NRNP-6635-21 Week 2 Main Post
The psychiatric interview is an assessment to determine the severity of a mental illness and whether it was prompted by some other factor, like stress from a job or relationship (American Psychiatric Association, 2022).
The three important components of this interview are patient history, health examination, and clinical judgment (Sadock, Sadock, & Ruiz, 2017).
Patient medical history is often a crucial step in evaluating patients. Information gathered by collecting a detailed medical history can have life-or-death consequences. In less extreme cases medical history will often direct care (American Psychiatric Association, 2022).
Physical examination is the process of evaluating objective anatomic findings by observation, palpation, percussion, and auscultation (Boland. Verduin, & Ruiz,2022). These tests can identify underlying conditions, such as heart disease and diabetes, even if the patient is not experiencing symptoms (Boland, Verduin, & Ruiz,2022). The test results also enable the psychiatric health professional to make recommendations for follow-up testing, as well as lifestyle, exercise, or diet changes that can help the client improve or maintain health (Boland. Verduin, & Ruiz,2022).
Clinical judgment is the accumulation of knowledge and skills over time, which contributes to the nurse’s ability to analyze and synthesize the patient presentation, objective, and subjective data, and then provide evidence-based nursing interventions to improve patient outcomes and, clinical decision-making (American Psychiatric Association. (2016).
This process is used to understand and interpret information in the delivery of care. Clinical decision-making based on clinical judgment is directly related to care outcomes (American Psychiatric Association, 2016). Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making, and health promotion.
Attention Deficit/Hyperactivity Scales
The rating scale selected for this discussion is the NICHQ Vanderbilt Assessment Scale ( VADPRS ). This scale is used by healthcare professionals to help diagnose ADHD in children between the ages of 6- and 12 years.
For a child to meet the criteria for ADHD, there must be at least two items of the performance set in which the child scores a 4, or 1 item of the performance set in which the child scores a 5. This means that there must be impairment, not just symptoms, to meet diagnostic criteria. The sheet has a place to record the number of positives (Sebalo et al, 2023).
In a study done by Sabelo et al., 2023, researchers found that the parent’s Vanderbilt rating scale report alone had a 56% rate of accuracy in predicting an ADHD diagnosis. These findings indicate that the VADPRS scale is more accurate in identifying individuals with ADHD when professionals provide the diagnosis, but fewer true negatives are found (Sebalo et al., 2023).
Psychometric Properties
The scale has good internal reliability with Cronbach’s alpha coefficient of >. 90 (parent) and >. 89 (teacher) Test-retest reliabilities were assessed as adequate (Sebalo et al., 2023).
It is proper to use the Vanderbilt Assessment Scales for the 6–to 12-year-old age group. However, since the scale is used to collect information to establish Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, they are applicable to other groups, particularly preschoolers, where they have identified that DSM-5 criteria are still appropriate (Carrick, & Hamilton,2023 ). These scales should not be used alone to make a diagnosis of ADHD without confirming and elaborating the information with interviews with at least the primary caregivers and patients. Information must be gathered from multiple sources (Carrick, & Hamilton,2023).
NICHQ Vanderbilt Assessment Scales are beneficial to a nurse practitioner’s psychiatric assessment because it helps the nurse practitioner in evaluating a child with a diagnosis of ADHD, and to make an informed diagnosis. It can also be used to monitor the child post-diagnosis (Kapogiannis, et al., 2022).
In conclusion, psychiatric interviews are vital in the gathering of diagnostic information during the assessment, diagnosis, planning, treatment, and evaluation of patients with mental health conditions. The scales are designed to meet various needs like screening, diagnosis, and treatment monitoring.
References
American Psychiatric Association. (2022). Section I: DSM-5 basics. In Diagnostic and statistical manual of mental disorders Links to an external site.Links to an external site.(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.Links to an external site.
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adultsLinks to an external site.Links to an external site. (3rd ed.).
https://psychiatryonline.org/doi/pdf/10.1176/appi.books.978089042676Links to an external site..
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Carrick, A., & Hamilton, C. J. (2023). Heated Behaviour in the Classroom for Children with FASD: The Relationship between Characteristics Associated with ADHD, ODD and ASD, Hot Executive Function and Classroom Based Reward Systems. Children, 10(4), 685.
Kapogiannis, A., Makris, G., Darviri, C., Artemiadis, A., Klonaris, D., Tsoli, S., … & Pervanidou, P. (2022). The Greek version of the Vanderbilt ADHD diagnostic parent rating scale for follow-up assessment in prepubertal children with ADHD. International Journal of Disability, Development and Education, 69(5), 1726-1735.
Sebalo Vňuková, M., Sebalo, I., Anders, M., PtáÄek, R., & Surman, C. (2023). Psychometric Properties of the Czech Version of the Vanderbilt ADHD Diagnostic Parent Rating Scale. Journal of Attention Disorders, 108705472311675.
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 PsychiatryLinks to an external site.Links to an external site. (4th ed., pp. 39–52). Wolters Kluwer.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Classification in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical PsychiatryLinks to an external site.Links to an external site. (4th ed., pp. 1–8). Wolters Kluwer.
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Discussion Response
Psychiatric Assessment
I am impressed by your approach to the psychiatric assessment and the relations to management. History taking, examination, and clinical judgment are the pillars of managing psychiatric conditions. The patient’s history provides insight into individual beliefs and experiences that impact health. Besides, it provides an extensive knowledge of the associated medical health status. The health examination process also illuminates the aspects of the patient’s health and the possible underlying conditions directly linked to the mental state. Moreover, health examination and the test results guide the diagnosis and meet the patient’s care needs. In light of this, clinical decision-making is mainly based on the history, health examination, and test results. However, as you stated, interpreting the test results is crucial in clinical judgment as it defines the scope of care and modifies the care plan to meet the patient’s care needs.
Anderson et al. (2022) emphasized the role of the Vanderbilt Attention Deficit/Hyperactivity Disorder (ADHD) Diagnostic Parent Rate Scale (VADPRS) in the scoring and diagnosis of ADHD in children between 5-12 years. The psychometric properties of VADRS rely on DSM-V information and reduce the interview duration (Bussing et al., 2020). The American Academy of Pediatrics/National Institute for Children’s Health Quality (AAP/NICHQ) is based on the client’s symptoms score of ADHD. It improves the clinical utility, especially in diagnosing children with comorbidities (Rakhmanov & Dane, 2019). This provides an alternative to the VADRS scale score, which you stated had a 56% accuracy rate in diagnosing ADHD. The diagnosis and intervention of ADHD are based on history, examination, and clinical judgment, with the scale score improving the clinical judgment and providing a definite approach to ADHD diagnosis.
References
Anderson, N. P., Feldman, J. A., Kolko, D. J., Pilkonis, P. A., & Lindhiem, O. (2022). National Norms for the Vanderbilt ADHD Diagnostic Parent Rating Scale in Children. Journal of Pediatric Psychology, 47(6), 652-661. https://doi.org/10.1093/jpepsy/jsab132
Bussing, R., Gagnon, J. C., Garvan, C. W., Ribuffo-Duggan, C., & Houchins, D. (2020). Psychometric properties of the Vanderbilt ADHD Diagnostic Rating Scale completed by juvenile corrections staff. Journal of Attention Disorders, 24(11), 1521-1529. https://doi.org/10.1177/1087054717690811
Rakhmanov, O., & Dane, S. (2019). Correlation between Vanderbilt ADHD diagnostic scale and the draw-a-man test in school children. Journal of Research in Medical and Dental Science, 7(6). https://www.jrmds.in/articles/correlation-between-vanderbilt-adhd-diagnostic-scale-and-the-drawaman-test-in-school-children-44783.html