Essential aspect of patient care that a mental health nurse practitioner
Response 1
The psychiatric examination is an essential aspect of patient care that a mental health nurse practitioner must know well to diagnose appropriately. According to Snyderman & Rovner (2009), "familiarity with the components of the psychiatric examination can help physicians evaluate for and differentiate psychiatric disorder." The psychiatric examination involves systematically gathering information, including many components such as the history of present illnesses, family history, personal history, medical history, psychiatric history, and suicide and violence risk assessment (Scher, 2018)). Among these components, the student found family history, medical history, and history of the present illness to be the most important when evaluating a patient for potential mental health concerns.
HISTORY OF THE PRESENT ILLNESS/CHIEF COMPLAINT
The history of the present illness is significant because it allows the patient to express the symptoms they are feeling and what is bothering them in their own words. Moreover, in return, if a patient or their loved ones is a good history, the clinician will have insights into what is going on with the patient at a differential diagnosis. During the interview, the clinician could have deduced other non-verbal clues from the patient which would aid their diagnosis. The student agrees that the history of the present illness is the most critical element of a psychiatric interview (Scher, 2018).
FAMILY HISTORY
Family history is another vital component of the psychiatric interview because major psychiatric illnesses have a strong biological component, especially schizophrenia, bipolar, or depression. In the case of schizophrenia, family history is the strongest indicator and risk factor for developing schizophrenia (Mortensen et al., 2010). Genetics and hormonal plays a role in mental illness as it is in most medical condition. Moreover, a family history of a suicide attempt is a red flag. Therefore, a family history of mental illness is a key factor that a clinician should understand about a patient because it will help in profiling the patient and support diagnosis, especially in a patient who may present with comorbidity.
MEDICAL HISTORY
Medical history includes medical diagnosis, illness, medication profile, and recent laboratory results. In a psychiatric interview, it is essential for the clinician to no other conditions that could be interfering with the patient's mental health presentation. Also, there is some medical condition that the symptoms that could mimic mental health, like hyperthyroidism and hypothyroidism. Understanding the other medical condition that a patient has will guide medication choices. For instance, selective serotonin reuptake inhibitors may not be the medication of choice for a patient diagnosed with depression. In addition, medical history is critical in a psychiatric interview because of tolerance, side effects, and drug interaction.
Other factors like personal history, substance abuse, and past psychiatric history are equally important in a psychiatric interview.
Adult ADHD Self-Report Scale
As ADHD could persist into adulthood, the adult ADHD self-report scale for adults is a tool that can be used to screen for ADHD in adults to gain more knowledge in addition to doing a full psychiatric interview. It is a checklist with eighteen symptoms of DSM-5 criteria. The Adult ADHD self-report scale has two parts. First, some part of the response is shaded, and the further the patient is into the dark shaded area in response, the likelihood of them having ADHD is higher.
ADHD self-report for adults is a tool aligned with DSM-5 diagnostic criteria for ADHD in adults. In a study of 960 participants, it was found that the Adult ADHD self-report scale is easy to use and also has high diagnostic accuracy for ADHD in adults (Brevik et al., 2020). In addition, according to Brevik et al. (2020), “Retrospective childhood symptoms of aggressiveness and social problems are highly predictive of an adult diagnosis of attention-deficit hyperactivity disorder.”
In another study adult ADHD self-report scale was described as a sensitive screener for identifying possible ADHD cases, with very few missed cases among those screening negative in this population (Van de Glind et al., 2013). Therefore, based on the presented information about the adult ADHS self-report scale in the write-up, the student concluded that it is an excellent tool for diagnosing ADHD in adults.
Sample Solution
irst, it is never just to intentionally kill innocent people in wars, supported by Vittola’s first proposition. This is widely accepted as ‘all people have a right not to be killed’ and if a soldier does, they have violated that right and lost their right. This is further supported by “non-combatant immunity” (Frowe (2011), Page 151), which leads to the question of combatant qualification mentioned later in the essay. This is corroborated by the bombing of Nagasaki and Hiroshima, ending the Second World War, where millions were intently killed, just to secure the aim of war. However, sometimes civilians are accidentally killed through wars to achieve their goal of peace and security. This is supported by Vittola, who implies proportionality again to justify action: ‘care must be taken where evil doesn’t outweigh the possible benefits (Begby et al (2006b), Page 325).’ This is further supported by Frowe who explains it is lawful to unintentionally kill, whenever the combatant has full knowledge of his actions and seeks to complete his aim, but it would come at a cost. However, this does not hide the fact the unintended still killed innocent people, showing immorality in their actions. Thus, it depends again on proportionality as Thomson argues (Frowe (2011), Page 141).
This leads to question of what qualifies to be a combatant, and whether it is lawful to kill each other as combatants. Combatants are people who are involved directly or indirectly with the war and it is lawful to kill ‘to shelter the innocent from harm…punish evildoers (Begby et al (2006b), Page 290).However, as mentioned above civilian cannot be harmed, showing combatants as the only legitimate targets, another condition of jus in bello, as ‘we may not use the sword against those who have not harmed us (Begby et al (2006b), Page 314).’ In addition, Frowe suggested combatants must be identified as combatants, to avoid the presence of guerrilla warfare which can end up in a higher death count, for example, the Vietnam War. Moreover, he argued they must be part of the army, bear arms and apply to the rules of jus in bello. (Frowe (2011), Page 101-3). This suggests Frowe seeks a fair, just war between two participants avoiding non-combatant deaths, but wouldn’t this lead to higher death rate for combatants, as both sides have relatively equal chance to win since both use similar tactics? Nevertheless, arguably Frowe will argue that combatant can lawfully kill each other, showing this is just, which is also supported by Vittola, who states: ‘it is lawful to draw the sword and use it against malefactors (Begby et al (2006b), Page 309).’