Discuss Psychiatric Assessment of the Adult and Older Adult
Psychiatric Assessment of the Adult and Older Adult
Many assessment principles are the same for children and adults; however, with adults/older adults, consent for participation in the assessment comes from the actual client and not parents or guardians. The exception to this is adults/older adults who have been determined incapacitated by a court of competent jurisdiction. Some adults may be easier to assess than children/adolescents as they are more psychologically minded. That is, they have better insights into themselves and their motivations than children/adolescents (although this is not universally true).
Older adults present some of their own unique assessment challenges in that they may have higher levels of stigma associated with seeking psychiatric care. Additionally, there are higher rates of neurocognitive disorders superimposed on other clinical conditions such as depression or anxiety, which creates additional diagnostic challenges.
Psychiatric Assessment of the Adult and Older Adult
This week, you will develop your own personal format for initial interviews of mental health clients. You also will explore the restrictions and limitations for practice as a PMHNP in your home state and create a plan for passing the national certification exam.
Week 1-developing skills in interviewing and diagnostic reasoning
As we begin Week 1, the module is focused on developing an interview format that provides you with questions/responses that you will use in your work-ups and diagnostic assessments or some call them Psychiatric H & P. By now, you have seen many different formats and ways that providers conduct interviews.
For this document, I encourage you to think of your personal style as well as assure that all relevant information is collected in the first interview. Do not use a template that you find online or that your preceptor uses in the office. The purpose of this assignment is for you to think through how you interview patients. There are many examples online to use as a guide. The key elements are similar to a medical H &P, HPI, PPH, PMH, FH, SH, ROS (psychiatric), MSE, Clinical Assessment and Formulation, Diagnosis, and Plan. This will be your ‘bread and butter’, so to speak for your entire career. It is worth spending some time and effort on this. If you put in a canned template, I will not accept your work.
My personal style is what I would call ‘conversational’. I try to engage in some social conversation to get the visit started and then as the patient talks, I make notes on follow-up questions. I keep a list of the basic things that I need for my write-up: HPI, PPH, PMH, Soc/Dev, Substance use, Medication history, Stressors, coping abilities, therapy history. At the end of what I consider ‘the interview’ I review my list to make sure that I have all the information and I sometimes say to patients, “let me make sure that I got all the information that I need to make an accurate diagnosis and develop a treatment plan”. Then, I will say to the patient, “do you have anything that you’d like to add?”
This conversational style is not for everyone and I know many providers that use more of a ‘checklist’ style. Think about what you want and how you will feel most comfortable. Feel free to provide feedback to your colleagues –there are no right or wrong styles.
Instructions- Week 1:
Despite what you may believe (or may have been told), there is no such thing as one “right” way to do an interview. In fact, there are numerous books written about the various ways of conducting the clinical interview. In actual clinical practice, you will find the format that “works” best for you and addresses your unique strengths and the needs of the client.
In this Discussion, you will practice finding the interview format that works for you and share those ideas with your colleagues for feedback.
Learning Objectives
Students will:
Develop formats for initial interviews of mental health clients
To prepare for this Discussion:
Review the Learning Resources.
Develop an interview format you would use for an initial interview of a client.
ASSIGNMENT
Attach the interview format document you would use for an initial interview of a client.
Describe what interview format your preceptor uses for the initial interview of a client.
Describe which element of your interview format is most helpful in your practice.
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Section 5.1, “Psychiatric Interview, Mental Status Examination” (pp. 192–211)
Section 5.2, “The Psychiatric Report and Medical Record” (pp. 211–217)
Section 5.3, “Psychiatric Rating Scales” (pp. 217–236)
Section 5.5, “Personality Assessment: Adults and Children” (pp. 246–257)
Section 5.7, “Medical Assessment and Laboratory Testing in Psychiatry” (pp. 266–275)
Chapter 6, “Classification in Psychiatry” (pp. 290–308)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Cautionary Statement for Forensic Use of DSM-5”
“Assessment Measures”
“Cultural Formulation”
“Glossary of Technical Terms”
“Glossary of Cultural Concepts of Distress”
Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/
American Psychiatric Association. (2016). Practice guidelines for the psychiatric
evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
Required Media
Laureate Education (Producer). (2017b). Working with Adults and Older Adults” [Video file]. Baltimore, MD: Author.
Hagen, B. (Producer). (n.d.-a). Conducting a mental status exam [Video file]. Mill Valley, CA: Psychotherapy.net.
Optional Resources
American Psychological Association. (2008). Assessment of older adults with diminished capacity. Retrieved from https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf
Rosen, S. L., & Reuben, D. B. (2011). Geriatric assessment tools. Mount Sinai Journal of Medicine, 78(4), 489–497. doi:10.1002/msj.20277
Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). TIP 59: Improving cultural competence. Retrieved from http://store.samhsa.gov/product/TIP-59-Improving-Cultural-Competence/SMA15-4849
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.