NURS 6635
Getting Started With the DSM-5-TR
If you were to give a box of 100 different photographs to 10 people and ask them to sort them into groups, it is very unlikely that all 10 people would sort them into the exact same groups. However, if you were to give them a series of questions or a classification system to use, the chances that all 10 people sort them exactly the same increases depending on the specificity of the system and the knowledge of those sorting the photographs.
This is not unlike what has occurred in the process of classifying mental disorders. A system that provides enough specificity to appropriately classify a large variety of mental disorders while also attempting to include all of the possible symptoms, many of which can change over time, is a daunting task when used by a variety of specialists, doctors, and other professionals with varied experience, cultures, expertise, and beliefs. The DSM has undergone many transformations since it was first published in 1952. Many of these changes occurred because the uses for the DSM changed. However, the greatest changes began with the use of extensive empirical research to guide the creation of the classification system and its continued revisions.
In order to assess and diagnose patients, you must learn to use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated as the DSM-5-TR, to render a diagnosis. In this second week of the course, you will examine how DSM-5-TR is organized and how clinicians use it to render diagnoses.
Review the Learning Resources this week, with special emphasis on viewing the Diagnostic Criteria video. This video explains the purpose and organization of the DSM-5-TR classification system, the purpose of the ICD-10 coding system, their relationship to one another, and the importance to the PMHNP role.
Discussion: The Psychiatric Assessment and Evidence-Based Rating Scales
Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.
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.
Main Assignment
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.
LEARNING RESOURCES
https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.5555/appi.books.9780890425787.Section_1
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Chapter 34, Writing Up the Results of the Interview
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Chapter 5, Examination and Diagnosis of the Psychiatric Patient
Chapter 6, Classification in Psychiatry
Chapter 31, Child Psychiatry (Sections 31.1 and 31.2 only)
https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf
https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=20
https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=39
https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=53
https://www.youtube.com/watch?v=U5KwDgWX8L8
https://www.youtube.com/watch?v=IRiCntvec5U
-SAMPLE ANSWER-
The psychiatric interview is an important tool used by nurse practitioners and other mental health professionals in the assessment and diagnosis of mental disorders. Three important components of the psychiatric interview include:
Gathering a thorough history: This includes obtaining information about the patient’s current symptoms, as well as their past medical, psychological, and social history. This information is important in order to understand the patient’s current condition, and to identify any risk factors or previous experiences that may be contributing to their symptoms.
Conducting a mental status examination: This includes assessing the patient’s mood, affect, thought process, thought content, perception, and cognitive functioning. This examination can provide important information about the patient’s overall level of functioning, as well as any signs of mental disorder.
Using standardized assessment tools: These include rating scales and diagnostic interviews, which are designed to measure specific symptoms and disorders, and can provide objective data that can help to support the diagnosis.
The psychometric properties of a rating scale refers to its reliability and validity. Reliability refers to how consistently the scale produces similar results when given to the same patient multiple times. Validity refers to how well the scale measures what it is supposed to measure. A good psychometric rating scale should be reliable, valid and appropriate for the population it is intended for.
The specific rating scale assigned to me by my instructor is the PHQ-9 (Patient Health Questionnaire-9). It is a validated scale for measuring symptoms of depression. It is appropriate to use this scale with clients during the psychiatric interview in order to Help in the assessment of depression and to monitor treatment progress over time. It is helpful to a nurse practitioner’s psychiatric assessment because it provides a quantitative measure of depression symptoms, which can aid in the diagnosis and treatment planning. According to research, the PHQ-9 has shown to be a reliable and valid measure of depression symptoms, ( Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097)
