Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
your approach with evidence-based literature.
Read a selection of your colleagues’ responses.
By Day 6 of Week 2
Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.
COLLEAGUE 1: WAS ASSIGNED THE Clinical Opiate Withdrawal Scale (COWS).
Psychiatric Interview and its Important Components
The psychiatric interview is the first step in diagnosing a mental illness patient. It plays a significant role in evaluating people with mental health conditions and their treatment planning. It gives the interviewer an understanding of the patient’s behavior, emotions, and intentions. The most important components of a psychiatric interview are psychiatric history, mental status, and family history.
The first important component is the psychiatric history of the patient. History plays an important role in the diagnosis and treatment planning of the psychiatric patient (Moldawsky, 2020). It covers the presenting complaint, history of presenting complaint, past psychiatric events, and any medications or procedures involved. For instance, a patient’s history initially presented with anxiety related to his job may reveal long-term anxiety, which would indicate an anxiety disorder.
The second essential component is the mental status examination. It is the section of the interview where the psychiatrists assess the patient’s actions and current behavior. This includes the patient’s speech, judgment, and thoughts (Voss & Das, 2022). The mental status examination and the psychiatric history can help in the diagnosis and treatment planning of the patient even before lab investigations.
The third vital component is family history. A family history of a mental illness could indicate a genetic predisposition. In addition to aiding in managing a patient’s disorder, a thorough family history may offer indications for screening and locating other at-risk patients for whom prevention or early intervention is appropriate. A family history of mental illness is clinically advantageous. It is an essential and easily accessible risk factor in disorders like schizophrenia (Lu et al., 2018).
Clinical Opiate Withdrawal Scale (COWS)
The rating scale I was assigned was the Clinical Opiate Withdrawal Scale (COWS). It is an 11-item scale that a clinician uses to assess the level of opioid dependence. As the usage of opioids for pain treatment increases, so does opioid dependence. The patient’s level of opiate addiction can be determined using the total of the 11 items’ scores. The usual signs and symptoms of opiate withdrawal can be rated and tracked over time using this tool in inpatient and outpatient settings. Patients who receive a score of 5 to 12 are categorized as having mild withdrawal, 13 to 24 as having moderate withdrawal, 25 to 36 as having moderately severe withdrawal, and more than 36 as having severe withdrawal (Canamo & Tronco, 2019). The physicians reported having more understanding, self-assurance, and pleasure with the COWS screening tool. In the end, the patients benefited from the healthcare professionals’ increased knowledge, confidence, and skill in observing withdrawal symptoms, as shown by COWS screening data (Uga et al., 2020).
Colleague 2: was assigned the The Zung self-rating scale
The three components of a psychiatric interview I consider essential are
The chief complaint/history of present illnesses: This is important to understand the need for the patient visit. It will give answers to the present illness’s history, such as the onset of the problem and whether it is a new or reoccurring problem. It will also help the nurse practitioner understand how the patient has been coping with the problem, such as alleviating and aggravating factors. This is a needed foundation in diagnosing and choosing a treatment plan (Kaplan et al., 2021).
- History: This includes psychosocial history, developmental history, and medical and family history. This is important to know any genetic factor that could be playing a role in the patient presentation. A key element is needed by the nurse practitioner. It is also essential to know if there are medical diagnoses that could be affecting the patient’s mental health as well as any trauma or social habits that could impact mental health in the negative. (Kaplan et al., 2021)
- Mental Status examination: this includes appearance, behaviors, orientation, effects, mood, speech, posture, safety-suicide ideation, memory, and concentration. It also includes perception, insight, and judgment.(Lenouvel et al., 2022)Not all mental status examination requires questioning. The nurse practitioner has to observe the patient assess for the objection answers. This information is also helpful for subsequent visits as a baseline to monitor therapeutic treatment outcomes (Kaplan et al., 2021).
The Zung self-rating scale asks twenty questions that are used to measure the severity of anxiety disorder. A scare of one to four is used to assess how the patient is affected by anxiety. The patient answers the below questions as happening a little, sometimes, a good part of the time, or most times. If the score is 44 or less, it is considered normal; 44 to 59 is mild to moderate anxiety, 60 to 74 is severe anxiety, and 75 and above is extreme anxiety. (Dunstan & Scott, 2020)
- I feel more nervous and anxious than usual.
- I feel afraid for no reason at all.
- I get upset quickly or feel panicky.
- I feel like I’mI’s falling apart and going to pieces.
- I feel everything is all right, and nothing terrible will happen.
- My arms and legs shake and tremble.
- I am bothered by headaches and neck and back pain.
- I feel weak and get tired quickly.
- I feel calm and can sit still easily.
- I can feel my heart beating fast.
- I am bothered by dizzy spells.
- I have fainting spells or feel like it.
- I can breathe in and out quickly.
- I get numbness and tingling in my fingers and toes.
- I am bothered by stomach aches or indigestion.
- I have to empty my bladder often.
- My hands are usually dry and warm.
- My face gets hot and blushes.
- I fall asleep quickly and get a good night’s rest.
- I have nightmares. (Dunstan & Scott, 2020)
It is appropriate to use the scale in the diagnosis of anxiety-related symptoms. This tool is helpful for the nurse practitioner to identify anxiety problems and how it impacts daily patient life. This information is vital in formulating a treatment plan for the patient and ensuring that the patient gets the appropriate care (Setyowati et al., 2019).