ASSESSMENT/ASSESSMENT TOOLSWhen Assessing symptoms, theDiagnostic and Statistical Manual (DSM) and the International StatisticalClassification of Diseases (ICD) is the general classification used by theworld to record the diagnosis of all mental health patients.
These tools are stated to have similarattributes; however, ICD is seen as more comprehensive whilst DSM add anadvantage to research and is seen as more accurate in psychiatry. Additionally,DSM is also favoured by clinicians than ICD (Tyrer, 2014).When measuring AB’s symptoms an assessment commencedby two Doctors and two Approved Mental Health Professional (AMHP).
The role ofthe AMHP is to make legal decisions by coordinating an assessment on a personthat is detained under a section of the Mental Health Act. The professionalwill make their decisions based on whether a person’s mental state hasdeteriorated and if they could pose a potential risk to themselves or others. Theservice user will be interviewed and they will either be offered inpatient careand put on admission under section 2 or 3. Furthermore, before making theirdecisions, they need to ensure that the person has insight on their rights, aswell as having access to an advocate (Mental Health Act, 2007). Due to AB’spast engagement with the Mental Health services and his current mental state,it is essential to assess him in relation to his past diagnosis and otherrelated symptoms he may be presenting when he arrived on the ward. By doing this,Positive and Negative Syndrome Scale (PANSS) was applied as seen in Appendix B.Deep et al (2010) stated that it is a clinical interview that is widely usedfor service users with Schizophrenia. Kay et al (1989) also suggested that PANSS wascreated so as to deliver a distinct tool which will be used specifically toassess the positive and negative symptoms of schizophrenia and psychopathology.
The assessment commenced with the Dr’s undergoing a 30-item rating scale, whichis narrowed down into 7 scales which measured positive and 7 scales fornegative syndromes whilst 16 scales are used to measure psychopathologysymptoms. The positive syndrome looked at features such as delusions,excitement hallucinations, whilst the negative features focused on emotionaland social withdrawal as well as poor rapport.Additionally, the tool also assessed the generalpsychopathology of the patient by looking at depression and anxiety as well ascognitive features. By the end of the assessment, the result showed that therewere times when AB showcase delusions, hallucination and excitement, which wasobserved as Positive syndromes. However, the majority of the time he wasobserved to have withdrawal syndromes.
He also had difficulty with focusing andappeared low in mood at times which is a negative syndrome. AB appeared not tohave insight into his current mental health deterioration and was unable toweigh the risks he poses to self and others when not treated, therefore,continuous medical treatment in hospital was considered and he was placed undersection, for he has not been compliant with medication and has resulted in himpresenting with distressing psychotic symptoms. When unwell he also tends toneglect his self-care, and presents risks of self-harm and also to others.Furthermore, he lacks concentration and gets easily distracted at times. He wasalso seen to be paranoid and anxious at times during the assessment process.
When questioned about any suicidal thoughts. ABavoided the question as much as possible by engaging in another activityentirely, however when pushed further he possessed passive aggression and builtup a barrier. When using PANSS there are some limitations that are likely tomake the score not clear as kay et al (1989) has stated previously in theirstudies. This is because, during the assessment, the tool can be seen as quite extensivehence why the calculation might be incorrect at times. A study by Kumari & Malik (2017) shows thatthere are doubts about the use of PANSS because it is believed that PANSS lackssensitivity when foreseeing cognitive functioning. Furthermore, the studyreveals that the scale fails to distinguish the difference between depressionand negative symptoms when measuring depression. This is a major problem as itcan result in an inappropriate diagnosis. On the other hand, they also arguedthat if the scales are minimised it can result in getting incomplete data andthe results will not be reliable.
Another toolthat could have been considered during the assessment is the Alcohol andsubstance misuse tool. This is because in AB’s case study it showed that he wasalso dealing with substance abuse. According to Rassool (2009) service usersthat deal with polysubstance misuse, require a full assessment, so as to createan effective treatment plan. Additionally, the assessment will focus on theIndividuals view on their substance abuse, the type of drugs that they use andthe quantity of dosage. Finally, it will look at the pattern as to which thepatient uses the drugs and how dependent they are on the substance. The toolcould potentially be looking at the possibilities that they might be dealingwith substance induce psychosis. However, studies have shown that when doing anassessment on those dealing with substance abuse and mental health disorders,it is very hard to get a valid result, because substance misusers can maskmental health symptoms.
Or misinterpret the diagnosis. Additionally, the inabilityto differentiate the substance from the mental health disorder can addcomplications to the assessment of the individual (Rassool, 2009).