Main Discussion Post

The psychiatric interview is an interaction between a mental health practitioner and a patient to evaluate the patient’s mental health condition and establish a diagnosis. The psychiatric interview consists of three crucial elements: the patient’s medical history, mental status examination, and clinical judgment.

The patient’s history encompasses details regarding the patient’s present symptoms, medical background, familial background, and social background. This information is crucial for excluding physical etiologies of the patient’s symptoms and comprehending the patient’s psychiatric medical background.

The mental status assessment evaluates the patient’s present cognitive and emotional condition. The mental status evaluation is a concise and objective assessment of cognitive functioning in adults. The tool can be utilized to assess cognitive impairment, gauge the extent of cognitive impairment at a specific moment, track cognitive changes in an individual over time, and record an individual’s reaction to treatment.

This encompasses evaluations of the patient’s physical appearance, demeanor, conduct, level of awareness, emotional state, expression, cognitive functioning, pattern of thinking, substance of thoughts, and any abnormalities in perception. This information is crucial for assessing the intensity of the patient’s symptoms and establishing a diagnosis.

Clinical judgment refers to the capacity of mental health professionals to diagnose a patient’s condition by analyzing the information obtained during the psychiatric interview. This encompasses considering the patient’s medical background, thoroughly assessing their mental state, and drawing upon the clinician’s expertise and practical knowledge. Clinical judgment is crucial for achieving a precise diagnosis and choosing the optimal treatment plan for the patient.

Evaluation of the Global Assessment Functioning Scale’s Psychometric Properties

Lester Luborsky established the Health-Sickness Rating Scale (HSRS) over 50 years ago, the first standardized instrument to evaluate patients’ total mental health. Subsequently, Endicott and his colleagues altered the first tool, creating the Global Assessment Scale (GAS). Both HSRS and GAS are uni-dimensional rating scales with a range of 100 points. They measure overall functioning and assess individuals on a scale from 1 (representing the most severely ill) to 100 (representing the healthiest possible human).

In the DSM-III, the third edition of the Diagnostic and Statistical Manual of Mental Disorders, axis V was added to assess “adaptive functioning.” This assessment is rated on a scale of 7 points, ranging from superior to seriously disabled. In DSM-III-R, the Global Assessment of Functioning (GAF) replaced axis V to evaluate psychological, social, and vocational functioning based on observations.

The GAF scale was derived from the GAS, but the top range was excluded, 91 to 100. In the DSM-IV, the GAF scale was expanded to include a 100-point scale, as the American Psychiatric Association stated. The American Psychiatric Association introduced the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. In this iteration, the axis system was eliminated, and GAF is no longer a constituent of the DSM classification system [Reference American Psychiatric Association].

The purpose of the GAF is to serve as a comprehensive assessment of the total functional impairment resulting from mental variables. The primary purpose of this tool is to convey the degree of seriousness and functional limitation, signify the necessity for expert assistance, and demonstrate progress or alteration over some time. This metric is non-specific and does not pertain to any particular condition.

The Global Assessment of Functioning (GAF) is a valuable tool that complements categorical diagnostic categories by indicating the severity level of a condition. The widespread and long-standing usage of this measure further underscores its significance.

The Global Assessment of Functioning (GAF) assesses the influence of symptoms on an individual’s daily life to quantify their psychological, social, and vocational performance. A Global Assessment Functioning, on a scale ranging from 0 to 100, quantifies the extent to which an individual’s current symptoms affect their social, occupational, and psychological performance. A higher score on the criteria used for evaluation shows superior performance in daily activities.

The data for calculating GAF ratings is derived from diverse sources, encompassing primary and secondary sources, questionnaires, medical and legal records, and client interviews. A higher score on a scale ranging from 0 to 100 signifies that the client can handle activities of daily living (ADLs). Medical expertise is restricted to mental, social, and occupational well-being matters.

The ratings reflect the overall level of functioning, with ten categories indicating different levels of symptom intensity and functionality. A rating of 1 indicates the most severe and long-lasting symptoms and functional impairment. In contrast, a rating of zero means that there is not enough information about the period being assessed.

                                                        References

Global Assessment of Functioning. (2020, June 1). Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/global-assessment-functioningLinks to an external site.

Mini-Mental State Examination | MMSE. (n.d.). https://www.parinc.com/Products/Pkey/237

Pedersen, G., Urnes, Ø., Hummelen, B., Wilberg, T., & Kvarstein, E. (2018). Revised manual for the Global Assessment of Functioning scale. European Psychiatry, 51, 16–19. https://doi.org/10.1016/j.eurpsy.2017.12.028