Comprehensive Integrated Psychiatric Assessment Paper
What the Practitioner Did Well
The practitioner did extremely well in creating a rapport with the patient. She was able to maintain eye contact with the patient throughout the clinical assessment. She also listened keenly without unnecessary interruptions to the patient. The practitioner, however, did not introduce herself to the patient nor did she give them a chance to the patient to identify himself. She should also assure the patient that whatever information is disclosed during the clinical interview is private and confidential to earn the patient’s trust.
The compelling concern at this point of the clinical assessment is the fact that the patient admits to thoughts of self-harm. This began after relationship trouble when his girlfriend broke up with him. This revelation is crucial since the patient might be at risk of taking his own life by committing suicide. He should thus be assessed for suicidal risk and necessary measures and interventions taken to ensure his safety.
The Next Question and Why
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The next question that the patient should be asked is whether he has a solid plan on how he plans to harm himself. This will bring out his suicidal ideations and thoughts as well as the level of risk. Any prior attempt of self-harm or intended harm to others should also be enquired about. The level of support from his family and loved ones will be critical at this point thus the need for their involvement in his therapy.
Importance of Psychiatric Assessment of a Child/Adolescent
A thorough evidence-based psychiatric assessment of children and adolescents is an important skill in the nursing profession. Information obtained ascertains the presence of any psychiatric illness as well as guide the decisions on management plan (Sharma et al., 2019). In addition to aiding in the formulation of an accurate diagnosis, a comprehensive integrated assessment can give meaningful insights into the prognosis, expected progress, management planning, and monitoring (Danielson et al.,2019). The predisposing, precipitating, and maintenance factors can also be identified and appropriate treatment is given including alternate treatment in case of prior treatment failure. Psychiatric assessments also facilitate psychoeducation of the patients and their families on their mental disorders.
Appropriate Symptom Rating Scales
Various symptom rating scales have been used in the psychiatric assessment of children and adolescents. Two such appropriate scales are the children’s depression inventory (CDI) and the child behavior checklist (CBCL). The children’s depression inventory assesses the presence and severity of depressive symptoms. The child behavior checklist, on the other hand, screens for and identifies any emotional or behavioral problems.
Psychiatric Treatment Options for Children and Adolescents
Early diagnosis and treatment of mental disorders improve the course, outcome, and overall prognosis. Generally, psychotherapy is preferred to pharmacotherapy and most interventions are similar to those of adult patients. The available psychotherapeutic option for this patient population includes cognitive behavioral therapy, parent-child interactions, play therapy, and dialectical behavior therapy among others (Bhide et al., 2020). Dialectical behavior therapy is particularly effective in reducing suicide risk among adolescents and in managing personality disorders (McCauley et al., 2022). Play therapy is also important in psychiatric assessment, especially in young children who may find it hard to give a verbal account of their situation.
Role of Parents/ Guardians in Psychiatric Assessment
Parents and guardians are a pivotal part of the psychiatric assessment of children and adolescents thus the need for effective collaboration. This is because evaluation, assessment, and psychiatric management are commonly offered in the context of their caregiving environment (Sharma et al., 2019). Caregivers play the role of recognizing psychiatric problems, decision to seek consultation, giving consent for psychiatric evaluation, and choice of treatment intervention (Villatoro et al., 2018). Children and adolescents may have less insight into their condition hence parents and guardians can give corroborative and additional information such as chronology and premorbid personality.
Bhide, A., & Chakraborty, K. (2020). General Principles for Psychotherapeutic Interventions in Children and Adolescents. Indian journal of psychiatry, 62(Suppl 2), S299–S318. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_811_19
Danielson, M., Månsdotter, A., Fransson, E., Dalsgaard, S., & Larsson, J. (2019). Clinicians’ attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry. Child And Adolescent Psychiatry And Mental Health, 13(1). https://doi.org/10.1186/s13034-019-0269-0
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., Avina, C., Hughes, J., Harned, M., Gallop, R., & Linehan, M. M. (2018). Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry, 75(8), 777–785. https://doi.org/10.1001/jamapsychiatry.2018.1109
Sharma, E., Srinath, S., Jacob, P., & Gautam, A. (2019). Clinical practice guidelines for the assessment of children and adolescents. Indian Journal Of Psychiatry, 61(8), 158. https://doi.org/10.4103/psychiatry.indianjpsychiatry_580_18
Villatoro, A., DuPont-Reyes, M., Phelan, J., Painter, K., & Link, B. (2018). Parental recognition of preadolescent mental health problems: Does stigma matter? Social Science &Amp; Medicine, 216, 88-96. https://doi.org/10.1016/j.socscimed.2018.09.040
Week 1 discussion
Discussion: Comprehensive Integrated Psychiatric Assessment
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Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.
Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.
In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.
• Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos.
• Watch the YMH Boston Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.
Based on the YMH Boston Vignette 5 video, post answers to the following questions:
• What did the practitioner do well? In what areas can the practitioner improve?
• At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
• What would be your next question, and why?
Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.
• Explain why a thorough psychiatric assessment of a child/adolescent is important.
• Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
• Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
• Explain the role parents/guardians play in assessment.
Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
Watch Examination B-6 and Simulation Scenario-Adolescent Risk Assessment videos
Watch the YMH Boston Vignette 5 video