The first component, and arguably the most important, is the history of present illness (HPI). This section discusses, chronologically, the events and the symptoms that lead the client to seek treatment. It also covers other changes that may impact these symptoms, such as interpersonal relationships, personal habits, physical health, and behaviors (Sadock, Sadock, and Ruiz, 2017). Because this part of the interview sets the tone for the remainder of the visit, and also allows for the collection of data relating to the client’s primary concerns, it is critical for a proper diagnosis and treatment plan Hamilton Anxiety Rating Scale (HAM-A).
The second component this post will discuss is the past psychiatric history (PH). This piece allows the provider to obtain relevant data related to the client’s psychiatric illnesses, including symptoms and treatment over the course of their lifetime (Sadock, Sadock, and Ruiz, 2017). These elements are important, as they help to create a complete picture of the mental illness that the client is seeking help for.
The third component is the family history. Hamilton Anxiety Rating Scale (HAM-A) This part of the interview covers mental health diagnoses, substance use issues, and suicidal or violent behaviors in biological relatives (American Psychiatric Association, 2016). This information is important, as genetic links have been found to influence the development of psychiatric illness in individuals.
In addition to the psychiatric interview, clinicians often use rating scales to get a clearer picture of the symptoms that clients report, such as severity, triggers, and other variables. For anxiety, the Hamilton Anxiety Rating Scale (HAM-A) is often utilized by practitioners. This scale discusses fourteen symptoms of anxiety, ranging from anxious mood to autonomic symptoms, and asks the client to rate them from 0, or not present, to 4, or very severe (Hamilton, 1959). It would be appropriate to use this scale during the history of present illness portion of the psychiatric interview (American Psychiatric Association, 2016). Utilizing the HAM-A at this point of the interview allows the PMHNP to determine if the described symptoms do support the diagnosis of anxiety and to what severity.
In conclusion, the psychiatric interview is crucial to the assessment, diagnosis, treatment planning, and evaluation of clients with mental health issues. Each section allows the collection of critical data for the PMHNP to utilize. In addition, clinical rating scales add to this information and allow for an objective piece of data to support the subjective data collected during the interview. When taken together, the big picture of a client’s concerns can be formulated and needs addressed. Hamilton Anxiety Rating Scale (HAM-A)
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
Hamilton, M. (1959). Hamilton anxiety rating scale (HAM-A). Br J Med Psychol 1959; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed.). pp. 9–15. Wolters Kluwer.
Thank you for an informative and interesting post on the Hamilton Anxiety Scale (HAM-A). This tool is a widely used interview scale that measures the severity of a patient’s anxiety. The scale predates the current definition of generalized anxiety disorder (GAD). However, it covers many of the features of GAD and can be helpful also in assessing its severity (Porter et al., 2017). The major value of the HAM-A is to document results of the psychotherapy, rather than as a diagnostic or screening tool. It takes roughly 15 minutes to complete the interview and scoring. Each item is given a 5 point score, 0 (not present) to 4 (severe). The questionnaire consist of a total of 14 questions (Porter et al., 2017). The scale has demonstrated high levels of accuracy and validity, and the results give important clues to possible mental disorders that warrant follow-up by a health care provider (Porter et al., 2017).
The assessment tool I chose was the CAGE Questionnaire. This test is widely used and measures the possibility of alcohol dependency. The test is composed of a total of 4 yes or no questions. Each question answered yes increases the chances of alcohol dependency. Answering with 2-3 yes responses often indicates alcohol abuse or dependency (Bush et al., 2016). The CAGE questionnaire aims to evaluate the current state of an individual rather than long-term (Bush et al., 2016). The questionnaire is reported to accurately identify people with alcohol dependency 93 percent of the time (Bush et al., 2016). This makes the questionnaire relatively accurate, and a quick way to screen people for alcohol dependency.
Bush, B., Shaw, S., Cleary, P., Delbanco, T. L., & Aronson, M. D. (2016). Screening for alcohol abuse using the cage questionnaire. The
American Journal of Medicine, 82(2), 231–235. https://doi.org/10.1016/0002-9343(87)90061-1
Porter, E., Chambless, D. L., McCarthy, K. S., DeRubeis, R. J., Sharpless, B. A., Barrett, M. S., Milrod, B., Hollon, S. D., &
Barber, J. P. (2017). Psychometric properties of the reconstructed hamilton depression and anxiety scales. The
Journal of Nervous and Mental Disease, 205(8), 656–664. https://doi.org/10.1097/nmd.0000000000000666