Midterm Exam:NR 547:NR 547 Midterm Exam: NR 547 Midterm Study Guide:Updated A+ Score Solution

The differential diagnosis: 1. Importance of the differential diagnosis: Critical step in providing, safe, quality care. It helps discern an accurate diagnosis; helps PMHNP gather useful responses to formulate and narrow the list of potential diagnoses based on client’s s/s 2. Analysis of: a) presenting symptoms: identify symptoms; ask length of time and any fluctuations in severity; determine presence of stressors included identify factors that alleviate or exacerbate symptoms. b) clinical data such as physical exam= must decide if medical, surgical, or neurological condition is the cause of mental disorder; once determined that no disease process can be held accountable, then the diagnosis of a mental health disorder can be made; knowledge and understanding of physical s/s enables providers to recognize s/s that may indicate possible medical or surgical illness c) laboratory analysis. = vital in achieving goals of arriving at accurate diagnoses, identifying medical comorbities, implementing appropriate treatment, and delivering cost effective care, CBC, CMP, thyroid function tests, serum B12, vitamin D, toxicology, and UA. d) Medical history including medications= includes treatments both past and present; past surgeries should also be reviewed; essential to understand patient’s reaction to illnesses and coping skills employed; important when determining potential causes of mental illness as well as comorbid or confounding factors and may dictate possible treatment options or limitations; Medical illness can precipitate a psychiatric disorder (ex. Anxiety in an individual recently diagnosed with cancer); Medical illnesses can mimic a psychiatric disorder (ex. Hyperthyroidism resembling an anxiety disorder); Medical illness can be precipitated by a psychiatric disorder or its treatment (ex. a metabolic syndrome in a patient on a secondgeneration antipsychotic medication); Medical illnesses can influence the choice of treatment of a psychiatric disorder (ex. renal disorder and the use of lithium carbonate); pay special attention to neurologic issues (seizures, head injury, pain disorder); know any hx of prenatal or birthing problems or issues with developmental milestones; reproductive and mensgtrual history is essential as well as a careful assessment of the potential for current or future pregnancy Medications: include all current psych meds and how long they have been used, compliance, effects and any side effects; non-psych meds, OTC meds, sleep aids, herbal, and alternative meds should also be reviewed; it is wise to advise patient should be asked to bring all medications to interview, allergies to medications should also be assessed (including with medication and the nature of the extent of and the treatment of the allergic response) 3. Evidence-based screening tools and psychiatric rating scales a) Scoring???? b) Advantages and disadvantages: key role is to standardize the info collected across time and by various observers; this standardization ensures consistent, comprehensive evaluation that may aid treatment planning by establishing a diagnosis, ensuring a thorough description of symptoms, identifying comorbid conditions, and characterizing other factors affectingtreatment response. Also, the use of the rating scale can establish a baseline for follow-up of the progression of an illness over time or in response to specific interventions. Helps to monitor patients over time or for providing information that is more comprehensive that what is generally obtained in a routine clinical interview; helps providers identify symptoms and assess their severity and can assist with the evaluation of response to treatment; healthcare administrators and payors are increasingly requiring standardized assessments to justify the need for services or to assess the quality of care; Also used in research that informs the practice of psychiatry; most rating scales also offer the user the advantages of a formal evaluation of the measures performance characteristics. This allows the clinician to know to what extent a given scale produces reproductible results (reliability) and how it compares to more definitive or established ways of measuring the same thing (validity) c) Components: WHO disability assessment schedule (WHODAS 2.0), Structured clinical interview for DSM (SCID), Brief psychiatric rating scale (BPRS), Positive and Negative syndrome scale (PANSS), Scale for the assessment of positive symptoms (SAPS) and scale for the assessment of negative symptoms (SANS), Hamilton rating scale for depression (HAM-D), Beck depression inventory (BDI), Hamilton Anxiety ratin