, F. (2019). The relationship between cognitive dysfunction and symptom dimensions across schizophrenia, bipolar disorder, and major depressive disorder. Frontiers in psychiatry, 10, 253.
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