Response – Important Components of the Psychiatric Interview

Response – Important Components of the Psychiatric Interview

Hello Brenda,

This is an insightful post. I fully endorse your focus on rapport building as one of the sections of the psychiatric interview. In addition, trust is the key to glacier information which can be obtained from the client for the project. However, I would like to stress that apart from rapport, it is pretty important to focus on what the patient thinks about their condition. Adherence and perceived efficacy, therefore, highly depend on insight or the client’s ability to understand and accept that he or she needs medical treatment (Sadock et al., 2017). In terms of the PHQ-9, I think it is well-suited for determining whether criteria for major depressive disorder are present or not. However, the Mini-Mental State Examination (MMSE) I mentioned above is specifically more orientated to cognitive diseases, which can be used in the assessment of dementia or other similar diseases. It is worth noting that both tools proved to be useful in the provision of data. But could there be scenarios where integration of both tools will have more benefits in the evaluation of the multifaceted case?

Reference

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry (4th ed.). Wolters Kluwer.

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Reply from Brenda
Important Components of the Psychiatric Interview

Mental health assessment begins with the psychiatric interview, and some factors affirm its effectiveness. One of the most important components is establishing rapport with the client. This aspect is crucial because it lays the groundwork for the rest of the communication process. Developing rapport encompasses the process of forming a strong, positive bond with the client within this kind of setting, which is crucial for achieving a high level of the identified client’s trust in the counselor. Rapport building is not an informal greeting or casual conversation but is about listening to the client, feeling for the client, and showing interest in what the client is going through. Such linkage helps establish rapport since the client is more likely to provide truthful information and feel comfortable while going through the assessment (Carlat, 2024). Lack of rapport also means that clients may not disclose important information, making the assessment less productive and subsequent treatment plans less efficient.

Response – Important Components of the Psychiatric Interview

Another important component is the evaluation of mood and affect, which offers information on the client’s emotional condition and potentially points to mood disorders. Mood is subjective and involves the client’s feelings, like sadness, anxiety, or irritability, whereas affect is the spirited, outward manifestation of those feelings. It may be insightful when a diagnostic impression of a particular client shows a discrepancy between a reported mood and affect, for example, a person who was asked how they felt and said they were sad but had an overly cheerful affect. This assessment comes in handy when working towards diagnosing conditions such as depression, bipolar disease, or any form of mood change. When it comes to mood and affect, distinct assessment allows the clinician to fine-tune the therapy process and connect with what the client presents with, which can enhance the therapy delivery (Boland et al., 2022).

The third is the Mental Status Examination (MSE), which is basically an overview of how the client appears in terms of cognition, perception, mood state, etc. In psychiatric evaluation, MSE is essential as it provides a structure for the assessor to conduct a current mental status examination of the client on aspects such as appearance, behavior, speech, mood, thought content, perception, and cognition (Sadock et al., 2017). This evaluation approach is important in diagnosing various forms of psychiatric disorders, such as mood disorders, psychotic disorders, and cognitive disorders. The MSE also aids in identifying other pressing threats to physical integrity, such as suicidal ideation and psychoses, to assist the clinician in making a decision. In this manner, the clinician is able to comprehend the extent of the client’s health status, which is highly advantageous in the strategic development of the mode of managing the condition.

Psychometric Properties of the Patient Health Questionnaire-9 (PHQ-9)

One of the common tools used to assess the presence, severity, and development of depressive disorder is the Patient Health Questionnaire-9 (PHQ-9). It is essential to use this nine-item questionnaire as it aligns with the DSM-5-TR diagnostic criteria to identify major depressive disorder in the clinical practice setting. The PHQ-9 demonstrated good reliability and internal consistency with acceptable validity for clinical psychiatry. The internal consistency is high, given that Cronbach’s alpha coefficient equals 0.89. It means that the items on the scale assess the key aspect of depression without much randomness. In addition, the PHQ-9 has strong internal consistency with high test-retest reliability [Kurtz & Ifrah, 2014; r = 0.84] since it is expected to act similarly when administered at two different times, but the client’s status has remained the same. The overall validity of the scale is also noteworthy as it reflects a high sensitivity of 88% and specificity of 88% in diagnosing major depression, making it useful as a screening tool (American Psychiatric Association, 2016). These characteristics make the PHQ-9 not only a good diagnostic tool but also a useful measure for assessing the severity of depression and change over time, which is useful for the assessment of treatment efficacy.

Appropriate Use of the PHQ-9 in Psychiatric Interviews

The PHQ-9 is useful during first encounters, revisits, and periodic evaluations in clients with depressive symptoms. Its design enables a rapid administration that usually takes five minutes or less, making it ideal for use in hectic clinical practices. It is particularly helpful for nurse practitioners because it offers a healthy measure of a patient’s degree of depression that can help in diagnosis, planning the course of treatment, or changing modes of therapy. The PHQ-9 has an easy scoring system with a total score of between 0 and 27; the higher end of the scale represents a more severe level of depression. Due to this clear scoring system, developed during their creation, clinicians can determine the amount and type of intervention required, for instance, whether pharmacological treatment should be started and whether the patient should be referred for psychotherapy or other support measures. It serves not only as a diagnostic tool; it is also used to assess the effectiveness of treatment and monitor the decline of the symptoms to reassess treatment plans if needed (American Psychiatric Association, 2016).

Specifically, the PHQ-9 is helpful with clients presenting depressive symptoms, as it provides a complete view of how depressive symptoms impact their day-to-day sleep, appetite, and concentration, among other aspects. This wider evaluation assists the clinician in determining how the condition of depression affects the client’s well-being, thus informing the complete individualized client care. Moreover, it was administered in primary care offices and psychiatric clinics, meaning that the scale is relevant for different ranges of clinical practice settings. Because of the above attributes, the PHQ-9 can be integrated into psychiatric evaluations as it is reliable, valid, and easy to administer across populations and settings, improving the quality of care for clients of the counseling agency.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.5555/appi.books.9780890425787.Section_1Links to an external site.

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760Links to an external site.

Boland, R., Verduin, M. L., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Carlat, D. J. (2024). The psychiatric interview (5th ed.). Wolters Kluwer.

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 (4th ed., pp. 39–52). Wolters Kluwer.