Explain the psychometric properties of the Montreal Cognitive Assessment (MOCA).

Respond to 2 post with at least 3 references using current peer review journals

Sketa Simone Bennett

The primary purposes of assessment tools are to diagnose clients and measure the intensity of psychiatric illnesses. It is common to find multiple assessment tools that diagnose the same psychiatric condition (Dwyer et al., 2020). Nevertheless, not all tools are ideal for all clinical scenarios. Psychiatrists must consider the strengths and weaknesses of each tool before using it in a given patient scenario. The three most important components of the psychiatric interview are mental status examination, history taking and therapeutic communication (Dwyer et al., 2020). Mental health experts must communicate therapeutically with patients to establish an emotional rapport that will set the tone for care delivery and improve patient compliance. Therapeutic communication involves broader openings, use of verbal and non-verbal cues as well as wearing a smile. History taking involves gathering information about a patient’s past psychiatric illnesses and mental problems (Dwyer et al., 2020). Additionally, it entails looking at a patient’s developmental and social history. The information obtained from a patient’s history aids in understanding their condition and formulating an appropriate treatment plan as per the patient’s needs. Mental status examination is the most crucial part of psychiatric interview. It involves assessing the patient’s thought process, mood, affect, speech, behavior, cognition and insight. Results from the psychiatric assessment aid in directing mental health experts in diagnosing patients and formulating appropriate treatment plans.

Depression is among the common psychiatric illnesses in the country. The issue affects anyone at any age and level stretching from childhood to adulthood. The common symptoms associated with depression are loss of interest in daily activities, persistent anxiety and sadness, changes in weight and appetite, sleep disturbances, loss of energy, suicidal thoughts and psychomotor agitation. The ideal tool for diagnosing depression is the Quality of Life in Depression Scale (QLDS).

QLDS is a self-report questionnaire that mental health experts use to assess the severity of depressive symptoms over the past one week (Rozjabek et al., 2022). It consists of 16 items representing a different symptom associated with depression which includes appetite changes, sleep disturbances, mood, suicidal thoughts and concentration difficulties. Patients fill the questionnaire range their symptoms on a scale of zero to three. The total score is calculated by adding all the scores (Rozjabek et al., 2022). The maximum possible score is usually 27. The tool is normally used in research studies and clinical settings to assess the symptoms of depression over time.

During the psychiatric interview, the tool helps nurses to determine the patient’s symptoms and the severity of the symptoms (Hohls et al., 2021). For instance, a nurse can use the tool to determine how intense are a patient’s suicidal thoughts. Such information guides caregivers in developing appropriate treatment plans as per patients’ needs.

PMHNPs can use the tool at various stages of the healthcare delivery process stretching from assessment to evaluation. In the diagnosis phase, nurses use the tool to screen patients and determine the presence and severity of depressive symptoms (Hohls et al., 2021). In the assessment phase, mental health experts assess patients to determine the mental health needs. Moreover, in the monitoring phase, the tool helps PMHNPs keep track of patients’ healthcare progress by looking at the severity of their depressive symptoms.

References

Dwyer, J. B., Aftab, A., Radhakrishnan, R., Widge, A., Rodriguez, C. I., Carpenter, L. L., … & APA Council of Research Task Force on Novel Biomarkers and Treatments. (2020). Hormonal treatments for major depressive disorder: state of the art. American Journal of Psychiatry, 177(8), 686-705.

Hohls, J. K., König, H. H., Quirke, E., & Hajek, A. (2021). Anxiety, depression and quality of life—a systematic review of evidence from longitudinal observational studies. International Journal of Environmental Research and Public Health, 18(22), 12022.

Rozjabek, H., Li, N., Hartmann, H., Fu, D. J., Canuso, C., & Jamieson, C. (2022). Assessing the meaningful change threshold of Quality of Life in Depression Scale using data from two phase 3 studies of esketamine nasal spray. Journal of Patient-reported Outcomes, 6(1), 74.

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Collapse SubdiscussionAmbrose Oyemhen Ukpebor
Ambrose Oyemhen Ukpebor
YesterdayMar 5 at 9:33am
Sketa,

It was interesting reading your post, as it presents some valuable information. Allow me to add that the Hamilton Depression Rating Scale (HAM-D) and the Quality of Life in Depression Scale (QLDS) are two different but complementary tools for assessing depression. The HAM-D has been regarded as a gold standard measure of the severity of depressive symptoms, and it has been widely used in clinical trials of anti depressive treatments in people with major depressive disorder (MDD) and other mood disorders (Bobo et al.,2016). It has 17 items that address several aspects of depression, such as mood, guilt, sleep difficulties, and suicide ideation. HAM-D offers clinicians a systematic way of assessing symptom severity and tracking changes in response to treatment across time.

While HAM-D focuses on symptom severity, QLDS provides a more thorough assessment of depression’s overall influence on a person’s life. HAM-D is more suited to clinical settings where clinicians must objectively assess symptom severity and track treatment progress. In contrast, QLDS is helpful in research and clinical practice for assessing the subjective experience of depression and its impact on daily functioning and quality of life (Rozjabek et al., 2022), as you argued in your post. Integrating both measures into practice provides for a more comprehensive assessment of depression, covering both clinical symptoms and the whole psychosocial burden on the patient’s life.

To summarize, the decision between HAM-D and QLDS is determined by the unique evaluation aims and the context of treatment. While HAM-D gives helpful information on symptom intensity and treatment response, QLDS sheds light on the functional impairment and quality of life implications of depression. Integrating both scales into the evaluation process allows for a more complete knowledge of the patient’s condition and informs individualized therapy options to meet their needs.

References

Bobo, W. V., Angleró, G. C., Jenkins, G., Hall-Flavin, D. K., Weinshilboum, R., & Biernacka, J. M. (2016). Validation of the 17-item Hamilton Depression Rating Scale definition of response for adults with major depressive disorder using equipercentile linking to Clinical Global Impression scale ratings: analysis of Pharmacogenomic Research Network Antidepressant Medication Pharmacogenomic Study (PGRN-AMPS) data. Human psychopharmacology, 31(3), 185–192. to an external site.

Rozjabek, H., Li, N., Hartmann, H., Fu, D. J., Canuso, C., & Jamieson, C. (2022). Assessing the meaningful change threshold of Quality of Life in Depression Scale using data from two phase 3 studies of esketamine nasal spray. Journal of Patient-reported Outcomes, 6(1), 74.

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Collapse SubdiscussionOluwatoyin Omolade Omosebi
Oluwatoyin Omolade Omosebi
3:44amMar 6 at 3:44am
Briefly explain three important components of the psychiatric interview and why you consider these elements important.

Introduction

Several crucial elements are necessary to build rapport, obtain pertinent data, and develop precise diagnoses during mental health interviews. For physicians to fully understand the subtleties of their patients’ mental health difficulties, open-ended inquiries are, first and foremost, fundamental tools that let patients openly express their experiences and worries. Second, active listening and empathy create a supportive environment where patients feel heard, understood, and validated, which fosters trust and cooperation in the therapeutic process. Thirdly, evaluating mental state helps doctors make diagnoses and plan treatments by giving them essential information about how the patient thinks, feels, and acts. When combined, these elements not only make thorough evaluations easier to complete but also set the stage for successful therapeutic interventions that cater to each patient’s unique requirements.

Open-Ended Questions: With open-ended inquiries, patients can freely communicate their ideas, emotions, and worries without feeling confined by predetermined queries. They aid medical professionals in comprehending patients’ opinions, signs, and experiences. Asking open-ended questions helps establish rapport and show empathy, which promotes a therapeutic bond between the patient and the healthcare provider. Clinicians can better diagnose and plan treatments for their patients by gaining insight into their context by inviting patients to tell their stories.
Active Listening and Empathy: Active listening entails paying close attention, comprehending, reacting, and retaining what the patient has stated. It entails listening to what the patient is saying and comprehending the feelings, worries, and hidden meanings they are trying to express. The capacity to comprehend and experience another person’s emotions is known as empathy. Clinicians may build trust, validate patients’ experiences, and foster a safe space for exploration and disclosure by practicing active listening and empathy. When patients feel valued, heard, and understood, the therapeutic process is improved, and patient cooperation is encouraged.
Assessment of Mental Status: A patient’s cognitive, emotional, and behavioral functions are systematically assessed during a mental status examination (MSE). Appearance, conduct, voice, emotion, mood, mental content, perception, cognition, insight, and judgment are among the many domains it evaluates. Regarding the patient’s present mental state, degree of functioning, and existence of psychiatric symptoms or cognitive deficiencies, MSE offers essential information. It supports the development of differential diagnoses, tracking symptom changes over time, and assessing therapy response by physicians. The selection of suitable actions and recommendations to other healthcare providers or services are guided by the results of the MSE when it comes to treatment planning.
Explain the psychometric properties of the Montreal Cognitive Assessment (MOCA)

Nasreddine, Phillips, Bédirian, Charbonneau, Whitehead, Collin, & Chertkow (2005) state that one of the most widely used assessments to gauge overall cognitive function and identify possible impairment in older persons is the Montreal Cognitive Assessment (MoCA). The MoCA takes just 10 minutes to administer and is appropriate for older individuals and adults (e.g., over 80 years old). A clinical screening tool called the Montreal Cognitive Assessment (MoCA) is used to identify cognitive impairment. It is especially well-known for helping determine moderate cognitive impairment (MCI), a condition that might be an early sign of dementias such as Alzheimer’s. The MoCA evaluates many cognitive areas, including conceptual thinking, computations, orientation, memory, executive processes, attention and focus, and language and vasoconstriction abilities. It is crucial to consider the instrument’s psychometric qualities, such as validity, sensitivity, specificity, and reliability, to assess its efficacy.

Reliability

The term “reliability” describes a measure’s constancy. The MoCA has shown test-retest solid reliability and internal consistency when given to the same person under the same circumstances. It often yields stable and consistent findings over time. This is essential for tracking changes in cognition over time in research and therapeutic practice.

Validity

A tool’s validity is evaluated by determining if it measures the intended subjects. Strong construct validity demonstrated by the MoCA suggests that it evaluates the cognitive domains it targets with efficacy. Its ability to discriminate between people with normal cognitive functioning and those with cognitive impairment further demonstrates its strong criterion validity.

Sensitivity and Specificity

“sensitivity” describes the tool’s actual positive rate or capacity to identify people with the ailment accurately. The MoCA is an invaluable tool for the early diagnosis of cognitive problems that other screening devices, such as the Mini-Mental State Examination (MMSE), can miss because of its high sensitivity to moderate cognitive impairment.

The term “specificity” describes an instrument’s capacity to accurately detect individuals who do not have the ailment (valid negative rate). Although the specificity of the MoCA is typically reasonable, it can vary based on the population being evaluated and the cut-off scores employed. Adjustments can be required to maximize specificity, especially in groups with higher educational attainment or distinct cultural backgrounds.
Cut-off Scores

A score of less than 26 out of 30 on the MoCA indicates cognitive impairment. This is the typical cut-off score. However, depending on the chosen cut-off score, sensitivity and specificity may change, and modifications may be required to consider age, educational attainment, and cultural variations. All things considered, the MoCA has a high sensitivity for identifying moderate cognitive impairment, making it a relevant and trustworthy tool for screening for cognitive impairment. It is recommended in many clinical and research contexts due to its comprehensive evaluation of cognitive domains. To ensure that the MoCA is utilized as part of a thorough evaluation, researchers and clinicians should be aware of the variables that might affect the MoCA’s specificity and how its results are interpreted.

Explain when it is appropriate to use the Montreal Cognitive Assessment (MOCA) scale with clients during the psychiatric interview.

The Montreal Cognitive Assessment (MOCA) scale can be effectively utilized during psychiatric interviews in numerous situations.

Screening for Cognitive Impairment: The main goal of the MOCA is to screen for cognitive impairment, especially in people at risk of developing early-stage dementia or mild cognitive impairment (MCI). For this reason, if a patient has symptoms or complaints that point to cognitive decline, the MOCA can be used to determine the type and severity of cognitive deficits during the psychiatric interview.
Baseline Assessment: Establishing the patient’s baseline level of cognitive functioning can be achieved by administering the MOCA at the start of the psychiatric interview. Using this baseline can help track changes in cognitive state over time and evaluate the efficacy of therapies or interventions meant to alleviate cognitive impairment.

Differential Diagnosis: Cognitive impairment can occasionally coexist with psychiatric diseases or present as a sign of a mental illness. The MOCA can be used to distinguish cognitive deficiencies linked to mental disorders (such as depression and schizophrenia) from those resulting from organic reasons (such as Alzheimer’s disease and stroke).
Treatment Planning: The MOCA may be used to evaluate cognitive functioning, which can help mental patients plan their treatments. For instance, choosing the best therapy treatments and accommodations to assist a patient’s cognitive functioning might be guided by their understanding of their cognitive strengths and limitations.
Monitoring Response to Treatment: By using the MOCA regularly in follow-up psychiatric interviews, doctors may monitor how treatment strategies are affecting cognitive performance. A rise or fall in cognitive scores might offer important information about the efficacy of psychiatric therapies and direct modifications to the treatment regimen.
It is crucial to remember that even though the MOCA is an effective screening tool for cognitive impairment, a thorough neuropsychological evaluation performed by a trained specialist should always come first. In addition, cultural and educational variables that might affect a patient’s performance on the MOCA should be considered by clinicians. Test results should be interpreted considering additional clinical data obtained during the psychiatric interview.

How is the Montreal Cognitive Assessment (MOCA) scale helpful to a nurse practitioner’s psychiatric assessment?

The Montreal Cognitive Assessment (MOCA) scale is a crucial tool for nurse practitioners doing psychiatric examinations, particularly in diagnosing cognitive impairment and distinguishing psychiatric symptoms from cognitive decline. Here is how the MOCA may help a nurse practitioner’s mental evaluation, supported by evidence-based literature.

Early Detection of Cognitive Impairment: The MOCA is helpful in diagnosing moderate cognitive impairment (MCI) and early dementia, which may be accompanied by psychiatric symptoms like sadness or anxiety. Luis et al. (2017) found that the MOCA has a high sensitivity (90.0%) and specificity (87.6%) for diagnosing MCI, making it a valuable tool for evaluating cognitive impairment in psychiatric patients.
Comprehensive Cognitive Assessment: The MOCA measures several cognitive areas, including attention, memory, language, visuospatial abilities, executive processes, and orientation. Nurse practitioners can gain a thorough understanding of a patient’s cognitive functioning by giving the MOCA during psychiatric examinations. This can aid in separating cognitive deficiencies from psychiatric symptoms, guiding appropriate therapies (Nasreddine et al., 2005).
Identification of Underlying Cognitive Impairment: Psychiatric symptoms can frequently conceal underlying cognitive impairment. Using the MOCA in conjunction with psychiatric examinations might assist nurse practitioners in identifying patients who may require additional neuropsychological evaluation or specialist dementia care. Freitas et al. (2019) discovered that the MOCA was successful in detecting cognitive impairment in people with mental diseases, which aids in differential diagnosis and therapy planning.
Monitoring Cognitive Changes Over Time: Longitudinal evaluation with the MOCA enables nurse practitioners to track changes in cognitive state over time, especially in patients undergoing psychiatric treatment. This can aid in evaluating therapy efficacy and modifying the treatment plan. Julayanont et al. (2014) found that the MOCA is helpful in assessing cognitive changes over time in people with mental illnesses.
Facilitating Interdisciplinary Collaboration: Collaboration between geriatricians and neuropsychologists, among other healthcare experts, is facilitated when the MOCA is incorporated into psychiatric evaluations. For patients with complex psychiatric and cognitive presentations, the MOCA gives interdisciplinary teams a common language for communication and makes it easier to coordinate care (Harper et al., 2016).
In summary, nurse practitioners doing psychiatric evaluations can benefit significantly from using the Montreal Cognitive Assessment (MOCA) scale as it facilitates the early identification, thorough evaluation, and ongoing monitoring of cognitive impairment in mental patients.

References

Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2019). Montreal Cognitive Assessment: Validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Disease & Associated Disorders, 33(1), 37-43.

Harper, L., Fumagalli, G. G., Barkhof, F., Scheltens, P., O’Brien, J. T., Bouwman, F., … & Henneman, W. J. P. (2016). MRI visual rating scales in the diagnosis of dementia: evaluation in 184 post-mortem confirmed cases. Journal of Neurology, Neurosurgery & Psychiatry, 87(7), 671-678.

Julayanont, P., Tangwongchai, S., Hemrungrojn, S., Tunvirachaisakul, C., Phanthumchinda, K., Hongsawat, J., & Nasreddine, Z. S. (2014). The Montreal Cognitive Assessment-Basic: A screening tool for mild cognitive impairment in illiterate and low-educated elderly adults. Journal of the American Geriatrics Society, 62(10), 1941-1945.

Luis, C. A., Keegan, A. P., & Mullan, M. (2009). Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. International Journal of Geriatric Psychiatry, 24(2), 197-201.

Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., … & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699.

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Collapse SubdiscussionLourdesse Charles
Lourdesse Charles
11:57amMar 6 at 11:57am
The Psychiatric Interview

The psychiatric interview is an essential part of the evaluation process in mental health care. To make the correct diagnosis and plan treatments, it is necessary to know what bothers a client most, when it started, how long it has been lasting, and the course of symptoms. This section is known as the chief complaint and history of the present illness; it helps to understand a situation or problem that resulted in seeking medical help with its context and seriousness (Leon et al.,1992). The mental status examination is a diagnostic procedure to identify cognitive, emotional, and behavioral aspects peculiar to this patient today. The physical appearance, behavior, speech pattern, mood changes, and thinking abilities have something to say about the mental state of an individual under study. The details regarding age or sex are significant while assessing this element because one cannot be aware of potential risks or lack thereof, as well as other factors leading to the development or aggravation of anxiety disorders (Leon et al., 1992).

Sheehan’s Disability Scale (SDS) was created to assess functional disability in three related areas: career/college, friendships, and home responsibilities/time management. The SDS bagged good psychometric properties with its indication of the Cronbach alpha which measures level of internal consistency between 0.76 to 0.89 and the convergent validity with other disabling and medical outcome measures, e.g., the Global Assessment of Functioning (GAF) scale and the Medical Outcomes Study-Short form-36 (SF-36) (Arbuckle et al., 2009).

Ultimately SDS is applied in the operational framework of the psychiatric interview for the purpose of collecting the data on how much the daily life of the client has been devalued as a result of the radical psychological disorder, which subsequently is used to defend the gravity of the interference in the numerous domains of life. This data is used to determine the treatment that suits the new patient best and allows for the assessment of the procedure progress. The SDS consists of three self-rated items which are designed based upon the 10 points Likert scale and this reflects the level of the impairment. This impairment is related to the aspects on social functioning, family relationships, and work/school activities (Arbuckle et al., 2009).

References

Arbuckle, R., Frye, M. A., Brecher, M., Paulsson, B., Rajagopalan, K., Palmer, S., & Degl’ Innocenti, A. (2009). The psychometric validation of the Sheehan Disability Scale (SDS) in patients with bipolar disorder. Psychiatry Research, 165(1-2), 163–174. to an external site.

Leon, A. C., Shear, M. K., Portera, L., & Klerman, G. L. (1992). Assessing impairment in patients with panic disorder: The Sheehan Disability Scale. Social Psychiatry and Psychiatric Epidemiology, 27(2), 78–82. to an external site.

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Collapse SubdiscussionGetz Bolivard
Getz Bolivard
12:00pmMar 6 at 12pm
Components of the Psychiatric Interview

Talking, listening, and observing play roles in the psychiatric interview. I think that building a therapeutic alliance between practitioner and patient, obtaining patient history including chief complaint, and assessing the patient for safety are the most critical components (Lapid et al., 2023; Lenouvel et al., 2022). The therapeutic alliance is the very foundation of building trusting rapport, providing the patient with a safe environment, utilizing neutral/empathetic emotions, treating the patient as a person, not their diagnosis, getting to know the patient, and also educating the patient in terms they understand how the psychiatric interview and treatment process works (Lapid et al., 2023; Lenouvel et al., 2022).

Second, obtaining the patient history, including the presenting problem, in order to understand what brought the patient in to seek assistance, what is currently stressing the patient and/or exacerbating the mental health disorder, whether they have ever obtained mental health help before, what has worked and what has not, gathering pertinent information to construct a patient narrative (Lapid et al., 2023; Lenouvel et al., 2022).

The third important component of the psychiatric interview is assessing the patient for safety; not all patients are in crisis or upfront about the severity of symptoms/issues. This does not mean safety is not of concern; therefore, assess for the immediacy of risk of harm to self and/or others (Lapid et al., 2023; Lenouvel et al., 2022). Building a trusting relationship allows the patient to have trust in you to place their story in your hands and begin to know someone has his/her best interest in mind. Minimal progress can be made without a therapeutic alliance. Also, collecting patient information and building a patient narrative is essential to diagnosis, treatment, and continuing with a therapeutic alliance; how can you treat a patient if you do not have a sufficient record to go off of? Also, in mental health, safety is key. As an inpatient psychiatric nurse, safety is the number one issue focused on and continuously assessed, as it can change multiple times for different reasons and safety concerns.

Global Assessment of Functioning (GAF)

The GAF is a 100-point scale from the DSM-IV Axis V, which is a provider-based assessment measuring the overall severity/impairments of psychological, social, and occupational functioning caused by mental health factors with higher scores indicating higher levels of daily functioning (Pedersen et al., 2018). Higher scores on the scale reflect normal functioning, and lower scores indicate poor condition (Pedersen et al., 2018). The GAF is used in the psychiatric interview process as an assessment tool by the provider/nurse practitioner to offer his/her clinical judgment to rate the patient’s severity of mental illness and how such affects the patient’s daily life. The GAF rating can provide a foundation or guidance related to the patient’s functional impairments for the nurse practitioner to develop the patient’s treatment plan. A relevant concern regarding the GAF was that of dropping GAF from the current DSM-V regarding its subjectivity in practice due to a lack of clarity regarding symptoms, risk of suicide, disabilities, etc. (Pedersen et al., 2018). The recommendation is to replace the GAF with the WHO Disability Assessment Schedule, which is believed to possess better psychometric properties (Pedersen et al., 2018).

In summary, the psychiatric interview establishes a relationship, collects patient information, and forms a patient diagnosis and treatment plan. The GAF has been utilized in the mental health field as an assessment rating scale to provide judgment on a patient’s ability to function in daily life regarding the severity of mental illness symptoms. It is imperative to utilize up-to-date assessment tools that are evidence-based. It is also essential for practitioners to select an assessment rating scale pertinent to the evaluation and treatment planning for the population they serve.

References

Pedersen, G., Urnes, ., Hummelen, B., Wilberg, T., & Kvarstein, E. H. (2018). Revised manual for the Global Assessment of Functioning scale. European Psychiatry, 51, 16–19.

Lapid, M. I., Kung, S., Alarcón, R. D., & Ursano, R. J. (2023). The Psychiatric Interview: Adapting to Diverse Settings. In Tasman’s Psychiatry (pp. 1-12). Cham: Springer International Publishing.

Lenouvel, E., Chivu, C., Mattson, J., Young, J. Q., Klöppel, S., & Pinilla, S. (2022). Instructional Design Strategies for Teaching the Mental Status Examination and Psychiatric Interview: a Scoping Review. Academic Psychiatry, 46(6), 750-758.

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Collapse SubdiscussionJennifer Matis
Jennifer Matis
1:08pmMar 6 at 1:08pm
There are several components of a psychiatric interview, which include gathering a patient’s history, assessing their mental status, and establishing rapport. Gathering a patient’s history involves asking the patient about their past and current mental health symptoms, medical history, family history, and any relevant life events (Korsnes, 2020). This helps the healthcare provider understand the context and potential causes of the patient’s current mental health concerns (Korsnes, 2020). During the assessment of mental status, the healthcare professional evaluates the patient’s current mental state. This includes assessing the patient’s appearance, behavior, mood, thought processes, cognition, and perception (Korsnes, 2020). This may help determine if there are any immediate concerns or potential diagnoses (Korsnes, 2020). Establishing rapport is another component of the psychiatric interview. Building a strong rapport is crucial in any therapeutic relationship. It involves creating a safe and trusting environment where the patient feels comfortable sharing their thoughts and emotions (Korsnes, 2020). This helps foster a collaborative and effective treatment process. These three components work simultaneously to provide a comprehensive understanding of the patient’s mental health and guide the provider in formulating an appropriate treatment plan.

The Mini-Mental State Examination (MMSE) is a commonly used rating scale to assess cognitive function. It measures various cognitive domains such as orientation, memory, attention, language, and visuospatial skills (Tombaugh & McIntyre, 2022). The psychometric properties of the MMSE refer to its reliability and validity. The MMSE has shown good internal consistency, which means that the items on the scale are consistent in measuring the same construct. It also demonstrates good test-retest reliability, meaning it produces consistent results when administered multiple times to the same individual (Tombaugh & McIntyre, 2022). The MMSE has also been found to have good concurrent validity, meaning it correlates well with other measures of cognitive function (Tombaugh & McIntyre, 2022). It has shown good sensitivity and specificity in detecting cognitive impairment, making it a useful tool for screening and assessing cognitive decline (Tombaugh & McIntyre, 2022).

However, it is important to note that the MMSE has some limitations. It may be influenced by factors such as education level and cultural background, which may affect performance on certain items (Su et al., 2021). Additionally, it may not capture subtle cognitive changes or be sensitive to all types of cognitive impairment (Su et al., 2021). Overall, the MMSE is a widely used and valuable tool for assessing cognitive function; however, it should be implemented in conjunction with other clinical information and assessments for a comprehensive evaluation (Su et al., 2021).

A suitable time to utilize the MMSE is during the psychiatric interview when there is a need to assess a client’s cognitive function (Su et al., 2021). It is particularly useful for advanced practice registered nurses (APRNs) in their psychiatric assessment when they suspect or want to screen for cognitive impairment or changes in mental status (Su et al., 2021). This rating scale can provide valuable information about a client’s orientation, memory, attention, language, and visuospatial skills. By administering the scale, the APRN can gather objective data about cognitive abilities, which can aid in diagnosing conditions such as delirium, dementia, or other cognitive disorders (Su et al., 2021). Using the MMSE in the psychiatric assessment allows the nurse practitioner to establish a baseline cognitive function, monitor changes over time, and track the effectiveness of interventions and/or treatments (Su et al., 2021). It can also help in determining the level of cognitive impairment and guide appropriate management strategies. The MMSE is just one tool among many that a healthcare provider may utilize in their assessment(s). It should be used in conjunction with a comprehensive clinical evaluation, including other assessments and observations, to get a holistic understanding of the client’s mental health.

References

Korsnes, M. S. (2020). Performance on the mini-mental state exam in a sample of psychiatric patients. SAGE Open Medicine, 8, 205031212095789. to an external site.

Su, Y., Dong, J., Sun, J., Zhang, Y., Ma, S., Li, M., Zhang, A., Cheng, B., Cai, S., Bao, Q., Wang, S., & Zhu, P. (2021). Cognitive function assessed by mini-mental state examination and risk of all-cause mortality: A community-based prospective cohort study. BMC Geriatrics, 21(1). to an external site.

Tombaugh, T. N., & McIntyre, N. J. (2022). The Mini‐Mental State Examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9), 922–935. to an external site.

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Collapse SubdiscussionChikamunario Joy Ekeke
Chikamunario Joy Ekeke
4:46pmMar 6 at 4:46pm
NRN 6635 Week 2 Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Psychiatric interview is an important tool used in psychiatry to fully assess the mental wellbeing of an individual. It is the gathering of information that will help a clinician to identify symptoms and patterns of an underlying mental illness and as such help in establishing an accurate diagnosis with an appropriate treatment plan.

Three important Components of Psychiatric Interview and Why they are important.

A reliable and successful psychiatric assessment will require the following important concepts

1) Initial Assessment which consists of patient profile, present, social, family, medication, and past medical/psychiatric history: For a clinician to obtain all this information, there must be a cordial trusting relationship. Thus the provider needs to create a therapeutic patient-provider (nurse) relationship. In this, the provider will be courteous and give the patient a warm reception, provide privacy, exhibit trust and empathy in his/her speech. According to Sadock et al, (2015), showing respect, empathy, comfort and maintaining patient’s confidentiality are very important ethics in obtaining information and being able to provide appropriate diagnosis and treatment to patients.

2) Physical Examination: consisting of subjective and objective complaints of the patient or symptoms including vital signs, Mental health Status (MSE) and screening

The vital signs: consists of patient body temperature, Heart Rate , blood pressure and Oxygen saturation, weight and height. These are important considering the potential effects of medications used in treating mental health disorders. The mental health status is the presenting signs and symptoms of mental health conditions and the general mental functioning. According to Boland et al., (2022), MSE provides information about a client’s mental state at the time of the interview and will be very useful for subsequent follow up care and for comparing and monitoring patients’ mental health changes. The information gathered is mostly by close observation of the patient and general appearance of the client. The neurological screening of the client is of more importance when treating the patient for instance, Abnormal involuntary movement rating scale. This scale is used to follow up with patient receiving psychotropic medication to monitor any side effects like tardive dyskinesia

3) Clinical Judgment which will lead to development of Diagnosis and treatment plan.: In this, the provider would be able to interview for the diagnosis using the psychiatric review symptoms, revealing the skills and the memorization of the DSM-5 focusing on using screening and questions that will help in diagnosing any of the major psychiatric conditions . Finally the provider and the patient will be able to develop an appropriate treatment plan that will help in managing the mental health of the patient.

Psychometric properties of the Abnormal Involuntary Movement (AIMS) rating scale

AIMS consists of 12 items rating involuntary movements of all aspects of a patient’s body and are rated on a five-point scale of severity from 0-4. Where 0 – no abnormal movement; 1- minimal movement, 2 – mild; 3 – moderate and 4 is severity of abnormal movement (DOI, 1976). The AIMS scale was established by the National Institute of mental health to help in assessing and measuring conditions of Tardive Dyskinesia. The scale is a short and accurate scale. The part of the body region to measure depends on the five points/region of the body, which include (1). facial, 2) trunk; 3) Extremities; 4). Global movement and 5) dental status (DOI, 1976).

Importance of the AIMS Scale

AIMS is used in Tardive Dyskinesia (TD), a condition of abnormal movement of a patient’s body parts, who is receiving antipsychotic medications, such as Thorazine, Haldol. TD occurs as a side effect of most first generation psychotropic neuroleptic medications. It presents mostly movement seen on the face, mouth, abdomen, and extremities. TD has a higher incidence rate in older patients, those with DM 2 and those with smoking habits. Research studies has shown that AIMS is globally approved as a valid measurement tool to detect the initial occurrence of TD and effectively measure its progression and use as a treatment measure for the disease condition (Guy, W (1976)

References

Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer. to an external site.

DOI (1976). Abnormal Involuntary Movement Scale Psych Test. to an external site.; 999948378_full_oo1.pdf

Erbs, S. (2019). Prevention and Treatment of Antipsychotic Induced Tardive Dyskinesia. Fortschritte Der Neurologie- Psychiatrie,

Guy, W (1976). ECDEU Assessment Manual for Psychopharmacology – Revised (DHEW Publ No ADM 76-338), US Department of Health
Education and Welfare

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Collapse SubdiscussionYahyli Gonzalez Munoz
Yahyli Gonzalez Munoz
5:24pmMar 6 at 5:24pm
The Psychiatric Evaluation and Evidence-Based Rating Scales

Three important components of a psychiatric interview are the patient’s psychiatric history, including past diagnoses and treatments, family history, and social and developmental history. The patient’s psychiatric history informs the interviewer about the patient’s previous psychiatric diagnoses and treatment trials, including whether the prescribed treatment worked or reasons why it did not work (Kamińska et al., 2020). The patient’s family history informs possible hereditary psychiatric illnesses, which can also inform the diagnosis of the current diagnosis. The patient’s social history, such as substance use, can inform the interviewer if the patient’s psychiatric history is due to substances they are using, such as addiction or withdrawal symptoms (Kamińska et al., 2020). On the other hand, developmental history can provide insights into certain psychiatric conditions that can be affected by childhood trauma or the failure of a child to meet their developmental milestones, such as autism spectrum development (ASD).

The rating scale I was assigned was the Saint Louis University Mental Status (SLUMS) Exam, an assessment tool used to examine dementia and mild cognitive impairment. SLUMS was developed to detect cognitive dysfunction among older adults aged 60 years and above (Patek, 2022). The psychometric properties of the rating scale I was assigned include validity, reliability, and objectivity. SLUMS is an 11-item questionnaire that evaluates an individual’s attention, executive functioning, memory, and visual-spatial function. SLUMS exam is a popular cognitive screening test widely used to identify signs of cognitive impairment. According to Patek (2022), SLUMS has shown adequate internal consistency, one global cognitive factor, and relatively stable scores across a one-year interval when used on a sample of older adults. The tool is appropriate for clients above sixty years old with suspected cognitive impairment (Patek, 2022). In other words, the SLUMS tool is helpful to a nurse practitioner’s psychiatric assessment when caring for older adults with suspected cognitive dysfunction as a supporting screening test to confirm clinical diagnoses.

References

Englander, M. (2020). Phenomenological psychological interviewing. The Humanistic Psychologist, 48(1), 54–73. to an external site.

Kamińska, O., Kaczmarek-Majer, K., & Hryniewicz, O. (2020). Acoustic feature selection with fuzzy clustering, self-organizing maps and psychiatric assessments. In Information Processing and Management of Uncertainty in Knowledge-Based Systems: 18th International Conference, IPMU 2020, Lisbon, Portugal, June 15–19, 2020, Proceedings, Part I 18 (pp. 342-355). Springer International Publishing. to an external site.

Patek, K. (2022). Improving Saint Louis University Mental Status (SLUMS) Exam Adherence (Doctoral dissertation, University of Missouri-Saint Louis).

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Collapse SubdiscussionMichelle J Vernon
Michelle J Vernon
5:58pmMar 6 at 5:58pm
There are numerous components to the psychiatric interview that contribute to the assessment, diagnosis, and care of mental health patients. There are also numerous ways to think about what the components of the psychiatric interview are. For this discussion, I am thinking of the components as the individual points that are important to touch upon – to gather information about – within the initial patient interview. Of these, I think three of the most important components are the history of the patient’s presenting illness, their psychiatric history, and the mental status exam. I think that if you only had information from these three categories, you could still develop a diagnosis and a meaningful treatment plan.

The history of the presenting illness can give you subjective information about what the patient is experiencing and what they want help with. More specifically, it provides information about the patient’s symptoms and the character, onset, duration, course, precipitating factors (which can also give clues to comorbidities, medical issues, personal habits, social issues, etc.), relieving factors (which can give clues to medications, treatments, coping skills, resilience, possible support systems, etc.), and the severity of the impact on their functioning (at home, work, school, in relationships, to their health, etc.) (Boland, Verduin, & Ruiz, 2022).

The patient’s psychiatric history can provide subjective information about previous symptoms and behaviors, diagnoses, comorbidities, medications, treatments (including alternative treatments), hospitalizations, and suicide attempts (Boland, et. al., 2022). This can lead to insights about substance use, legal issues, relationship problems, and other social factors as well (Boland, et. al., 2022). The psychiatric history helps to establish the severity and lethality of their condition, compliance with treatment, and potential barriers to positive treatment outcomes (Boland, et. al., 2022).

The mental status exam provides objective, observational information about all aspects of the patient’s mental functioning throughout the entire interview (Carlat, 2017). It provides the data or evidence of observable signs and symptoms of mental illness that clinicians need, along with the subjective information stated above, to arrive at the correct diagnosis and treatment/care decisions for their patients (Carlat, 2017).

The rating scale I was assigned is the Patient Health Questionnaire (PHQ-9). It is a multipurpose screening tool that uses a patient’s self-report to help with the assessment, diagnosis, monitoring, and measuring of depression (APA, n.d.). It is brief and easy to administer and interpret. It consists of nine scorable questions that incorporate DSM-5 diagnostic criteria for depression (APA, n.d.). It rates the frequency and duration of symptoms to establish the severity of depression, and the degree to which the symptoms affect normal functioning, and identifies the presence and risk of suicidal ideation (Kroenke, Spitzer, & Williams, 2011).

The diagnostic validity of the PHQ-9 is widely accepted. A score >/= to 10 has a sensitivity of 88% and a specificity of 88% for major depression (Levis, Benedetti, & Thombs, 2019). Scores of 5, 10, 15, and 20 represent mild, moderate, moderately severe, and severe depression respectively (Levis, et. al., 2019). The PHQ-9 can be used by the PMHNP or any health care provider in any setting who is concerned that their patient may have signs and symptoms of depression or to differentiate between depression and another disorder (Kroenke, et. al., 2011). In a psychiatric interview, the PMHNP may introduce it during the mental status exam, to assist with the other components of formulation, diagnosis, and treatment planning (Boland, et. al., 2022). It is also a useful tool for monitoring a patient’s response to treatment because it can be used repeatedly and easily to demonstrate if a patient is feeling better or worse (Kroenke, et. al., 2011).

Reference:

APA: American Psychological Association. (n.d.). Patient health questionnaire-9 (PHQ-9).

to an external site. > depression-guideline > patient

Boland, R., Verduin, M. L., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th

ed.). Wolters Kluwer.

Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2011). The PHQ-9: validity of a brief depression

severity measure. Journal of general internal medicine, 16(9), 606–613.

to an external site..

Levis, B., Benedetti A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9

(PHQ-9) for screening to detect major depression: individual participant data meta-

analysis BMJ 2019; 365 :l1476 doi:10.1136/bmj.l1476.

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Collapse SubdiscussionOctayvia Walker
Octayvia Walker
6:14pmMar 6 at 6:14pm
Initial Discussion-Octayvia Walker

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain 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.

Psychiatric interviews are essential because, after about half of them, most patients do not return. The psychiatric interviews can be intrusive, and admitting specific symptoms is humiliating to some patients. Clinician–patient communication is important in psychiatry because social interaction with the patient is the clinician’s primary means for understanding, evaluating and eventually diagnosing the patient’s mental suffering (Savander et al., 2021). That is why the three essential components of the psychiatric interview are the opening phase, the body of the interview, and the closing phase because all phases involve communication. In the opening phase, the provider would meet the patient and start to build an alliance. The body of the interview is where you will explore, clarify details, and start prioritizing different objectives. The closing phase is where patient education occurs, and the provider speaks on the assessment and plan for the patient. Communication is the key to success in any interview, but especially psychological interviews.

Depression is a significant issue affecting the elderly population. The elderly are a vulnerable population due to the increase in suicide risk. Geriatric Depression Scale (GDS) is a self-report measure of depression in older adults (American Psychological Association, 2020). The GDS contains thirty questions, but a shorter version has 15 questions. Among the strengths of the GDS, its use may be easier in people with cognitive impairment because of the simple yes-no format, and it can be used in hospital and community settings (Brañez-Condorena et al., 2021). GDS is an excellent tool to use during psychiatric interviews because it can give insight into whether an elderly patient is suicidal or not without the interviewee being direct about the issue. The elderly population does not readily report thoughts of suicide. The body of the interview phase would be the best time to use the rating scale during the body.

References

American Psychological Association. (2020). Geriatric Depression Scale (GDS). Https://Www.apa.org. to an external site.

Brañez-Condorena, A., Soriano-Moreno, D. R., Navarro-Flores, A., Solis-Chimoy, B., Diaz-Barrera, M. E., & Taype-Rondan, A. (2021). Accuracy of the Geriatric Depression Scale (GDS)-4 and GDS-5 for the screening of depression among older adults: A systematic review and meta-analysis. PloS One, 16(7), e0253899. to an external site.

Savander, E. È., Hintikka, J., Wuolio, M., & Peräkylä, A. (2021). The Patients’ Practises Disclosing Subjective Experiences in the Psychiatric Intake Interview. Frontiers in Psychiatry, 12. to an external site.

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