Week 2: Assessment and Diagnosis of the Psychiatric Patient

A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the ?ow of information necessary for an accurate diagnosis and appropriate treatment plan. NRNP 6635 Week2 Discussion

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.

This week, as you explore assessment and diagnosis of patients in mental health settings, you examine assessment tools, including their psychometric properties and appropriate uses. You also familiarize yourself with the

DSM-5

classification system.

<sub>Reference

: Bjorklund, P. (2013). Assessment and diagnosis. In K. Wheeler (Ed.),

Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice

(2nd ed.) (pp. 95–168). Springer Publishing Company.</sub>

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Learning Objectives

Students will:

• Evaluate elements of the psychiatric interview, history, and examination
• Analyze psychometric properties of psychiatric rating scales
• Justify appropriate use of psychiatric rating scales in advanced practice nursing

Learning Resources – NRNP 6635 Week2 Discussion

Required Readings

(click to expand/reduce)

American  Psychiatric Association. (2013). Section I: DSM-5 basics. In

Diagnostic and statistical manual of mental disorders

(5th ed., pp. 5–29). Author.

Carlat, D. J. (2017).

The psychiatric interview

(4th ed.). Wolters Kluwer.

• Chapter 34, Writing Up the Results of the Interview

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).

Kaplan & Sadock’s synopsis of psychiatry

(11th ed.). Wolters Kluwer.

• Chapter 5, Examination and Diagnosis of the Psychiatric Patient
• Chapter 6, Classification in Psychiatry
• Chapter 31, Child Psychiatry (Sections 31.1 and 31.2 only)

American Academy of Child and Adolescent Psychiatry (1995).

Practice parameters for the assessment and treatment of children and adolescents

. https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

American Psychiatric Association. (2016).

Practice guidelines for the psychiatric evaluation of adults

(3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Classification in psychiatry. In

Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry

(4th ed., pp. 1–8). Wolters Kluwer.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In

Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry

(4th ed., pp. 9–15). Wolters Kluwer.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Medical assessment and laboratory testing in psychiatry. In

Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry

(4th ed., pp. 16–21). Wolters Kluwer.

Required Media

(click to expand/reduce)

Classroom Productions. (Producer). (2015).

Diagnostic criteria

[Video]. Walden University.

_________________________________________________________________

00:00:00



BEGIN

transcript

:

00:00:00



DIAGNOSING MENTAL DISORDERS

00:00:00



DSM-5® AND ICD-10

00:00:05



DIAGNOSTIC CRITERIA

00:00:10



Dr. Matthew Macaluso, D.O.

00:00:10



ABPN Board Certified

00:00:10



MATTHEW MACALUSO


There’s not a single lecture that I give that doesn’t have DSM criteria


imbedded into it. So because it’s the gold standard for diagnosis, that’s what we teach


medical students in residence.

00:00:20



Dr. Tracie Collins, MD, MPH

00:00:20



Professor, Practising Physcian

00:00:20



TRACIE COLLINS


As a primary care position, you see a lot of depression,


generalized anxiety disorders, uh… adjustment disorders with depressed mood.


And the DSM is very helpful for understanding how to


accurately diagnose a patient as far as put them into a certain category.

00:00:40



MATTHEW MACALUSO


You know, I think that there are aspects of the billing and coding system


that a little clunky. Umm… And I think physicians need to be well educated on them.


And I think that’s one of the purposes of this video series is to help doctors understand


the differences between DSM and ICD and how they cross-walk


and how they can understand the DSM criteria, how they can use those codes in their practice


and how those codes apply to their billing.  NRNP 6635 Week2 Discussion

00:01:10



SIOBHAN DOHERTY


Every year, nearly one in five American adults, or 42.5 million people, experience a mental illness.


A mental illness or mental disorder can be defined


as a clinically important syndrome, that is, it’s a collection of symptoms,


these can be behavioral or psychological that causes the person disability


or distress in social, personal or occupational functioning.


This definition helps to convey the scope of these mental disorders,


as they cover a wide range of symptoms, with no two individual’s experiences


exactly alike. While some may experience a lower depressed mood,


others could be easily excitable or agitated. And there are those that can swing


back and forth from one set of symptoms to another.


The symptoms can manifest in physical compulsions or could be relegated to the individual’s internal life,


with the individual experiencing racing thoughts or hallucinations.


And well there are individuals that may find their symptoms completely debilitating,


others may find them to be a mild but still problematic facet of their lives, which nonetheless


causes a degree of functional impairment. Each set of symptoms


can require its own mode of treatment, and so the first step in beginning that treatment process


is evaluating these symptoms, in order to diagnose the patient with a specific mental disorder.


Because of this, it is crucial for a clinician to have both


an effective diagnostic method and set of diagnostic criteria.


In the United States, the gold standard for diagnosing a mental disorder is the


Diagnostic and Statistical Manual of Mental Disorders, or DSM.

00:02:50



MATTHEW MACALUSO


DSM is a necessity in psychiatry


because we’re operating on a syndromic level.


And so psychiatric illnesses are different from illnesses elsewhere in medicine, in that we don’t have to discreet biomarkers


to diagnose them. For example, if someone comes in with


signs and symptoms of kidney failure, there are lab tests that can be done to confirm that diagnosis.


In psychiatry, no such lab tests or brain imaging exists as of today


that can definitively confirm a diagnosis.


So because of that we’re operating on a syndromic level.

00:03:25



SIOBHAN DOHERTY


Since the same tests or biomarkers may not be available


to diagnose a mental disorder as when diagnosing a physical condition.


DSM can provide the clinician with the standardized method of identifying a patient’s disorder.


This allows for the disorder to be treated or even communicated


to another clinician during the treatment process. However, it is not


the only diagnostic criteria used both in the United States and throughout the world.


The World Health Organization’s International Classification of Diseases,


or ICD, is used in concert with DSM in the United States.


It is also considered the standard throughout the rest of the world. Because of this,


it is vital for the clinician to be familiar with these two classification systems,


their role in the current medical landscape and their use in the field, so that the clinician can


better guide the patient along their path to recovery.

00:04:25



CLINICIANS

00:04:30



SIOBHAN DOHERTY


To better understand that DSM, ICD and their use in various healthcare or academic settings,


we consulted with two experts in the field, Dr. Tracie Collins, MD, MPH


and Dr. Matthew Macaluso, D.O..

00:04:40



TRACIE COLLINS


I first came into contact


with the DSM and ICD when I was a medical student.


The DSM was really emphasized during my psychiatry rotation, umm… and during that time


I learned about the various umm… codes and how to


diagnose a patient based on their symptoms and signs. DSM was very helpful to categorize patients


as being either major, umm… where’s they having either major depression


or other symptoms, umm… other diagnosis.

00:05:10



MATTHEW MACALUSO


DSM has been a major part of my professional life


since the time when I was a resident and I learned the DSM criteria.


I was tested on DSM when I became Board Certified as a psychiatrist.


And in clinical practice, I used DSM to document patient diagnosis


and for billing purposes.

00:05:35



TRACIE COLLINS


As far as my practice… So after medical school in residency, I practiced General Internal Medicine.


As a primary care position you see a lot of depression,


generalized anxiety disorders, uh… adjustment disorders with depressed mood.


And the DSM is very helpful for understanding how to accurately


diagnose a patient as far as put them into a certain category.


And so in my practice, it has been helpful as far as communicating with other practitioners about


what I believe is going on with the given patient.

00:06:05



MATTHEW MACALUSO


Although, I teach it to medical students


and residence umm… and it’s the gold standard within the profession and so use DSM everyday,


have a copy of it on my desk.

00:06:15



SIOBHAN DOHERTY


Before delving into the current


use of DSM and ICD, it is important to understand their history in the larger context of psychiatry.

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