JACQULINE POST
The PHQ-9
Importance and Vitality of Components of the Psychiatric Interview
The chief complaint is one of the important components of the psychiatric interview. It involves identifying and understanding the specific symptoms, issues, or concerns that brought the patient to the psychiatric interview. The chief complaint provides the initial focus of the interview and helps guide the diagnostic process. It allows the psychiatrist to gain insight into the patient's primary distress or symptoms, facilitating the formulation of an accurate diagnosis and developing an appropriate treatment plan (English et al., 2022). Psychosocial history is another important component of the psychiatric interview. The psychosocial history encompasses various aspects of the life of the patient, such as personal, social, and occupational factors, as well as past experiences and current circumstances that may impact their mental health. This interview component explores areas such as education, employment, relationships, family history, substance use, trauma history, and any recent life events or stressors. Understanding the patient's psychosocial history is crucial for assessing their overall functioning, identifying potential contributing factors to their current condition, and tailoring the treatment plan to address specific needs and challenges.
Another vital component of the psychiatric interview is the Mental Status Examination (MSE), a structured assessment of the current mental state of the patient. MSE involves observing and evaluating various aspects, including appearance, behavior, speech, thought processes, mood, affect, perception, cognition, and insight. The MSE provides objective information about the patient's psychological functioning during the interview. It helps diagnose psychiatric disorders, assess the severity and nature of symptoms, monitor treatment progress, and identify any cognitive impairments or risk factors.
The psychometric properties of the Patient Health Questionnaire (PHQ-9)
The Patient Health Questionnaire (PHQ-9) is a widely used self-report measure designed to assess the extent of depressive symptoms in individuals. It comprises nine items, each of which corresponds to the nine major depressive disorder diagnostic criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The PHQ-9 possesses several psychometric properties that contribute to its validity and reliability. For starters, reliability is one of the psychometric properties of the PHQ-9. Here, the PHQ-9 demonstrates high internal consistency, indicating that the items reliably measure the same construct (depressive symptoms). Validity is yet another psychometric property of PHQ-9 since the scores of the PHQ-9 are strongly correlated with other measures of depression (Maroufizadeh et al., 2019). The PHQ-9 has also shown good sensitivity and specificity in the identification of major depressive disorder. It has a well-established cutoff score (often 10) that helps determine the likelihood of depression. Test-retest reliability and responsiveness to change are other psychometric properties of PHQ-9. The PHQ-9 has demonstrated good test-retest reliability, meaning that individuals who retake the questionnaire after a short period (e.g., two weeks) tend to have consistent scores. On the other hand, the PHQ-9 is sensitive to changes in depressive symptoms over time. It can be used to monitor treatment progress and evaluate interventions' effectiveness by assessing scores changes before and after treatment.
Appropriateness of the PHQ-9
The PHQ-9 can be used during the psychiatric interview in screening, monitoring, research, and outcome measurement. The PHQ-9 can be used in screening to identify individuals experiencing depressive symptoms. It can be administered early in the interview process to quickly evaluate the existence and extent of depressive symptoms. It can also be used to monitor the extent of depressive symptoms and treatment progress over time. By administering the PHQ-9 at regular intervals, such as during follow-up appointments, clinicians can track symptom severity changes and assess interventions' effectiveness. PHQ-9 also comes in handy when researching and measuring outcomes. It provides a standardized and validated measure of depressive symptoms, allowing researchers to assess treatment efficacy and compare results across different studies. In psychiatric interviews, the PHQ-9 can be administered to gather data on the severity of depressive symptoms and track changes throughout the study.
Ultimately, the PHQ-9 is helpful for the psychiatric assessment of nurse practitioners by serving as a screening tool, providing objective measurements of depressive symptoms, guiding treatment planning and monitoring, and facilitating communication and shared decision-making. It enhances the nurse practitioner's ability to identify, evaluate, and manage depression effectively within their scope of practice.
References
English, M., McCullough, S., Sommerhalder, M. S., Day, D., Lingenfelter, M., Edwards, S., & Scardamalia, K. (2022). Factors associated with readmissions to a child psychiatric inpatient unit. Evidence-Based Practice in Child and Adolescent Mental Health, 7(4), 493-502.
Maroufizadeh, S., Omani-Samani, R., Almasi-Hashiani, A., Amini, P., & Sepidarkish, M. (2019). The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility. Reproductive health, 16(1), 1-8.
PERKALOA POST
The Psychiatric Evaluation and Evidence-Based Rating Scales
Psychiatric evaluation is necessary to make the correct diagnosis and initiate the appropriate movement. A detailed psychiatric evaluation contributes the most to diagnosing psychiatric conditions, given that there are few laboratory or imaging modalities to investigate them. Evidence-based rating scales are important in gauging the severity of a psychiatric disorder (Hofmann et al., 2022). They can also be used in assessing the patient's response to treatment. This paper discusses the components of a psychiatric interview and the application of evidence-based rating scales in psychiatric evaluation in the paragraphs below.
The main components of a psychiatric interview are history taking, mental status examination, and physical examination. Each of these components is important and must never be overlooked during a psychiatric interview. History taking involves collecting the patient's details, symptoms, significant past psychiatric and medical history, family history, and social history (Ball et al., 2019). The patient's presenting complaint is discussed in detail, including its duration, progression, impact on the patient's life, and associated symptoms. Risk factors for the patient's presentation must also be assessed during the interview. The mental status examination of the patient assesses his cognition, memory, speech, thought, perception, consciousness, judgment, insight, and abstract thinking (Boland et al., 2022). Physical examination is important in identifying abnormal movements or behavior that could contribute to the patient's presentation, e.g., the disordered movement associated with catatonia. Physical examination can also reveal evidence of substance abuse disorder, such as tobacco stains on fingers (Ball et al., 2019). Finally, physical examination is important in ruling out organic causes of the patient's symptoms, such as hypothyroidism and heart failure could contribute to depression.
I was assigned the Brief Psychiatric Rating Scale (BRPS) for my discussion. The Brief Psychiatric Rating Scale measures psychiatric symptoms such as hallucinations, anxiety, disorganized behavior, and depression. The BRPS assesses 18 components, namely; anxiety, conceptual disorganization, emotional withdrawal, guilt, tension, feelings, mannerisms and posturing, depressive moods, grandiosity, suspiciousness, hostility, hallucinations, uncooperativeness, motor hyperactivity, blunted affect, unusual thought content, somatic concerns, disorientation, and excitement (Hofmann et al., 2022). The psychometric property of the BRPS I was assigned for the discussion was sensitivity to change. The severity of the patient's symptoms can be assessed during the treatment of psychiatric disorders using the BRPS to assess the severity of symptoms at presentation and monitor response to treatment.
The interview to assess psychiatric disorders using the BRPS by at least two healthcare providers on a Likert scale of 1 (not present) to 7 (extremely severe) on each component. The reason for relying on two healthcare professionals is to minimize and ensure interrater reliability (Hofmann et al., 2022). The BRPS effectively assesses patients at all times, during initial and subsequent visits, to monitor progress (Chan et al., 2019). Therefore, the BRPS rating scale is useful in assessing the severity of the patient's symptoms and monitoring the patient's response to medication. Finally, the BPRS can also be used in screening for psychiatric disorders in the population.
References
Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel's guide to physical examination: An interprofessional approach (9th ed.). Elsevier.
Boland, R. J., Verduin, M. L., & Ruiz, P. (2022). Kaplan & Sadock's synopsis of psychiatry (12th ed.). Wolters Kluwer.
Chan, C. Y. W., Abdin, E., Seow, E., Subramaniam, M., Liu, J., Peh, C. X., & Tor, P. C. (2019). Clinical effectiveness and speed of response of electroconvulsive therapy in treatment‐resistant schizophrenia. Psychiatry and Clinical Neurosciences, 73(7), 416–422. https://doi.org/10.1111/pcn.12855
Hofmann, A. B., Schmid, H. M., Jabat, M., Brackmann, N., Noboa, V., Bobes, J., Garcia-Portilla, M. P., Seifritz, E., Vetter, S., & Egger, S. T. (2022). Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale. Psychiatry Research, 314, 114659. https://doi.org/10.1016/j.psychres.2022.114659
