Psychiatric Assignment of the Adult and Older Adult

Many assessment principles are the same for children and adults; however, with adults/older adults, consent for participation in the assessment comes from the actual client and not parents or guardians. The exception to this is adults/older adults who have been determined incapacitated by a court of competent jurisdiction. Some adults may be easier to assess than children/adolescents as they are more psychologically minded. That is, they have better insights into themselves and their motivations than children/adolescents (although this is not universally true).

Older adults present some of their own unique assessment challenges in that they may have higher levels of stigma associated with seeking psychiatric care. Additionally, there are higher rates of neurocognitive disorders superimposed on other clinical conditions such as depression or anxiety, which creates additional diagnostic challenges.

You will develop your own personal format for initial interviews of mental health clients. You also will explore the restrictions and limitations for practice as a PMHNP in your home state and create a plan for passing the national certification exam.

Developing skills in interviewing and diagnostic reasoning

As we begin Week 1, the module is focused on developing an interview format that provides you with questions/responses that you will use in your work-ups and diagnostic assessments or some call them Psychiatric H & P. By now, you have seen many different formats and ways that providers conduct interviews.

For this document, I encourage you to think of your personal style as well as assure that all relevant information is collected in the first interview. Do not use a template that you find online or that your preceptor uses in the office. The purpose of this assignment is for you to think through how you interview patients. There are many examples online to use as a guide. The key elements are similar to a medical H &P, HPI, PPH, PMH, FH, SH, ROS (psychiatric), MSE, Clinical Assessment and Formulation, Diagnosis, and Plan. This will be your 'bread and butter', so to speak for your entire career. It is worth spending some time and effort on this. If you put in a canned template, I will not accept your work.

My personal style is what I would call 'conversational'. I try to engage in some social conversation to get the visit started and then as the patient talks, I make notes on follow-up questions. I keep a list of the basic things that I need for my write-up: HPI, PPH, PMH, Soc/Dev, Substance use, Medication history, Stressors, coping abilities, therapy history. At the end of what I consider 'the interview' I review my list to make sure that I have all the information and I sometimes say to patients, "let me make sure that I got all the information that I need to make an accurate diagnosis and develop a treatment plan". Then, I will say to the patient, "do you have anything that you'd like to add?"

This conversational style is not for everyone and I know many providers that use more of a 'checklist' style. Think about what you want and how you will feel most comfortable. Feel free to provide feedback to your colleagues --there are no right or wrong styles.

Instructions-

Despite what you may believe (or may have been told), there is no such thing as one "right" way to do an interview. In fact, there are numerous books written about the various ways of conducting the clinical interview. In actual clinical practice, you will find the format that "works" best for you and addresses your unique strengths and the needs of the client.

In this Discussion, you will practice finding the interview format that works for you and share those ideas with your colleagues for feedback.

Learning Objectives

Students will:

• Develop formats for initial interviews of mental health clients

To prepare for this Discussion:

• Review the Learning Resources.

• Develop an interview format you would use for an initial interview of a client.

• Attach the interview format document you would use for an initial interview of a client.

• Describe what interview format your preceptor uses for the initial interview of a client.

• Describe which element of your interview format is most helpful in your practice.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Section 5.1, "Psychiatric Interview, Mental Status Examination" (pp. 192-211)
• Section 5.2, "The Psychiatric Report and Medical Record" (pp. 211-217)
• Section 5.3, "Psychiatric Rating Scales" (pp. 217-236)
• Section 5.5, "Personality Assessment: Adults and Children" (pp. 246-257)
• Section 5.7, "Medical Assessment and Laboratory Testing in Psychiatry" (pp. 266-275)
• Chapter 6, "Classification in Psychiatry" (pp. 290-308)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• "Cautionary Statement for Forensic Use of DSM-5"
• "Assessment Measures"
• "Cultural Formulation"
• "Glossary of Technical Terms"
• "Glossary of Cultural Concepts of Distress"

Barton Associates. (2017). Nurse practitioner scope of practice laws.

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults.

Required Media

Laureate Education (Producer). (2017b). Working with Adults and Older Adults" [Video file]. Baltimore, MD: Author.

Hagen, B. (Producer). (n.d.-a). Conducting a mental status exam [Video file]. Mill Valley, CA: Psychotherapy.net.

Optional Resources

American Psychological Association. (2008). Assessment of older adults with diminished capacity.

Rosen, S. L., & Reuben, D. B. (2011). Geriatric assessment tools. Mount Sinai Journal of Medicine, 78(4), 489-497. doi:10.1002/msj.20277

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). TIP 59: Improving cultural competence.