differential diagnosis - ANSWERThe provider's initial hypothesis
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
Psychia...
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
Psychiatric assessment: History taking - ANSWER-History of Present Illness
-How long have you been feeling this way?
-Did something happen in your life that may have triggered these emotions?
-How is this current situation impacting your life?
The Psychiatric History
-Have you ever been hospitalized for any mental health issues?
-Have you ever had counseling or psychotherapy?
-Have you ever taken medications for your mental health in the past?
-Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions
-Do you have a primary care provider?
-Do you have any medical illnesses?
-Are you currently taking any medications or herbal supplements?
-Do you have any allergies to medications?
-Have you ever been hospitalized for any reason?
-Have you ever had surgery?
Rationale: While the client's responses do not indicate a need for a stat full safety and mental health
evaluation, the client requires a brief suicide safety assessment to determine whether a full mental
health evaluation in necessary. It is also important to notify the client's physician or the clinician
responsible for the client's care.
,Diagnostic Testing when diagnosing mental health disorders - ANSWER-Diagnostic tests and labs are
most used to rule out physical conditions that may cause psychiatric symptoms and to evaluate the
effects of treatment
-In mental health, the CBC is used to rule out medical conditions that may present with symptoms
that can be attributed to both medical and psychiatric diagnoses
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP) - ANSWERcommon blood
test used to determine general health status
-fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney function
,-used to monitor the effects of medications, such as antipsychotics, on liver function and glucose
levels
-rule out medical conditions that could cause symptoms
Basic Laboratory Interpretation: Thyroid Function Tests (TFTs) - ANSWERused to rule out thyroid
disorders as a cause for symptoms
• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood swings,
sleeping difficulties, difficulties with concentration, short-term memory lapses, and lack of mental
alertness
Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
, Basic Laboratory Interpretation: Vitamin B12 Level - ANSWERDeficiency of vitamin B12 can affect
mood and other brain functions
-psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic
symptoms, and cognitive impairment
Family Psychiatric History
-Has any relative of yours ever been hospitalized for a mental health issue?
-Has any blood relative of yours ever been diagnosed with a mental health issue?
-Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
Social and Developmental History
-Tell me a little bit about your childhood and how you grew up.
-How was your experience in school when you were younger? Did you enjoy school?
-How do you support yourself with your finances?
-Do you have a good support system? Are you currently in a relationship? Where do you live? Who
do you live with?
-What do you do in your free time? What activities do you enjoy?
Screening and Psychiatric Rating Scales - ANSWEREvidence-based screening tools and psychiatric
rating scales
-can help the provider identify symptoms and assess their severity and can assist with the evaluation
of response to treatment
A 52-year-old client presents to the emergency department following a car accident. The emergency
department (ED) physician is concerned that the client may have intentionally crashed her car and
requests a stat PMHNP consult. In speaking with the PMHNP, the client describes persistent feelings
of sadness and hopelessness. She states that she often wonders if her husband would be happier if
she wasn't around anymore since she's never happy and sometimes thinks about what it would be
like to just take a handful of sleeping pills and go to sleep forever. The client reports a previous
suicide attempt when she was 16 but denies that she is considering killing herself right now.
Based on the client's ASQ score, what is the most appropriate response?
No action is necessary as the client is not currently considering suicide.
Provide a brief suicide safety assessment.
Alert the client's primary care physician.
Provide a ST - ANSWERProvide a brief suicide safety assessment.
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