Week two ain discussion post

There are many points in the initial psychiatric assessment that are important, with the hierarchy tending to be the symptoms or behaviors resulting in the patient receiving a psychiatric evaluation. Obtaining the patient’s present symptoms and a history of psychiatric care are two specific areas this writer feels are important.  In the initial interview, one can learn much about the patient.  The patient may not be forthcoming in saying why he is present for an interview or assessment. This behavior could be because he is paranoid, ashamed, fearful of reprisal, or wishing to hold his feelings inside to hide what he has plans to do if suicidal.  To determine a correct diagnosis, it is essential to identify the symptomology, which will build a case for the diagnosis (Kaplan and Sadock, 2015). The use of open-ended questions facilitates communication of what the patient feels is necessary.

A second concept of the interview includes others in the development of a diagnosis and treatment plan. To obtain a patient’s history of psychiatric treatment and another’s view or perceptions of the patient’s behavior, collaboration with family members, caregivers, teachers, and other significant people who frequently see the patient may be needed.  (American Academy of Child and Adolescent Psychiatry,1995).  Without the accurate and complete present presentation of symptoms, past diagnoses, and treatment received, the ability to develop a treatment plan that meets the patient’s needs becomes difficult.  When working with geriatrics, the patient may not know why they are being assessed.  The patient being unclear is an example of why a Mini-Mental Exam is useful when doing a systematic review.  The geriatric depression scale should be given during the systematic review as well because depression may not always be manifested blatantly or overtly in geriatric patients.  Symptoms of depression and early dementia can overlap. Difficulty concentrating, trouble sleeping, forgetfulness is just a couple of symptoms seen in both disorders.  When depression can be detected and treatment initiated while mild or moderate, there is a greater prognosis. The Geriatric Depression Scale (GDS) is a scale made up of thirty questions that have been developed into a fifteen-question scale.  “The GDS-15 scale is the most widely psychometric tool designed specifically for measuring depression in the elderly” (He et al., 2018, Sjoberg et al., 2017; Tsoi et al., 2017; Yesavage et al., 1982 as cited by Merkin, Medvedev, Sachev, Tippett, Krishnamurthi, Mahon, Kasabov, Parmar, Crawford, Doborjeh, Doborjeh, Kang, Kochan, Bahrami, Brodaty, Feigin (2020). The MMSE and GDA-15 would be essential in examining a geriatric patient and easily incorporated into the systems review.  The questions of the GDS-15 INCLUDE 1) Are you basically satisfied with your life? 2) Have you dropped many of your activities and interests? 3) Do you feel that your life is empty? 4) do you often get Bored? 5) Are you in good spirits most of the time? 6) Are you afraid that something bad is going to happen to you? 7) Do you feel happy most of the time? 8) do you often feel helpless? 9) Do you prefer to stay at home at night, rather than going out and doing new things? 10) Do you feel you have more problems with memory than most? 11) Do you think it is wonderful to be alive not? 12) do you feel pretty worthless the way you are not? 13) Do you feel full of energy? 14) Do you feel that your situation is hopeless? 15) Do you think that most people are better off than you are? (Merkin et al., 2020).

Another area this writer believes is essential is obtaining the past medical history and labs to determine the patient’s present state of health.  This writer has seen many geriatric patients admitted with increased confusion and behavioral issues with a severe urinary tract infection. Their behavior and confusion cleared with the treatment of the urinary tract infection.

References

American Academy of Child and Adolescent Psychiatry (1995), Practice parameters for the assessment and treatment of children and adolescents. https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

Merkin, A.G., Medvedev, O. N., Sacdev, P. S., Tippett, L., Krishnamurthi, R., & Mahon, S., et al., (2020), Mew avenue for the geriatric depression scale:  Rasch transformation enhances reliability of assessment, Journal of Affective Disorders, 264(2020. [[7-14

Sadock, B. J., Sadock, V.A., & Ruiz, P. (2017), Psychiatric interview, history, and mental status examination In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4^th ed., pp9-15), Wolter Kluwer

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

To Prepare:

• Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
• Consider the elements of the psychiatric interview, history, and examination.
• Consider the assessment tool assigned to you by the Course Instructor.

By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support 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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Thank you for the detailed information regarding the Geriatric Depression Scale.

While depression appears in a significant portion of aging individuals, doctors stress that the feelings associated with depression are not a natural part of aging (Bisconti, 2020). Instead, experts argue that with proper treatment, the symptoms associated with geriatric depression can be reduced or eliminated. As you have mentioned, the concept of the scale is for providers to determine a proper diagnosis based on the exhibited signs and symptoms.The development of the GDS was initiated to aid medical workers in this process.

The GDS-15 originated as a thirty-question test in the early 1980s and was created by Stanford University professor Jerome Yesavage and his colleagues, which was then shortened to fifteen questions to be less time-consuming and stressful to test takers. Ten of the questions indicate the presence of depression when answered positively, while the other five indicate depression when answered negatively.

The GDS-15 has two highly desirable features for the screening of depression in the elderly, namely, the ease and time-effectiveness of its administration. However, the strength of these two features could be improved if the number of items on the GDS-15-J were reduced.

Doctors might recommend the patient focus on a hobby, increase socialization, participate in forms of therapy such as art, increase physical activity, and eat a well-balanced diet (Sheikh et al., 2017). If depression is not well controlled holistically, practitioners may also prescribe antidepressants. Elderly individuals whose depression is diagnosed and treated have a greater chance of living a full and happy life (Sheikh et al., 2017).

Biscontini, T. (2020). Geriatric Depression Scale (GDS). Salem Press Encyclopedia of Health.

Sheikh, J. I., Yesavage, J. A., Sugishita, K., Sugishita, M., Hemmi, I., Asada, T., & Tanigawa, T. (2017). Geriatric Depression Scale–Short Form. [Japanese Version]. Clinical Gerontologist, 40(4), 231–238.