response to discussion

I need to respond with reference to each of these discussions.

The Psychiatric Evaluation and Evidence-Based Rating Scales

            The psychiatric interview is a crucial component of psychiatric evaluation. Since there are no laboratory examinations that provide evidence for psychopathological processes, the psychiatric interview is a key diagnostic instrument for psychiatrists (MacKinnon, et al., 2015). Psychiatry is a field that derives its practice from clinical observations that take place in a face-to-face encounter between a patient and a healthcare provider where mental disorders are examined closely (MacKinnon, et al., 2015). Through a comprehensive psychiatric interview, the healthcare provider can understand the patient’s behaviors, emotions, experiences, motivators, psychological, religious, and social influences. Information obtained, therefore, serves as a diagnostic tool and guides treatment plans.

            There are several components of a psychiatric interview, but this paper will discuss three of the components, including chief complaint and history of presenting illness, past psychiatric history, and mental status examination. A chief complaint is the patient’s chief symptom that warrants them to seek psychiatric care. The healthcare provider can ask an open-ended question such as “what brings you to the hospital today?” The healthcare provider should also explore events leading to current symptoms. A longitudinal approach that explores the course of an illness or the approach that only considers the immediate events leading to the patient’s current symptoms can be used (MacKinnon, et al., 2015). Past psychiatric history provides a perspective concerning the patient’s current symptoms by comparing past illness episodes and treatments (MacKinnon, et al., 2015). The past psychiatric history should explore all past psychiatric diagnoses, history of hospitalizations, treatments tried, and the effects of those medications. In addition, special considerations such as suicidal and homicidal ideations and episodes of self-injury should be noted. Mental status examination explores all areas of mental functioning. Mental status examination assesses the appearance of a patient, behavior, speech, mood, affect, perception, thought process and content, memory, judgment, and insight (Saddock et al., 2015).  

Psychometric properties Brief Psychiatric Rating Scale (BPRS)

            The Brief Psychiatric Rating Scale (BPRS) was developed in 1960 to assess the effectiveness of treatment among patients with severe psychiatric illnesses such as depression with psychotic symptoms, bipolar affective, and schizophrenia (Hofmann et al., 2022).  It also yields a comprehensive description of major symptom characteristics (Yee et al., 2017). The current version of BPRS contains 18 items that assess a range of symptoms, including hostility, grandiosity, anxiety, emotional withdrawal, somatic concerns, guilt feelings, mannerisms and posturing, hallucinatory behavior, unusual thought content, disorientation, uncooperativeness, blunted affect, hostility, conceptual disorganization, tension, excitement, and suspiciousness (Yee et al., 2017). The symptoms are rated on an eight-point Likert scale of 0-7 with the highest score being 126 (Yee et al., 2017). BPRS scale demonstrates good reliability and validity in assessing schizophrenia (Andersen et al., 2007) and internal consistency in assessing manic excitement/disorganization, negative and positive symptoms, and depression/anxiety (Eggink, et al., 2019).

            The BPRS tool can be used by the nurse practitioner to assess the severity of the symptoms on the scale on the first encounter with a patient. The tool can also be used by the nurse practitioner to evaluate the effectiveness of psychopharmacological agents or psychotherapy on a patient’s symptoms. The BPRS is useful because it allows the nurse practitioner to modify the treatment plans of patients if there is no symptom improvement.

References

Andersen, J., Larsen, J. K., Kørner, A., Nielsen, B. M., Schultz, V., Behnke, K., & Bjørum, N. (2007). The brief psychiatric rating scale: schizophrenia, reliability and validity studies. Nordisk Psykiatrisk Tidsskrift, 40(2), 135-138. https://doi.10.3109/08039488609096456

Eggink, E., de Waal, M. M., & Goudriaan, A. E. (2019). Criminal offending and associated factors in dual diagnosis patients. Psychiatry research, 273, 355-362. https://doi.org/10.1016/j.psychres.2019.01.057.

Hofmann, A. B., Schmid, H. M., Jabat, M., Brackmann, N., Noboa, V., Bobes, J., … & Egger, S. T. (2022). Utility and Validity of the Brief Psychiatric Rating Scale (BPRS) as a Transdiagnostic Scale. Psychiatry Research, 114659. https://doi.org/10.1016/j.psychres.2022.114659

MacKinnon, R. A., Michels, R., & Buckley, P. J. (2015). The psychiatric interview in clinical practice. American Psychiatric Pub.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Yee, A., Ng, B. S., Hashim, H. M. H., Danaee, M., & Loh, H. H. (2017). Cultural adaptation and validity of the Malay version of the brief psychiatric rating scale (BPRS-M) among patients with schizophrenia in a psychiatric clinic. BMC psychiatry, 17(1), 1-10. https://doi.org/10.1186/s12888-017-1553-2