6635-W2-D15

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Nov 24, 2024

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A few major components of the psychiatric interview include the following; past psychiatric history, substance use / abuse and addictions, family history. Each of these sections will help paint a clearer picture of the patient as a whole as well as some predisposing factors that may give clues to their current mental state. Past psychiatric history is a great place to start digging for information regarding the patient’s history with mental illness. To properly do this, we need to rely on the patient to describe in their own words what mental illnesses they have either been diagnosed with or feel like they have been dealing with throughout their life. Hmm many times human memory is flawed, or the patient will not be given all the appropriate information to understand all of their diagnosis. Information gathering on this category will be important outside of the patients’ direct statements. Doing a thorough chart review especially filtering for visits that include psychiatric facilities, behavioral health, or emergency room visits will often be three places for the practitioner to start when attempting to gather information related to say psychiatric encounters(Sadock et al., 2017). Many times, the patient information will be easily obtained just by looking at encounters that are designated as behavioral health, but looking in the emergency room notes may give clues to instances where the patient was seen for acute mental illness symptoms and their primary behavioral clinic was unavailable. These encounters may I also paint a picture when this patient is having their most severe symptoms and dealing with situations that are not in line worth what would be considered typical for them. Outside of this checking through all the behavioral health appointments will show which providers have seen the patient, what medications they've been taking, which diagnosis the providers think are most appropriate for this patient, and how extensive their mental health background is(Sadock et al., 2017). Having an accurate record of all the medication trials that the patient has tried will be especially important in a new treatment plan so that we may skip past medications that were either not effective or caused side effects that were not well tolerated. Patients with an extensive psychiatric history will oftentimes not be able to recall all the medications they have taken, the time frame that they took them, what the dosages were, and what effects were exhibited. This is why being able to check past medical records for these psychiatric medications will be paramount when developing a treatment plan so that the practitioner will not have to rely on the patient's memory by itself. The second section that I feel will be very important to review as part of the psychiatric interview would be the patient’s substance use, abuse, and addictions. For many people this information may be a sensitive subject for them to really discuss in thorough detail which is why it will take a compassionate and thoughtful provider to elicit truthful information from them. Being able to gain information on these subjects in a nonjudgmental way will give the provider a much better chance of understanding their patient on a holistic level. On a base level it is highly important to understand what substance the patient is taking on a daily basis so that the provider can consider potential interactions, exacerbations, or potentiating effects that could occur in combination with medications that are prescribed. Alcohol or opiates in combination with a medication that is considered a central nervous system depressant we'll combine and have potentiating effects which can lead to poor patient outcomes or death. Understanding the patient’s substance abuse history will also allow the practitioner to know if the patient is potentially putting themselves in harmful situations, such as driving a motor vehicle under the influence of drugs or alcohol. For many patients a psychiatric consultation and treatment plan must start with sobriety treatment so that the practitioner knows the patient reports are based on only the drugs being prescribed without being altered by anything else. Being able to prescribe medication and alter those

dosages is difficult on its own, and far more challenging if the patient is taking illicit street drugs at unknown dosages or using alcohol. In addition to the considerations that need to take place when prescribing medications to a patient with substance abuse issues, we also need to figure out if their psychiatric symptoms are related to substance abuse. Determining if the patient's mental illness came before substance abuse, during, or after is very tricky especially if the patient is still using(Nordgaard et al., 2013). Finding sobriety and establishing A baseline for the patient to treat them it's a great place to start. The last area that I would give a high level of importance to in relation to a psychiatric interview would be the patients family history of mental illness. Many mental illnesses will at a minimum genetically predispose relatives to their development. To a more profound extent these genetic occurrences may all but ensure the patient develops a mental illness or a number of traits that are associated. It is also possible for a specific mental illness to not be passed on however many of the symptoms overlap which also makes it highly dependent on the provider to sort through them(Nordgaard et al., 2013). Understanding family history as part of the patient's initial intake will also give many clues to the provider on where to look for genetic abnormalities as well as possible indications of illness that is being passed on. In addition to mental illness family history is also a great place to go to find physical illness or other disease processes that may be leaving the patient at a predisposition to contract. The overlap between physical illness and disease versus mental can be significant especially when considering that the physical symptoms may be highly contributing to the patient’s mental state. Attempting to examine the patient, and their family history as a whole will be the best way to have proper context. Michigan Alcoholism Screening Test (MAST) Is my assigned screening tool for this discussion post. Examining the psychometric properties of this screening tool is meaning to find the validity, or reliability of the tool. The Michigan alcoholism screening test consists of 25 questions that the clinician can use to gauge the severity of a patient's alcohol dependence. The screening questions attempt to gauge how often the person is drinking, if they are having any medical concerns related to alcohol, their social and home life, areas of their life that are being neglected because of alcohol, and if they are having any physical symptoms related to times that they are not drinking. The tool will really help the provider to gauge how much disruption alcohol is causing in the person's life when it comes to physical health, family and work life, and legal status(American Addiction Centers, 2023). The higher the score the more symptoms and adverse effects the patient is experiencing related to their alcohol use. For example, if the patient alcohol drinking has led to legal problems such as being arrested for driving while under the influence the score would go up two points. Is an interesting tool to use and the great place to start with the patient that has an alcohol use disorder however there will be times where the patient is either dishonest with the questions or is highly functioning so that many of the areas that would score points may not, however this would not in turn reflect that the patient does not have an alcohol abuse problem. American Addiction Centers. (2023, November 30). Mast assessment: The Michigan Alcohol Screening Test (25 questions). https://americanaddictioncenters.org/alcoholism-treatment/mast-alcohol- assessment-test Nordgaard, J., Sass, L. A., & Parnas, J. (2013, June). The psychiatric interview: Validity, structure, and subjectivity. European archives of psychiatry and clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668119/

Sadock, B., Sadock, V., & Ruiz, P. (2017, February 4). Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry. Proquest. https://ebookcentral.proquest.com/lib/waldenu/reader.action? docID=5340671&ppg=39

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