NRNP 6665 Discussion: Comprehensive Integrated Psychiatric Assessment
Discussion: Comprehensive Integrated Psychiatric Assessment
Assessment of children and adolescents, like adults, share some similarities, but overall will be somewhat different. The classical approach to making a comprehensive psychiatric evaluation will be age-dependent when it comes to younger age groups. Furthermore, the difficulty is enhanced when you take into consideration the contextual complexities including culture and environment. Therefore, with regard to the vignette 5 video, this post will attempt to highlight some of these aspects of a comprehensive integrated psychiatric assessment.
What The Practitioner Did Well
The practitioner is using nonverbal cues such as nodding and making eye contact with the patient at good measure. These are desirable traits for a psychiatric interview. Additionally, she practices active listening. This is seen when she gives a summary of the pertinent findings from the patient history back to the patient to help them both in breaking down the situation.
What The Practitioner Can Improve Upon
The provider starts off with the wrong line of questioning when you consider the patient’s age and gender. Males have been considered to be more likely to relate to questions concerning rage and irritability as opposed to sadness and hopelessness as symptomatic of depression. In addition, the interview could benefit from better rapport cultivated by the provider as this does not seem to be the case with the patient on close observation.
Compelling Concerns and The Next Question
Suicidality and the risk of self-harm appear to be the most compelling issues in the patient with a background of anxiety and depressive symptomatology. The next question to be asked would therefore assess the risk of follow-through. It would be pertinent to know if there have been any suicide attempts and if so, how many. This is extremely helpful in determining an appropriate management plan (Oquendo & Bernanke, 2017).
Why A Thorough Psychiatric Assessment of a Child/Adolescent Is Important
A thorough psychiatric assessment of a child is important because most of the time children do not have insight into their issues. It may be required that the health care provider dig a little deeper to bring these issues to the forefront. Moreover, children and adolescents suffer many mental conditions that may not be present in adults.
Symptom Rating Scales That Would Be Appropriate to Use During the Psychiatric Assessment of A Child/Adolescent
Two appropriate symptom rating scales include The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) scales. As part of the Achenbach System of Empirically Based Assessment, these tools provide assistance in the quantification and qualification of many mental health conditions of childhood that are represented in the DSM V. Consequently, these scales provide useful information to the clinical assessment of children and adolescents (Sisteré et al., 2014).
Psychiatric Treatment Options for Children and Adolescents That May Not Be Used When Treating Adults
Children and adolescents may benefit from relationship-based therapies such as parenting interventions and attachment-orientated interventions. These types of interventions depend on their developmental stage and the level of maturity attained at that time of the illness. For instance, attachment interventions will involve enhancing parental sensitivity to the child’s emotions and behavior whereas parental interventions aim to change parental practices that may be harmful (Macdonald et al., 2016).
The Role Parents/Guardians Play in Assessment
parents can provide insight into the child’s or adolescent’s current problem. They can also be a guide in enhancing the efficacy and communication during the evaluation interview. Parental participation in the process also creates an environment where the child feels safe and protected making them amenable to getting the help they need (Haine-Schlagel & Walsh, 2015).
Haine-Schlagel, R., & Walsh, N. E. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child and Family Psychology Review, 18(2), 133–150. https://doi.org/10.1007/s10567-015-0182-x
Macdonald, G., Livingstone, N., Hanratty, J., McCartan, C., Cotmore, R., Cary, M., Glaser, D., Byford, S., Welton, N. J., Bosqui, T., Bowes, L., Audrey, S., Mezey, G., Fisher, H. L., Riches, W., & Churchill, R. (2016). Types of interventions. In The effectiveness, acceptability, and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: An evidence synthesis. NIHR Journals Library. https://www.ncbi.nlm.nih.gov/books/NBK385382/
Oquendo, M. A., & Bernanke, J. A. (2017). Suicide risk assessment: Tools and challenges. World Psychiatry, 16(1), 28–29. https://doi.org/10.1002/wps.20396
Sisteré, M., Massons, J., Granero, R., & Ascaso, L. (2014). Validity of the DSM-Oriented Scales of the Child Behavior Checklist and Youth Self-Report. Psicothema, 26, 364–371. https://doi.org/10.7334/psicothema2013.342
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Response to my colleague NO 2-Discussion Post
Hello Bridgette. I find your discussion quite engaging with adequate incorporation of information from different literature covering the question at hand. Concerning the provided video, you have mentioned the use of non-verbal cues and active listening tactics, which are effective communication strategies that must be adopted by all practitioners to promote the patient’s interest and engagement during the psychiatric interview. However, I disagree with the notion that the provider would have used a gender-specific approach to engage the male client (Rafferty et al., 2018). I believe that she did an excellent job giving the client clues of what she wanted to know. However, she should have given the client more time to further explain how he was feeling based on his terms, rather than the practitioner’s terms (Tillmann et al., 2018). Following up with questions relating to suicide and self-harm is however necessary just like you have pointed out.
Conducting a thorough psychiatric examination is crucial among children given their increased interaction with numerous triggers to psychiatric complications. You have accurately identified and elaborated the two main symptoms rating scales for children and adolescents such as the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) scales. An additional scale would be the Conners’ Rating Scales-Revised (CRS-R), which is effective in rating behavioral symptoms displayed by children (Guerrera et al., 2019). Furthermore, I do not think relationship-based therapies are specific for children. Studies show that adults can also benefit from this kind of therapy. You should have explored children-specific therapeutic interventions such as play therapy which help equip young people with resilient and coping skills to promote their mental health (Guerrera et al., 2019). It is however true that parents and guardians play a significant role in providing more insight regarding the health problems their children are suffering from.
Guerrera, S., Menghini, D., Napoli, E., Di Vara, S., Valeri, G., & Vicari, S. (2019). Assessment of psychopathological comorbidities in children and adolescents with autism spectrum disorder using the child behavior checklist. Frontiers in psychiatry, 10, 535.https://doi.org/10.3389/fpsyt.2019.00535
Rafferty, J., Yogman, M., Baum, R., Gambon, T. B., Lavin, A., Mattson, G., … & Committee on Psychosocial Aspects of Child and Family Health. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142(4).https://doi.org/10.1542/peds.2018-2162
Tillmann, S., Tobin, D., Avison, W., & Gilliland, J. (2018). Mental health benefits of interactions with nature in children and teenagers: A systematic review. J Epidemiol Community Health, 72(10), 958-966.http://dx.doi.org/10.1136/jech-2018-210436