Assessing and Diagnosing Patients With Disruptive, Impulse-Control, Conduct, Dissociative, and Somatic Symptom-Related Disorders

Assignment: Assessing and Diagnosing Patients With Disruptive, Impulse-Control, Conduct, Dissociative, and Somatic Symptom-Related Disorders

Choose one of  the following five videos to use for the comprehensive psychiatric evaluation during week 5.  The videos are found in the Walden Library (waldenlibrary.org) within the ProQuest Company videos:

Video Links (Week 5)

• Training Title 30. (2016).[Video/DVD] Symptom Media. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-30
• Training Title 35. (2016).[Video/DVD] Symptom Media. Retrieved from https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-35
• Training Title 54. Anonymous Symptom Media, 2017. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-54
• Training Title 39. Anonymous Symptom Media, 2017. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-39
• Training Title 89.(2017).[Video/DVD] Symptom Media. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-89

Comprehensive Psychiatric Evaluations General Feedback

Here is some feedback that may help you as you prepare further comprehensive evaluations:

The chief complaint should be a few words or a sentence that is the client’s own words (in quotes).

The HPI should include information about how long the issue has occurred and how the issue has affected functionality, quality of life, etc.

Medication history needs to include over the counter/ herbals and needs to include response, side effects, or issues.  Include doses if possible.

Be sure to include suicide risk assessment:  Lifetime risk and immediate risk are usually assessed.

Example:  History of suicide attempt s X 2 (medication overdoses with medical hospitalizations with intubations and psychiatric hospitalizations) about 5 and 10 years ago.  Currently, passive suicidal ideation without plan or intent.  No self-harm or homicidal ideation.  No guns in the home.  Medications are dispensed by client’s husband and are locked in a container.  Lifetime risk:  Moderate.  Immediate risk:  Mild.

Lifetime risk is moderate because there is a history of serious suicide attempts X 2 and current passive suicidal ideation.  Immediate risk is mild due to no plan or intent, no guns in the home, and no access to medications.

There should be a notation of brain injuries, developmental history, siblings (ages and where the client was in the family such as the oldest, middle, youngest, etc), psychosocial history should include childhood (where the client grew up, family dynamics, school functioning, etc).

Substance use needs to include drugs, alcohol:  Type of drugs, alcohol, current use, use within the past 12 months, history of use, amount used, how used (smoked, IV, snorted, etc), age of first use, total length of use.  A template can be found at the following link:   CHEMICAL DEPENDENCY AND ADDICTIVE BEHAVIOR ASSESSMENT (amitahealth.org)

Family history needs to include medical and psychiatric issues.  Also include suicides, mental health diagnoses, substance abuse, and inpatient hospitalizations.

The Review of Symptoms needs to include a physical review of symptoms and a psychiatric review of symptoms (often times symptoms overlap so you need to ask questions about issues such as bipolar, OCD, anxiety, psychosis, trauma, etc).

The following includes examples of the psychiatric review of symptoms:

med-9780195307740-interactive-pdf-030.pdf (oxfordclinicalpsych.com)

APA updates to the psychiatric evaluation:   APA Updates Guidelines on Psychiatric Evaluation in Adults (aafp.org)

Department Of Psychiatry And Behavioral Health Adult Symptom Checklist (sutterhealth.org)

You need to assess anxiety and panic attacks.  Panic attacks need to be assessed using frequency, duration, symptoms, interventions to relieve anxiety.

Diagnostics can and should include screening tools (such as the GAD 7, PHQ-9, Columbia Suicide Severity Rating Scale, CAGE questionnaire, etc.  If none are used, this may be good information to include in your reflection.

Physical exam should include information such as height, weight, vital signs, BMI, etc.  No tics or tremors.  Ambulatory without difficulty.  In no acute distress.  If you don’t have the information, you can write in that this information was not provided (you need to know to include these, especially if certain medications are utilized).  If no information is provided, this may be good information to include in your reflection.

The three differential diagnoses should include three diagnoses that have similar signs and symptoms with your rationale why this differential diagnosis was chosen (pertinent positives and negatives).  Probable, possible, and unlikely diagnoses are usually utilized.

Example:

Major Depressive Disorder:  Probable Diagnosis.  Pertinent Positives:  SIGECAPS (DSM-V criteria):  Insomnia, decreased interest, increased guilt, fatigue, decreased concentration, decreased appetite, psychomotor agitation, and passive suicidality present.

Substance Use Disorder/ Alcohol Use Disorder:    Possible Diagnosis.  Pertinent Positives:  Client uses alcohol with binge drinking three times per week and has had issues with relationships due to drinking.  CAGE score is 2.  Pertinent Negatives:  Denies cravings, denies inability to complete responsibilities or obligations, no physiological tolerance, no withdrawal symptoms.  Awaiting UDS.

Hypothyroidism:  Unlikely Diagnosis.  Pertinent Positives:  Fatigue (may be related to insomnia).  Pertinent negatives:  No change in bowel habits, no change in menses, no change in skin.  TSH was normal in 11/2019.  Current TSH pending.

Reflection:

What happened during the video?  Does this support evidence-based practice?  Why or why not?  Would you have done anything differently?  What did you learn?  How will you apply this to clinical practice?  You can use the SOAR method:

Strengths:  What was done that represented high quality psychiatric practice, assessment?

Opportunities:  What could be done differently or better?

Aspirations:  How do you analyze the strengths and opportunities?  How will you use the information in clinical practice?

Results:  What are the expected results?

I do realize the videos may be lacking regarding some of this information, but you need to be aware that the comprehensive psychiatric evaluation needs to include a myriad of information to consider biological, psychiatric, and psychosocial issues.

Many psychiatric disorders overlap regarding signs and symptoms.  You want to insure you are completing a comprehensive assessment that takes into account different issues such as cognitive impairments, trauma, anxiety, depression, mania, etc.

Resources:

American Psychiatric Association. (2013). Disruptive, impulse-control, and conduct disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm15

American Psychiatric Association. (2013). Dissociative disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm08

American Psychiatric Association. (2013). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09