Psych Eval
Psych eval is _________ and the _______ as what we do as PMHNPs
essential, base
___________ first when completing an interview.
provide an example
Safety
put yourself between the door and the pt ( you being closet to the door)
Active listening is
If uncomfortable than _______ then resume
asking appropriate questions
pause (pt may shut down)
don't press for details
Name this part of psych eval
which has current and historical presence or absence of s/s of major psychiatric disorder which includes
depressive sx
mania/hypomania
anxiety(worry, panic, obsessions, compulsion)
Trauma & assoc. sx
Psychosis
Risk
Psych review of SX
Family History includes:
medical
psychiatric (dx, treatment)
SI attempts and Completions
essential d/t genetic components in psych illness b/c genetic can influence psych behavior
PMHNP do a ________ evaluation but _________ does not stop
formal, evaluating
It is important to provide _________ to pt during interview
privacy
Phases of interview (3 parts)
Pt Concerns time sensitive(ex. 10 mins of 60 min appt) Why is the pt perceive they are seeing you?
Clarification -directed by provider
Planning- invite pt to participate and ask for agreeance
Name this part of the psych eval which includes information OTHER than what is in current focus of treatment
i.e. previous dx, previous care (inpt, outpt- dates), med hx, other tx(ECT,TMS)
safety self harm, Suicide attempts suicide thinking, violence
Psychiatric Hx
What is important to ask regarding safety Risk to others?
What should you ask about each visit?
intent
hx of violence
observation
impulse control
substance use- it can increase violence
SI/HI
Evaluations can ________ over time or may not be _________. You may need more than one visit to DX
change, clear
It requires _________ to assess needs and determine the ___________ environment
skill, appropriate
Pt concerns starts with ________ ______
chief complaints( should be in quotes)-tell me why your here? "my mom made me come-not vested
followed by open ended questions or statement
**** important because it captures aspects of pts Insight
identify areas of concern (
Name this part of psych eval includes:
substance use
ex. tobacco, ETOH, MJ, Opiates)
age 1st use
duration
current use
longest sobriety
drug and ETOH tx
Substance Use
What to know about Suicide Risk Assessment and what to ask
not all thoughts of death are suicidal thoughts
ask about death directly- may not want to die (feeling anxious)
Self harm- injurious behaviors
Passive thoughts- ex. "I would not take my like but if I got hit by a bus I would not be upset".
Psych Eval includes
Interview
MSE
Risk Assessment
Dx Formulation
Dx
Plan
__________ can vary depending on pt and setting
Timing
_________ is to elicit important information that will aid in the formulation of DX
Clarification ask questions about HPI
Hx gathering
MSE
Name this part of the eval that includes exposure to traumatic life events
Traumatic Hx
pt may or may not discuss details
don't open box , you can't close
and don't pressure pt for details
What to ask re SI thoughts
What is the thought
plan
access
reason they would not go through with it
Hope?
Future oriented?
how long do the thoughts last
how often thought about
told anyone else?,
Passed attempts (what, when, note, impulsive vs. planned, severity, happy to survive?, lesson learned? Look for residual intent -" next time""
Psych evals can be completed in which settings
Office
Acute
Prison/Jail
While interviewing be attentive to:
content of what pt is saying
observing
critical thinking
biological, psychological, and social will help formulate a holistic approach to care
Elaboration of Chief compliant is
History of Present illness - IT IS SUBJECTIVE
which includes sx present and NOT present (pertinent negatives)
ex. pt. denies suicidal thoughts, plan, and/or intent
Name this part of the eval that includes birth history, milestones, schooling and and they did and should be included in Social Hx
Developmental
*** more important in peds and adolescent parent may be collaborating.
Evaluating Suicide Risk can be done by:
formally or with use of scales and rating tools
assessment of risk & protective factors
risk: access, HOPELESSNESS, past attempts, impulse, stress
Protective factors are: social support, reasons for living, religious beliefs, cultural beliefs