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Discussion1
The Psychiatric Evaluation and Evidence-Based Rating Scales
Three types of elements that make up the psychiatric interview include the rapport with the patient, the history taking, and the mental state assessment (Carlat, 2024). Trust is essential as it ensures that the patient opens up to reveal some information. This relationship forms the basis for the appropriate evaluation and development of a unique treatment plan for these patients. Psychiatric, medical, and social history provides information about the history of the patient’s condition and what may have led to the development of the patient’s mental health issues. The MSE is significant as it accounts for the patient’s mental status in terms of cognition, emotion, and behavior in relation to the time of the assessment (Madmed, 2017). This can be particularly helpful as some of these abnormalities may not be identified during the taking process, but with this structured assessment, they can be easily identified.
The basic psychometric properties of the rating scales, such as reliability, validity, and sensitivity, are crucial in assessing the rating scales in clinical practice (Sadock et al., 2017). Reliability refers to the extent to which scale yields a dependable measure of what has been claimed to measure. On the other hand, validity is a test of the accuracy of the scale in offering a measure of the condition under study. Sensitivity is the extent to which the scale is capable of demonstrating the alterations in the status of the patient. The use of evidence-based rating scale during a psychiatric interview is dependent on the circumstances of the interview (Psychiatry Lectures, 2015). This tool offers an indication of the extent of the symptoms, which not only aids in the management of the patient but also monitors the patient’s evolution. The evidence-based rating scale is very useful to nurse practitioners because it provides factual information that augments and supports clinical reasoning, hence improving diagnoses and management plans.
The Brief Psychiatric Rating Scale (BPRS)
The Brief Psychiatric Rating Scale (BPRS) was developed in the late 1960s as a concise tool for evaluating the intensity of psychiatric symptoms (Sadock, 2015). The assessment tool was specifically designed to measure changes in psychotic inpatients and encompasses a broad spectrum of areas, including disruptions in thinking, emotional detachment and slowing, anxiety and hopelessness, anger and distrust, as well as disturbances in mental functioning (Sadock, 2015). The current iteration commonly employed entails the assessment of 24 distinct symptom domains by medical practitioners, while a subset of doctors may opt for a condensed version comprising only 18 symptoms (MacMillan, 2020). The person who scores can assess the level of psychopathology using the current 24-item Brief Psychiatric Rating Scale (BPRS, version 4.0) (Zanello et al, 2013). The BPRS has been often used as an outcome measure in schizophrenia therapy research for many years. It effectively assesses changes in this context and has the advantage of being comparable to past trials (Sadock, 2015). The BPRS is a useful tool for assessing the efficacy of treatment in individuals with moderate to severe psychoses. The rater assigns a numerical value ranging from 1 (absent) to 7 (very severe) for each symptom component. Despite extensive examination of its psychometric properties such as reliability, validity, and sensitivity, the research on psychiatric diseases has revealed multiple factor solutions due to their diverse nature (Yee et al., 2017). The reliability of the BPRS is high to outstanding when raters possess expertise, but attaining this level of reliability is challenging without extensive training (Sadock, 2015). Furthermore, the BPRS is specifically suitable for persons who have a moderate level of impairment due to its focus on psychosis and the associated symptoms (Sadock, 2015). The use of this technique in clinical practice is not well supported, mostly due to the need for extensive training to ensure the required reliability (Sadock, 2015).
Discussion 2
Three Important Components of the Psychiatric Interview
History Taking: Collecting a comprehensive psychiatric history is crucial, including the patient’s personal and family history of psychiatric disorders, substance use, and medical history (Norris et al., 2016). This component helps establish a diagnosis and treatment plan by understanding the context and potential contributing factors (Norris et al., 2016).
Mental Status Examination (MSE): This structured assessment of a patient’s current cognitive, emotional, and psychological functioning is essential. The MSE includes evaluating appearance, behavior, mood, thought processes, perception, cognition, and insight. It provides a snapshot of the patient’s mental state and helps identify any immediate concerns, such as psychosis or severe depression (Norris et al., 2016)
Establishing Rapport: Building trust and a therapeutic relationship is fundamental to any psychiatric interview. A good rapport ensures that the patient feels safe and understood, facilitating open communication and more accurate information sharing. This element is particularly important because many patients may feel stigmatized or hesitant to discuss their mental health issues (Butt, 2021).
2. Psychometric Properties of the Mini Mental State Examination (MMSE)
The Mini Mental State Examination (MMSE) is a widely used cognitive screening tool. Its psychometric properties include: (Gallegos et al., 2022).
Reliability: The MMSE has demonstrated high inter-rater and test-retest reliability, meaning it produces consistent results across different administrators and over time (Gallegos et al., 2022).
Validity: It has good face validity and construct validity, effectively distinguishing between different levels of cognitive impairment. It also shows high sensitivity and specificity in detecting dementia and other cognitive disorders (Gallegos et al., 2022).
Standardization: The MMSE has been standardized on various populations, allowing for age and education-adjusted norms to be applied in clinical practice (Gallegos et al., 2022).
3. Appropriate Use of the MMSE in Psychiatric Interviews
When to Use: The MMSE is appropriate for use when there is a suspicion of cognitive impairment, such as in cases of dementia, delirium, or after a traumatic brain injury. It is also useful in assessing baseline cognitive functioning and monitoring changes over time in conditions like Alzheimer’s disease or other dementias (Han et al., 2020).
Utility in Psychiatric Assessment: For nurse practitioners, the MMSE provides a quick and efficient way to assess cognitive function as part of a broader psychiatric evaluation. It helps in distinguishing between psychiatric symptoms due to cognitive decline versus other psychiatric disorders, informing both diagnosis and treatment planning. (Han et al., 2020).
