MN-663 WEEK-6

 

Assignment-1 

 

Choose one diagnosis from the Anxiety Disorders group:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.

• Scan Pages 189-233

Overview 

As you will learn throughout the program, the diagnosis of a variety of psychiatric illnesses is not always an easy or straightforward process. Multiple observations and assessment methods are often employed to reach a diagnosis. This approach can include the use of standardized assessment instruments. This then aids you in defining a treatment plan and choosing specific treatment plans to use in the care of your clients.

You are tasked with identifying a standardized assessment instrument/tool to measure the disorders listed for each week. You will keep these instruments in the form of a “portfolio” that you can use in your clinical practice to assess clients who present with a variety of symptoms.

Instructions:  

Instrument/ Tool criteria:

For each assessment you are tasked with selecting from the DSM5 section of diagnoses (pages you scan for the week of the DSM5); you will identify an instrument and:

1. List what DSM diagnosis the tool/instrument is used for.
2. Identify an assessment/diagnosis instrument.
3. Appraise a scholarly, peer-reviewed article that addresses the use of the instrument to support your choice as an evidence-based instrument for practice.
4. Evaluate the instrument’s appropriateness for diagnosing the condition it is designed to assess or if the developers of the instrument reported that the instrument is only part of a comprehensive assessment for the disorder.
5. Describe whether or not the instrument can be used to measure patient response to therapy/treatment or if it is strictly for assessment and diagnosis.
6. Discuss the psychometrics/scoring of the instrument, including reliability and validity.
7. Discuss any limitations associated with the use of the instrument.
8. Include a link to view the assessment if possible.

Use the following Journal template in completing your portfolio assignments. Your information can be in bulleted format or just a couple of sentences for each criterion listed above. However,  you must use APA citations.  You are NOT required to write this in a paper format. Turn in one document for each week’s topics.  (However, create a file on your desktop to compile your portfolio as you move through the term. This will ensure you can have easy access to show the full portfolio and once you begin clinicals and practice. Throughout the program, you will continue to add to the portfolio in each course.

Review this example.

 

Student Example Anxiety and Related Disorders

Week 7

 

Instrument: Social Phobia Inventory (SPIN)

 

Article: Psychometric properties of the Social Phobia Inventory

 

Appropriateness for Dx: This tool is meant for screening of individuals with social phobia and assignment of a severity score (Connor et al., 2000). The tool was created in congruence with DSM-4 but is consistent with the DSM-5 diagnosis of social anxiety disorder, minus some minor changes (Substance Abuse and Mental Health Service Administration [SAMHSA], 2016). Although the study is outdated, Duke University School of Medicine (2020) acknowledges that the tool is still relevant and utilized by their Anxiety and Traumatic Stress Program.

 

Response to Therapy/Treatment: The SPIN is appropriate for testing treatment response and through studies has proven sensitive to symptom changes over time. Changes in scores are able to determine treatment efficiency (Connor et al., 2000).

 

Psychometrics: The tool is self-administered and consists of 17 separate statements regarding problems a patient may exhibit if they have social phobia. The statement is then rated on how much it has bothered the individual in the last week, from ‘not at all’ (0) to ‘extremely’ (4). Any score over 21 is considered clinically significant. In the study, the assessment tool was able to effectively separate individuals with and without social phobia. Validity is strong in regard to detecting the severity of illness and is sensitive to symptom reductions during treatment. The scale shows significant correlation with the Liebowitz Social Anxiety Scale Test, The Brief Social Phobia Scale and The Fear Questionnaire social phobia subscale (Connor et al., 2000).

 

Limitations: Limitations exist in the tool’s alignment with DSM-4 instead of the more recent edition, although differences are very minor (SAMHSA, 2016). With a cutoff score of 19, sensitivity and specificity were good, but some individuals consider the cutoff score to be 15, in which these measures are weaker (Connor et al., 2000).

 

Journal Discussion Prompt from Assignment: This tool could be used when suspected social anxiety is present.  It would be helpful to assess the client’s strengths and weaknesses as well as know the degree of social anxiety.

 

References

 

Connor, K., Davidson, J., Churchill, E., Sherwood, A., Foa, E., & Wisler, R. (2000).

Psychometric properties of the Social Phobia Inventory. British Journal of Psychiatry, 176, 379-386.

 

 

 

To view the Grading Rubric for this assignment, please visit the Grading Rubrics section of the Course Resources.

Submit your assignment to the unit Dropbox before midnight on the last day of the unit.

 

 

 

 

 

 

 

 

 

Assignment -2 /SOAP note

 

Case Study 3: A man who is displaying symptoms of moderate anxiety

Your writing Assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and;
• use APA formatting and citation style.

 

Allen, a university graduate aged 21 years, attends the pharmacy of the campus counseling health center and asks to speak to the pharmacist in private. He states he is worried about heart palpitations that he has been experiencing. He is visibly sweating and looks on edge. The pharmacist calls the provider on duty at the psychiatric clinic for the counseling health center and she arrives.

Assessment

As the PMHNP on duty, you invite Allen into the consultation room and ask him about his symptoms. He states that he has started a new job and that the palpitations start when he is feeling anxious. His symptoms are occurring most days of the week and he says it makes him “feel on edge.” He adds that he does not want to socialize with his co-workers. It is starting to affect his sleep and he does not know what to do. He also states that he has occasional pain in his chest.

Treatment options

Allen is demonstrating symptoms of moderate anxiety, given his desire to avoid socializing, and has a degree of functional impairment. However, as he has potential cardiac symptoms, these issues could be related to another condition.

When questioned, he confirms he has no other problems with his health, but you feel the patient needs further investigation. For example, tests to measure the electrical activity of his heart to rule out underlying cardiac problems should be considered. His presentation concerns you and you feel he needs these tests today to assess the differential diagnosis, as you are worried about his chest pain and palpitations.

Vitals:

• 138/80
• 4
• 20
• 78
• 99%
• 5’10”
• 188 lbs.

Advice and recommendations

You encourage Allen by saying that it is great that he felt he could talk to a pharmacist about this, but explain that he would benefit from continued management with you as the PMHNP and possibly some additional psychotherapy. You explain that his symptoms could be related to anxiety and that you think he may need something to help him manage. He agrees to let you continue the assessment and design a treatment plan.

Use the Initial Psychiatric Assessment SOAP Note template to complete the documentation with the information provided, diagnose the patient and design a treatment plan.

 

Initial Psychiatric SOAP Note Template

 

There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.

 

Criteria	Clinical Notes
Informed Consent	Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and(Will review additional consent during treatment plan discussion)
Subjective	Verify Patient Name: DOB:   Minor: Accompanied by:   Demographic:   Gender Identifier Note:   CC:   HPI:   Pertinent history in record and from patient: X   During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.   Patient self-esteem appears fair,no reported feelings of excessive guilt, no reported anhedonia,does not report sleep disturbance, does not report change in appetite, does not report libido disturbances,does not report change in energy, no reported changes in concentration or memory.   Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria.Patient does not report excessive fears, worries or panic attacks. Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits.  Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.   SI/ HI/ AV:Patient currently deniessuicidal ideation, deniesSIBx,denieshomicidal ideation, deniesviolent behavior, deniesinappropriate/illegal behaviors.   Allergies: NKDFA. (medication & food)   Past Medical Hx: Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury. Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C. Surgical history no surgical history reported     If Minor obtain Developmental Hx: (most often from parents), in utero, birth and delivery hx, early childhood, school hx, behavior, etc…   Nutritional status (this is an important component to gauge how well the mind and body are being nourished for full function. Ex: lack of iodine create thyroid issues, thyroid issues creates metabolism issues which affects function of cognition, mood, etc…)   Past Psychiatric Hx: Previous psychiatric diagnoses: none reported. Describes stable course of illness. Previous medication trials: none reported.   Safety concerns: History of Violence to Self:none reported History of Violence to Others: none reported Auditory Hallucinations: Visual Hallucinations:   Mental health treatment history discussed: History of outpatient treatment: not reported Previous psychiatric hospitalizations: not reported Priorsubstance abuse treatment: not reported   Trauma history: Client does not report history of trauma including abuse, domestic violence, witnessing disturbing events.   Substance Use: Client denies use or dependence on nicotine/tobacco products. Client does not report abuse of or dependence on ETOH, and other illicit drugs.   Current Medications: No current medications. (Contraceptives): Supplements:   Past Psych Med Trials:   Family Medical Hx:   Family Psychiatric Hx: Substance use Suicides Psychiatric diagnoses/hospitalization Developmental diagnoses   Social History: Occupational History: currently unemployed. Denies previous occupational hx Military service History:Denies previous military hx. Education history:  completed HS and vocational certificate Developmental History: no significant details reported. (Childhood History) Legal History: no reported/known legal issues,no reported/known conservator or guardian. Spiritual/Cultural Considerations: none reported.   ROS: Constitutional:  No report of fever or weight loss. Eyes:  No report of acute vision changes or eye pain. ENT:  No report of hearing changes or difficulty swallowing. Cardiac:  No report of chest pain, edema or orthopnea. Respiratory:  Denies dyspnea, cough or wheeze. GI:  No report of abdominal pain. GU:  No report of dysuria or hematuria. Musculoskeletal:  No report of joint pain or swelling. Skin:  No report of rash, lesion, abrasions. Neurologic:  No report of seizures, blackout, numbness or focal weakness.  Endocrine:  No report of polyuria or polydipsia. Hematologic:  No report of blood clots or easy bleeding. Allergy:  No report of hives or allergic reaction. Reproductive: No report of significant issues. (females: GYN hx; abortions, miscarriages, pregnancies, hysterectomy, PCOS, etc…)