Psychiatric-Mental Health Nurse Practitioner
Exam 2 Week 3-4 Covered latest update 2025/2026
1. Psychiatric interview: the process by which psychiatric assessment is conduct- ed
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the course of the
diagnostic interview, a sense of rapport, trust, and warmth
-most important goal of the interview process
,-the cooperative working relationship between the therapist and client
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• begins during the initial or opening phase of the interview
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-fundamental component of successful therapy B B B B
• Without trust, adherence to treatment recommendations may be compromised
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• interview may not elicit the information needed to formulate an appropriate dx & plan
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B of care without rapport & trust
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3. Creating rapport: tips: -Be Yourself B B B B
-Be Warm, Courteous, and Emotionally Sensitive
B B B B B
-Actively Defuse the Strangeness of the Clinical Situation
B B B B B B B
-Give Your Patient the Opening Word
B B B B B
-Gain Your Patient's Trust by Projecting Competence
B B B B B B
4. How to approach threatening topics (sensitive/embarrassing material): -
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-Normalization
-Symptom Expectation B
-Symptom Exaggeration B
-Reduction of Guilt B B
-Use Familiar Language When Asking about Behaviors
B B B B B B
5. Normalization: Introducing Q with some type of normalizing statement B B B B B B B B
,-two principal ways to do this:
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1. start the question by implying that the behavior is a normal or understandable
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B response to a mood or situation
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• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this
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B been true for you?
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2. Begin by describing another patient (or patients) who has engaged in the behavior, showing
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B your patient that she is not alone
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• ex: I've talked to several patients who've said that their depression causes them to have
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strange experiences, like hearing voices or thinking that strangers are laughing at them. Has
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B that been happening to you?
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, 6. Symptom Expectation: communicate that a behavior is in some way normal or expected
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-Phrase your Q's to imply that you already assume the patient has engaged in some behavior
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B and that you will not be offended by a positive response
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-high index of suspicion of some self-destructive activity
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-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You
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B suspect suicidality, but you sense that the patient may be too ashamed to admit it. Rather than
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B gingerly asking "Have you had any thoughts that you'd be better off dead?" you might
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B decide to use symptom expectation. "What kinds of ways to hurt yourself have you though
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B about?"
*reserve this technique for situations in which it seems appropriate
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7. Symptom Exaggeration: suggesting a frequency of a problematic behavior that is higher
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B than your expectation, so that the patient feels that their actual, lower frequency of the
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B behavior will not be perceived by you as being "bad."
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-helpful in clarifying the severity of symptoms
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*reserve this technique for situations in which it seems appropriate
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8. Reduction of guilt: seeks to directly reduce a patient's guilt about a specific behavior
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B in order to discover what they have been doing
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