WK2 Discussion Main Post
Responding to Katherine
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. Support your approach with evidence-based literature.
Each component of the psychiatric interview is important in helping to assess, diagnose and treat a patient. In this discussion, briefly describe 3 elements of the interview and highlight their importance.
Katherine Post: In my experience in the emergency room, outpatient PACT team and involuntary inpatient hospital, establishing the acuity of presenting the issue is the most important part of the provider-client interaction. The chief complaint and the history of present illness can give the clinician a snapshot picture of the level of care needed for the concerned individual. The chief complaint should be the reason for seeking care, preferably in the patient’s own words. The first few moments of the interview may uncover a multitude of cues for further inquiry. This initial snapshot may reveal thoughts of violence towards others, self-harm or suicide which can elevate the provider’s level of concern appropriately and lead to the use of protective measures for the patient, staff, and community. Having the patient or other source identify what is most concerning to them may reveal limited insight, poor judgement, and symptoms of psychosis almost immediately. In addition, this is the first opportunity to observe important indicators of grave disability; body habitus, dress, weight, eye contact and ability to understand and express ideas are excellent indicators of their level functioning. The chief complaint goes hand in hand with the history of present illness (HPI) when the patient can expand on onset/time frame, precipitating factors, perpetuating influences, and elements of protection like coping skills/strengths, medications, and treatment. The psychiatric review of systems is the subjective picture of mental health functioning which may identify issues with “mood, anxiety, psychosis and other” symptoms not immediately apparent to the subject and is included in the HPI (Sadock, Sadock & Ruiz, 2015, p. 198).
Although all elements of the psychiatric interview are important, inquiry about substance use/abuse and addiction issues is paramount. Often drug use, smoking, drinking, gambling, social media/internet use are overlooked as just a part of the social history but are a key element in understanding the etiology and perpetuation of serious anxiety, depression and psychosis. In 2018, out of 21.2 million Americans suffering from a substance use disorder, only 11% of those patients received treatment (Scutti, 2019). According to the CDC, overdose rates increased significantly during the pandemic; in 2021 the numbers were approximately 30% higher than the year before (CDC, 2021).
According to Richter et al. (1988), the Beck Depression Inventory was the most highly utilized self-reporting depression tool at the time. It consists of 21 item self-rated questionnaire and a total point rating scale published in 1961 (Richter et al., 1988). Each item addresses a different symptom, and they include: sadness, suicidality, guilt, appetite, weight and sexual interest (Beck et al., 1961). According to a review of the literature the internal validity or reliability for the BDI is highly rated on average at 0.75 to 0.88. (Richter et al., 1988). However, Beck himself reported that the test-retest reliability is often low and extremely variable due to the sensitivity to therapeutic changes that occur over short periods of time (Richter et al., 1988). The concurrent validity or comparisons in measurement effectiveness with other scales ranged from 0.58- 0.79, showing higher scores with other assessment tools that also rated severity of depression (Richter et al., 1988). Unfortunately, the BDI fails to adequately discriminate between anxiety and depression (Richter et al., 1988). Overall, the BDI is most sensitive for the use in determining severity of depression and its changes over time in moderately depressed patients (Richter et al., 1988). The content validity analysis shows that the original BDI adequately measured 6 of the 9 depression components from the DSM-III, excluding sleep, eating and agitation (Richter et al., 1988). There have been two revisions, the latest of which is the BDI-II which more closely reflects the newer DSM symptoms and subtypes of depression and has an average reliability 0.9 (Wang & Gorenstein, 2013). The brevity, reliability, and ability to discriminate between depressed and non-depressed individuals lead to the world-wide translation and adaptation of the BDI assessment tool (Richter et al., 1988).
