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Assessment and Diagnosis in Psychotherapy

Assignment: 

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues by comparing your assessment tool to theirs. APA Format with at least two references in each responses no more than five years old

Response Post #1

Main Post – Brief Psychiatric Rating Scale

Week 2 Discussion – Assessment and Diagnosis in Psychotherapy

Main Post

Assessment Tools

It is paramount as health care professionals to be skillful in assessing clients to be able to diagnose, plan, and produce optimal care yielding full or partial recovery of the clients.  Various assessment and measuring tools are available for mental health providers to help measure illness, diagnose clients, and measure a client’s response to treatment that will help supplement data obtained from the clinical interview.  Though assessments usually span the entire treatment cycle, a thoughtfully constructed initial intake meeting can be a great tool to establish and reinforce the required therapeutic alliances between client and therapist, provide reassurance, ease anxiety, and enhance information gathering process required for an accurate diagnosis and suitable treatment plan (Wheeler, 2014). 

Brief Psychiatric Rating Scale

The Brief Psychiatric Rating Scale (BPRS) was developed in the sixties.  It is still one of the most popular behavioral rating scales/instruments use today by clinicians to quickly gather information about the possible presence and severity of various psychiatric symptoms and to assess changes in symptoms in response to medications (Zanello et al., 2013).  Originally, the BPRS was a 16-item scale, it was later extended to the standard 18-item version and currently expanded to a 24-item scale to measure additional aspects of schizophrenia symptoms thereby increasing its sensitivity to psychotic and affective disorders and to be used for patients living in the community (Shafer et al., 2017). 

The 18-item BPRS assess the following symptoms: somatic concern, anxiety, emotional withdrawal, conceptual disorganization, guilt feelings, tension, mannerisms and posturing, grandiosity, depressive mood, hostility, suspiciousness, hallucinatory behavior, motor retardation, uncooperativeness, unusual thought content, blunted affect, excitement, and disorientation (Yee et al., 2017).  The manual of administration of the 24-item BPRS offers a more detailed semi-structured interview with more probe questions for each symptom, and providing supplementary rules for the rating (e.g., delusions) including a well-defined anchor point (Zanello et al., 2013).  The recent analysis of the 24-item BPRS produced a four-factor solution: Negative Symptoms, Positive Symptoms, Manic-hostility, and Anxiety–Depression (Zanello et al., 2013).  The current BPRS is rated on a seven-point Likert-type scale.  A rating of “1” indicates the absence of symptoms, ratings of “2–3” indicate “very mild” to “mild” symptoms that are considered to have nonpathological intensity, and ratings of “6–7” indicate “severe” or “extremely severe” symptoms associated with significant distress or impairment (Zanello et al., 2013). 

The BPRS 18 has been studied extensively and has been proven to be reliable, valid, and reliable in many languages such as German, Portuguese, Dutch, based on score correlations with other rating scales and longitudinal sensitivity to changes in psychiatric symptoms (Yee et al., 2017).  When the psychometric properties of validity, sensitivity, and reliability of BPRS were explored, various factor solutions were found due to the heterogeneity of psychiatric diseases (Yee et al., 2017).  Clinicians/therapists must pay close attention to the clients they interact with, instilling hope in them, making sure they are comfortable, maintaining security, privacy, and safety to ensure their return for follow-up care (Wheeler, 2014).

Response Post #2

Quality of Life in Depression Scale

           According to Kennedy, Eisfeld, and Cooke (2001, p. 23), the concept of quality of life serves to evaluate the efficacy of treatment intervention from the patient’s perspective and how they influence a person’s overall sense of well-being and satisfaction with life. The theoretical foundation of the Quality of Life in Depression Scale (QLDS) is that quality of life derives from the patient’s own aptitude and capacity to fulfill their individual needs (Kennedy et al. 2001, p. 25).

Psychometric Properties of QLDS

           To create the QLDS, researchers conducted interviews with patients who had active or recent depression treated by psychotropic medication to discover how their depression affected their quality of life (Tuynman-Qua, Jonghe, and McKenna, 1997, p. 8). The interviewers extrapolated 75 general statements from the interviews and eventually winnowed the total number to 35 positive and negative statements about their quality of life (Tuynman-Qua, Jonghe, and McKenna, 1997, p. 8). The respondents who complete the QLDS respond either “true” or “not true” to these statements which include examples such as, “I feel as if I am not in control of my life” and “I look forward to things” (Tuynman-Qua, Jonghe, and McKenna, 1997, p. 8).

Appropriate Utilization of QLDS

           De Fruyt and Demyttenaere (2009, p. 214), discuss that health is not merely defined or measured as the absence of disease but a more holistic state of total well-being in the realms of physical, mental, and social health. This comprehensive understanding of health requires more than objective metrics like diagnostic imaging and blood tests to determine the absence of disease. Instead, implementation of a questionnaire such as the QLDS serves to gather essential data on the patient’s perception of their current state of well-being (Tuynman-Qua, Jonghe, and McKenna, 1997, p. 12). Tuynman-Qua, Jonghe, and McKenna (1997, p. 4), note that the presence of objectively identifiable symptoms and disease correlates less with health care utilization than the patient’s perception of feeling unwell. Additionally, patient perception of effect on well-being also correlates treatment compliance (Tuynman-Qua, Jonghe, and McKenna, 1997, p. 12). Therefore, it is appropriate to implement the QLDS before and after the implementation of a psychopharmacological intervention to understand the patient’s perception of benefit from treatment on their overall well-being  

           The QLDS is appropriate for use to evaluate the efficacy of psychopharmacologic medications. Per Fruyt and Demyttenaere (2009, p. 216), a Medline search for the utilization of the QLDS in Antidepressant trials found eight papers that used the QLDS. In one study on the efficacy of treatment of Major Depression (MD) with duloxetine in 40 to 55-year-old women, the study utilized the QLDS to capture the patient-perceived quality of life pre and post-treatment (Burt, Wohlreich, Mallinckrodt, Detke, Watkin, and Stewart, 2005, p. 345). The QLDS captured improved perception of quality of life consistent with improvements seen in both clinician-rated scales such as Hamilton Depression Scale and Clinician Global Impression as well as the patient-rated Patient Global Impression of Improvement Scale (Burt et al. 2005, p. 351).

 

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