Clinical Reflections- Challenges and Successes from This Weeks Experience

Clinical Reflections- Challenges and Successes from This Weeks Experience

The initial psychiatric interview of patients is critical for gathering detailed and extensive information on their complaints and symptoms before recommending or administering intervention. One reason for gathering detailed information is to identify the precipitating factors contributing to the chief objection, which can be used to build the patient’s health history. According to Dhanpal (2017), identifying the precipitation factors that influenced the patient’s visit improves the ability of the psychiatric mental professional to conduct the initial differential diagnosis of the presented symptoms. As a result, thoroughness is required to investigate the patient’s narratives further to identify the precipitating factors for the condition.

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Furthermore, the importance of medication history in determining the patient’s health risk necessitates collecting detailed and extensive information during the interview process. In this regard, the psychiatrist will take a medication history to select the reason for the prescription, frequency, the role of side effects or drug interactions in the complaints, and approaches for planning the current treatment. As Sai et al. (2021) pointed out, information on medication history is required to improve the effectiveness of any therapeutic approach the psychiatrist uses for the patient. Finally, extensive data collection is necessary to evaluate the relationship between the affective and cognitive history and current complaints and symptoms. For example, information about a child’s abuse history can assist a psychiatrist in identifying post-traumatic stress disorder triggers in the current context. As a result, comprehensive data collection assists psychiatrists in determining the best interventions and the factors that influence their effectiveness. Malingering is the falsification of symptoms of mental illnesses and extreme exaggeration of the condition to obtain material and non-material benefits such as paid and unpaid leave from work and school, as well as avoiding work duties, legal trials, or military service. According to Bass and Wade (2019), Malingering is a non-psychiatric disorder with no defined criteria in the Diagnostic and Statistical Manual of Mental Diseases, Fifth Edition (DSM-5), but may require clinical attention. In this regard, PMHNPs must be able to assess themselves to differentiate between established DSM-5 disorders.

One method for distinguishing malingering from DSM-5 diagnosis is to consider discrepancies in the individual’s behavior during the detailed and extensive interview to assess the secondary gain the patient would derive from the sickness role after the psychiatric diagnosis. One method for achieving this goal is to detect incoherence in answers to quick questions about the patient’s legal status and personality. According to Ullah-Alozai and McPherson (2020), a patient’s mental status examination is also helpful in distinguishing malingering from DSM-5 diagnosis due to its utility in determining exaggerated visual and auditory hallucinations and the patient’s inability to differentiate between the symptoms of the fake illness and natural DSM-5 disorders. Furthermore, a thorough mental examination makes the patient irritable, hostile, and unwilling to establish rapport with the psychiatrist. Malingering can thus be distinguished from DSM-5 diagnosis by a detailed and comprehensive mental evaluation performed by a psychiatrist.

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References

Bass, C., & Wade, D. T. (2019). Malingering and factitious disorder. Practical Neurology, 19(2), 96-105. http://dx.doi.org/10.1136/practneurol-2018-001950

Dhanpal, H. N. (2017). The Initial Psychiatric Interview: A Nursing Perspective. International Journal of Neurological Nursing, 3(1), 25-29. Retrieved from https://www.researchgate.net/profile/Dhanpal-H- N/publication/358606741_The_Initial_Psychiatric_Interview_A_Nursing_Perspective/lin ks/620b51b7634ff774f4ce68a4/The-Initial-Psychiatric-Interview-A-Nursing- Perspective.pdf

Sai, L. V., Ramana, V., Mamatha, K., Saritha, D., Evagelin, J., Veenasri, K., & Jyothi, C. D. (2021). A descriptive review of patient medication history interview. World Journal of Current Medical and Pharmaceutical Research, 01-04. DOI: 10.37022/jumper.vi.163

Ullah-Alozai, U., & McPherson, P. K. (2020). Malingering. StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507837/

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Describe your clinical experience for this week.

• Did you face any challenges or successes? If so, what were they?
  

  Weekly Clinical Experience

• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least three possible differential diagnoses with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can benefit you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guidelines.
•  The post should be at least 500 words, formatted and cited in the current APA style, with support from at least two academic sources.