Download Psychiatric Interview and Mental Status Examination and more Exams Psychology in PDF only on Docsity!
NR548 Exam 3 2024-2025.
QUESTIONS & CORRECT
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ABSATTC - ANSMnemonic for Elements of the Mental Status Examination -All Borderline Subjects Are Tough, Troubled Characters • Appearance • Behavior • Speech • Affect • Thought process • Thought content • Cognitive examination All components of a clinical encounter should be documented including: - ANS• chief complaint • referral source • history of present illness • current treatments including medications and therapies • past medical, family, social histories • review of systems • mental status examination • diagnosis • treatment plan An absence of speech is seen with some diagnoses such as ___________ - ANSdementia Assessment - ANS-includes the diagnosis -concise and informative -A list of differential diagnoses may be included, but the initial diagnosis listed is the DSM-5 TR diagnosis. Chief Complaint - ANSreason client gives for presenting for treatment at this time; typically, a direct
quotation or subjective statement Closing the Interview - ANSPMHNP explains the diagnosis and treatment options to the client -offers an opportunity for the client to ask questions and give input -discussion includes recommendations for any additional psychological assessments and laboratory testing needed -education regarding recommended medications and therapies -If a need to collaborate with other providers for information or treatment, the PMHNP should seek permission from the client at this time to do so -opportunity to address any client concerns about stigma -discuss need for F/U care closure
- ANS-final phase of the psychiatric interview process -provides the client with a summary and findings of the interview and allows for discussion of future plans -PMHNP may provide education during this phase Common problematic request - patient seeks hospitalization for a problem that can be treated in an outpatient setting: What is important to keep in mind? - ANSpossibility that the patient is suffering much more than originally indicated -their request for hospitalization is their
can help you? How were you hoping that I could help you to feel better? -Sometimes patients have a pretty clear idea of what they'd like; medication, counseling, advice about something, a letter to someone -don't have a specific request or agenda; don't force the issue with these patients Factors that affect the interpretation of the MSE - ANSculture native language educational level literacy social factors Family History
- ANS-includes history of psychiatric disorders, substance abuse, and suicide in the client's family -provides an understanding of the client's home life, their childhood experiences, education, and relationships -genogram will suffice for family psychiatric hx final step of the psychiatric interview - ANSdocumentation -Thorough, accurate documentation is necessary for clinical and legal purposes Follow-Up care - ANSPMHNP should discuss the need for follow-up care with the client during the closure of the interview -include clients in determining the need for and frequency of follow-up visits • promote adherence -Two-week
intervals are common when starting new medications • assess for tolerability, efficacy, and the need for dose adjustment - four-week intervals (or longer) are typical for stable clients - Scheduling future visits is important as noncompliance is common in mental health Follow-Up homework - ANSPMHNP may assign homework to the client -especially when tx plan includes cognitive-behavioral or family therapy -explain the purpose and goal of the assignment -explain whether the client will be expected to report on the homework at the next appointment General Cultural Knowledge - ANSInability to recall at least half of these items is presumptive evidence of long-term memory impairment. -Last three presidents -famous figures • George Washington, first president • Abraham Lincoln, freed the slaves • Martin Luther King, Jr., civil rights leader • Princess Diana, British princess killed in car accident • William Shakespeare, writer • Christopher Columbus, discovered America -Famous dates • When did World War II happen? (Any time in the 1930s or 1940s is adequate.) • When
as occupation, living situation, and presence of other family. Implementing the Agreed-On Plan - ANSlikely fall into one or both of the following categories: -follow-up therapy appointment with you or someone else • highest F/U aherence: wait for F/U appt is short, referrals made to specific clinicians rather than to a clinic, specific appt made at time of disposition, pt speaks directly to someone at referral clinic during evaluation session. -Medication trial • Determine how your patient will pay for medication: Some patients can't afford the copays - if so, you may be able to provide samples • Make sure pt understands the side effect profile of the medication • Simplification increases recall and compliance • Having pt repeat what you say increases recall of instructions individual who presents with an extremely rapid and pressured speech with constant interruptions may be experiencing __________ or __________ - ANShypomania or mania Interpret a mini-cog score - ANS(Total Possible Score: 0-5): Add the 3-item recall and clock drawing scores together. Recall Score (Total Possible
Score: 0-3) -1 point for each word correctly recalled Clock Drawing Score (Total Possible Score: 0-2) -2 points for normal clock (include all numbers, 1-12) -0 points for abnormal clock - must be 2 hands present (one pointing to the 11 and one pointing to 2) -hand length not scored Medical History - ANSincludes significant medical illnesses, hospitalizations, surgeries, seizures, head injuries with loss of consciousness, and prescribed medications and the primary care provider -may use mnemonic MIDAS -usually begin with general statement about pt's general health mental health - ANS"a state of well- being in which every individual realizes his or her own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community" mental status - ANS-refers to emotional (feeling) and cognitive (knowing) function -functioning is inferred through assessment of an individual's behaviors: • consciousness • language • mood and affect • orientation • attention • memory • abstract reasoning • thought process •
of monitoring deterioration over time -age, education, and visual or hearing impairment may impact scores • Most studies have defined poorly educated as 8 or fewer years of education —that is, no high school -sensitivity of the test is high, specificity is low MSE: Appearance - ANS-posture -dress - grooming -physical appearance • distinguishable markings; scars or tattoos -facial expressions level of alertness -attitudes - Self-esteem -Personal statement MSE: Behavior - ANShow the client presents themselves during the examination -eye contact -psychomotor activity • increased or decreased -movements - mannerisms -stereotypies -posturing -how the client responds to the exam • responses appropriate to topics? • sit still through exam? -gait -movements • coordinated, slowed, excessive MSE: Cognitive Assessment - ANS-evaluation of a client's level of awareness, attention, concentration, and memory -Awareness: observation with emphasis on the client's eyes and speech -alertness or wakefulness provides information about cognitive function • help rule out potential
substance use or intoxication -levels of awareness: alert and oriented, somnolent, drowsy, or even comatose -Attention and concentration: observation of responses during the interview • can they stay on topic? • able to focus and respond to Q's? • can use standardized tools such as the Mini-Mental State Exam (MMSE), digit span test and the SSST -Memory assessment: immediate recall, short-term, and long-term memory • particularly important when ruling out dementia or Alzheimer's disease • Stress, anxiety, and depression can also impact memory • orientation, three-object recall -Mini-Cog exam is commonly used to help rule out significant cognitive issues MSE: Insight and Judgment - ANS-final components of the mental status exam -determined to be good, limited, or poor depending on the actions the client has taken, awareness of their illness, and the plans they have for the future. Insight - client's awareness of their illness or situation Judgment -ability to anticipate the consequences of their behavior and safeguard their well-being -may be measured with a standard question
execute the plan • more detailed and thorough the plan, the higher the risk • assess if plan is composed of fleeting thoughts rather than action steps • assess whether the client is angry and lashing out or intending to bring actual harm -SCREENING FOR SUICIDAL AND HOMICIDAL IDEATIONS IS AN ETHICAL OBLIGATION OF THE PMHNP & IS ESSENTIAL FOR PROTECTING ONESELF, THE CLIENT, & THE PUBLIC MSE: Thought Process - ANS-rate of thoughts and how they flow and are connected - coherent vs. incoherent -Normal: linear & goal-directed -Other: loose, circumstantial, or tangential -Clients may experience flight of ideas with little connection between thoughts or words -Assessment: questioning client, listening to responses Negotiate a Plan - ANStreatment adherence is enhanced when the patient and practitioner agree on the nature of the problem -agree at the outset about a plan, go directly to the implementation phase -must negotiate a mutually agreed-on goal Negotiating a Treatment Plan: Essential Concepts - ANS- Elicit the patient's agenda -Negotiate a plan that you and your
patient can agree on -Help the patient implement the agreed- on plan non-sensical speech is often associated with _______________ - ANSpsychotic disorders Past Psychiatric History (PPH) - ANSincludes psychiatric hospitalizations, outpatient treatments, current and past medications, types of psychotherapy, and any suicide and/or violence history spanning early childhood to the present -Can use mnemonic Go CHaMP for write-up • General statement • Caregivers • Hospitalizations • Medication trials • past Psychotherapy (include if it was helpful, why/why not) Personal Knowledge - ANSmemory of remote personal events -Cognitively intact patients should be able to tell you: • Current address and phone number • Names and ages of spouse, siblings, and children • Spouse's birthday, wedding anniversary, and date and place of marriage (if married) • Parents' names and birthdays (primarily for younger patients who are not married) Q's to probe for degree of insight - ANS-So, why do you think you've been having these problems? -What do you think needs
Use History - ANS-includes drug and alcohol use, when used, consequences of use, the recent pattern of use, last use, and treatment -also includes nicotine and caffeine usage three object recall - ANSRecall of three objects after at least 2 minutes has been shown to be a useful test in diagnosing cognitive impairments -Repeat the following three words: ball, chair, purple. -Once you are satisfied that your patient has registered all three words, say: Now I want you to remember those three words, because I'm going to ask you to repeat them in a couple of minutes. -In the meantime, ask your patient general knowledge questions bout general cultural and personal information. -Then ask him to repeat the three words. -If trouble, use the following hints: • One of them is something you can play with • One is a piece of furniture. • One is a color. three objectives for clinical documentation - ANS-Thoroughness
- thorough yet succinct description of the client mindful of presenting an accurate, objective account of the client encounter • Be aware of personal bias -Time efficiency •
typically take no more than 10-15 minutes -Readability • 2- pages maximum to allow for easy review Treatment Plan - ANSincludes any diagnostic testing planned, medications, therapy, client education (dosing instructions, side effects, expected benefits, when to note efficacy), referrals, follow-up care Two attention and concentration assessments - ANSdigit span test -patient is given 5-7 numbers & asked to repeat them forward and backward SSST -pt asked to subtract 7 from 100 and to continue counting back by 7s until told to stop *research studies have not endorsed them -SSST given to 132 normal adults, only 42% with errorless performance -325 hospitalized psychiatric pts given SSST, no diff. in performance from 50 healthy control subjects -Digit span test among 60 elderly pts with memory impairment and 44 elderly who were healthy found no difference Which of the following should be included when providing client education about medication regimens? Select all that apply. explain how the medication targets the symptoms, specific benefits, and expected time course. identify
