Discussion Week 2
200 word each response
1. Reply from Kelly Zukowski
NUR 620 Discussion Posting Two
Describe the three reasons it is important to gather detailed and extensive
information from any patient before you counsel him/her or make medical suggestions. Use
evidence-based research to support your position.
The first and probably most important reason to gather detailed and extensive information
during the Psychiatric Interview (PI) is to formulate an accurate diagnosis. Establishing an
accurate primary diagnosis will formulate the most effective treatment plan for the patient. The
diagnosis is developed from the Diagnostic and Statistical Manual of Mental Illness (DSM-5-
TR) criteria after obtaining subjective data gathered in the PI and mental status exam (MSE.) The
goal of a psychiatric interview and assessment is to describe the patient’s complaints, appearance
and existence in an actionable psychological format, namely, one that results in a diagnostic
classification (Nordgaard et al, 2023.) The PI not only establishes the primary, secondary and
tertiary diagnoses but it constructs the differential diagnoses as well. Differential diagnosis can
be important when reassessing the treatment plan at the time of a patient’s follow-up. Also,
without an accurate diagnosis we cannot provide an effective plan of care.
The second reason to gather detailed and extensive information from the patient prior to
making medical decision or counseling him/her is to individualize the treatment plan to the
specific needs of the patient. Obtaining an understanding of their social and family history will
guide one to respect any cultural or religious considerations to the patient’s plan of care. Creating
a specific treatment plan tailored to the patient’s individual experiences and lifestyle creates a
foundation for the patient to be successful in reaching their collaborative goals. Also,
individualizing the plan of care helps build a more therapeutic relationship with the patient.
The third reason for gathering detailed information prior to making medical decisions or
counseling is that the information gained will provide insight to enhance patient shared decision-
making. Incorporating the patient to collaborate on their goals of treatment will have them
actively participating in their treatment plan. This active collaboration can improve patient
adherence, therefore improving patient outcomes. Incorporating evidence-based practice by
reviewing clinical guidelines with patients in shared decision-making can provide the patient
with the rationale of their treatment plan. Reviewing clinical guidelines gives the patient a better
understanding of the intricacies, the “why” of their treatment plan. Many patients are now doing
their own research online and supporting them with evidence-based clinical guidelines instead of
Dr Goggle in the shared decision-making practice can be empowering.
Define malingering. Discuss two ways to differentiate between malingering and a
DSM-5 diagnosis. Use evidence-based research to support your position.
Malingering is falsification or profound exaggeration of illness (physical or mental) to gain
external benefits (gain) such as avoiding work, seeking drugs, avoiding trial, seeking attention,
avoiding military services, leave from school, paid leave from a job, among others. It is not a
psychiatric illness according to the DSM-5-TR (Alozai et al 2023.) Per DSM-5-TR criteria,
malingering does remain a V code and can be a clinical consideration in many disorders. A way
to differentiate malingering is external or secondary gain is the necessary component for
differentiating malingering from Factitious Disorder.
According to the DSM-5-TR Factitious Disorder (FD) is the falsification of physical or
psychological signs or symptoms, or induction of injury or disease associated with identified
deception (American Psychiatric Association 2022.) Another point to differentiate FD from
malingering, is in FD the patient consciously creates physical or psychological symptoms to
obtain the primary gain, assuming the sick role. Malingering is associated with anti-social
personality disorder and histrionic personality disorder. In malingering, the patient is consciously
lying to receive a benefit and once they achieve this benefit, they stop complaining. There is not
any specific intervention or prescribed medication that can treat malingering. The DSM-5-TR
suggests that malingering should be a consideration if any of these complaints are noted:
medicolegal context, marked discrepancy between the patient’s complaint and objective findings,
lack of compliance with treatment/follow-up care and presence of anti-social personality
disorder. In summation, malingering can be a challenging facet of patient care and usually
handled by interdisciplinary team collaboration for the best outcome.
2. Reply from William Joseph Sierra
Module 2 Discussion: Patient Information
Important information in psychiatric assessment includes taking a comprehensive patient
history and performing a complete mental status examination (MSE). Clinicians risk making a
mistaken diagnosis, administering the wrong medication, or overlooking safety issues without
these components. Lisa displayed paranoia, delusional thinking, auditory hallucinations, and
safety hazards, as shown in the video Understanding the MSE – Lisa (Dream Schema Media,
2011). Determining her mental state and possible treatment needs required the counselor to
conduct a mental status examination (MSE) and gather comprehensive background information.
Three Reasons Detailed Information Is Essential
For clinicians to properly diagnose and differentiate between psychiatric disorders,
substance-induced conditions, and medical illnesses that may mimic psychiatric symptoms,
comprehensive patient information is crucial in psychiatric care. In Lisa’s case, her use of
cannabis and speed complicated her presentation of paranoia and hallucinations. A careful
history revealed medication nonadherence and recent drug use, which were critical to
understanding her symptom exacerbation. Research by American Psychiatric Association
emphasizes that diagnostic accuracy in psychiatry depends heavily on thorough historical and
contextual assessment, particularly when substance use or medical comorbidities may influence
symptoms (American Psychiatric Association, 2022).
To assess the risk of suicide, harm to others, and self-protective behaviors, comprehensive
information is also required. To protect herself, Lisa acknowledged sleeping in the shed with a
knife. This was a deliberate sign of danger that needed immediate attention. Clinicians can detect
impending dangers with a structured mental status examination, which offers vital insight into
judgment, insight, and thought content (American Psychiatric Association, 2022). Clinicians risk
missing risky behaviors if they do not inquire about these details.
Furthermore, the development of treatment plans that address symptoms and contextual
stressors is guided by a thorough history including social, medical, and psychiatric data. The
need for both pharmacological and psychosocial interventions was brought to light by Lisa’s
tense relationship with her parents, cohabitation with her boyfriend, and noncompliance with
antipsychotic medication. Research by Manolova et al., (2021) demonstrates that for patients
with severe mental illness, tailored treatment planning based on thorough evaluation enhances
adherence and long-term results (Manolova et al., 2021).
Malingering and Differentiation from DSM-5 Diagnoses
According to the DSM-5, Malingering is the deliberate fabrication or exaggeration of
symptoms for outside benefit, such as monetary compensation, evading legal responsibility, or
obtaining medication; it is not a mental illness (American Psychiatric Association, 2022).
Patients who engage in malingering often display symptom patterns that are inconsistent with
recognized psychiatric syndromes. For example, they may overreport bizarre hallucinations or
behaviors that are inconsistent with clinical observation. However, Lisa’s symptoms, such as
restlessness and reacting to unseen stimuli, were in line with paranoid delusions and auditory
hallucinations.
Malingering symptoms also often change depending on external factors, like being
observed by an assessor, unlike actual psychiatric symptoms, which typically show persistence
or follow recognizable clinical trajectories. For example, in Lisa’s case documented history of
substance abuse, medication noncompliance, and paranoia, malingering was unlikely. Tools like
structured interviews and psychological testing, like MMPI-2 validity scales, can be used to
differentiate malingering from actual mental illness (Manolova et al., 2021). Finally, this process
ensures a precise diagnosis, identifies safety risks, and guides personalized treatment planning.
Understanding malingering differences from DSM-5 helps prevent mislabelling and ensure
patients receive appropriate, evidence-based care.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental
disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
(DSM-5-TR), 5.
Dream Schema Media. (2011). Understanding the MSE – Lisa (w/- commentary).
Www.youtube.com.
Manolova, H., Hristova, M., & Staykova, S. (2021). The Importance of Early Psychological
Assessment for Differential Diagnosis and Detection of Comorbidity in Children With Autism
Spectrum Disorder. Frontiers in Psychiatry, 12.
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