NRNP 6665 Discussion WEEK 1: Comprehensive Integrated Psychiatric Assessment

NRNP 6665 Discussion WEEK 1: Comprehensive Integrated Psychiatric Assessment

 

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.

To Prepare
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.
By Day 3 of Week 1
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.

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Solution

NRNP 6665

Discussion WEEK 1: Comprehensive Integrated Psychiatric Assessment

A comprehensive psychiatric assessment comprises medical and psychiatric history, neurological examination, mental status exam, and educational and developmental growth assessment. The YMH Boston Vignette 5 video is about Tony, who was referred to a social worker by his primary care provider after presenting with symptoms of anxiety and depression.  This will analyze the patient’s interview assessment and discuss the psychiatric assessment of a child and adolescent.

What the Practitioner Did Well

The examiner asked the client about his mood, which is essential in evaluating mood disorders and determining if the patient has anxiety or depressive disorder. The practitioner encouraged the client to talk more about his mood after stating that he gets angry and feels like he wants to fight. The practitioner also did well by asking the client about his school performance since school performance is significantly affected by anxiety and depressive disorders (Mullen, 2018). The practitioner also inquired whether the client uses alcohol or drugs, which is crucial since most adolescents with anxiety or depressive disorders tend to abuse alcohol and drug substances (Mullen, 2018). Lastly, the practitioner did well by summarizing the patient’s problems identified during the assessment, which allowed the client to add more symptoms.

Areas the Practitioner Can Improve

The practitioner should first create a rapport with the patient by greeting them and introducing herself to the client (Bhide & Chakraborty, 2020). The practitioner should also have assured the client that the information given will be confidential to increase the client’s trust in the practitioner.

Compelling Concerns

The client mentioned that he gets angry and feels like he wants to fight. My compelling concern is whether the client has undergone anger management therapy. In addition, the patient stated that he had thoughts about harming himself and sometimes did not feel like he wanted to be alive. My concern is whether the patient has any solid plans to hurt himself and whether he has previously tried to harm himself or others.

Next Question and Why

The next question would be: Have you had thoughts of hurting your ex-girlfriend? I would ask this question to assess whether the client is a danger to others (Mullen, 2018). Since the patient’s distress began after breaking up with his girlfriend, it would be important to know his feelings towards her and assess the risk of harm.

Why a Thorough Psychiatric Assessment of a Child/Adolescent Is Important

A detailed psychiatric assessment in a child/adolescent is essential to identify emotional and behavioral problems that often go unnoticed in this population. A psychiatric assessment helps to identify developmental delays in children as well as deficits in social skills and speech (Srinath et al., 2019). Furthermore, a thorough psychiatric assessment helps the child/adolescent better understand their difficulties and offers them an opportunity to think about the information they share.

Symptom Rating Scales Appropriate in a Child/Adolescent

Symptom rating scales appropriate for a psychiatric evaluation of a child or an adolescent include the Child and Adolescent Symptom Inventory-4R (CASI-4R) and the Pediatric Symptom Checklist (PSC).  CASI-4R rates affective and behavioral features. It is used in assessing mood disorders in the pediatric population, specifically depressive and dysthymia symptoms. Other psychiatric disorders assessed by CASI-4R include generalized anxiety disorder, bipolar disorder, ODD, ADHD, conduct disorder, schizophrenia, separation anxiety disorder, social phobia, autism, anorexia, and bulimia nervosa (Salcedo et al., 2018). The PSC is a psychosocial screen developed to help identify cognitive, behavioral, and emotional problems in the pediatric population so that proper interventions can be initiated promptly (Murphy et al., 2016). It has two versions: the parent-completed version and the youth self-report(Y-PSC) for adolescents aged 11 years and above.

Psychiatric Treatment Options for Children/Adolescents

Psychiatric treatment modalities used only in children and adolescent patients include Play Therapy and parent-child interaction therapy. Play Therapy entails using toys, dolls, blocks, games, and drawings to help a child recognize, identify, and express feelings (Bhide & Chakraborty, 2020). A combination of talk and play gives the child an opportunity to better recognize and manage their feelings, behavior, and conflicts. Parent-child interaction therapy is used in parents and children struggling with behavior problems or connection using physical coaching sessions. Parents interact with their children, while the therapist guides the family toward positive interactions.

The Role Parents/Guardians Play In Assessment

           The parents’ role in assessment is to provide detailed information about the child’s symptoms. A child may give their symptoms but may not remember details, such as duration and the order the symptoms occurred. Obtaining information from the parents helps to minimize discrepancies in the patient’s history, thus facilitating diagnosis and management (Bhide & Chakraborty, 2020). In addition, parents are valuable agents in carrying out therapeutic principles for a child or adolescent behavioral problems in the home setting, such as positive and negative reinforcement, activity scheduling, and time management.

Conclusion

A thorough psychiatric assessment is important in the pediatric population to identify emotional and behavioral problems and speech and social skills deficits. The CASI-4R and PSC are suitable rating scales for affective, cognitive, behavioral, and emotional problems in the pediatric population. Treatment modalities exclusive to the population include play therapy and parent-child interaction therapy.

References

Bhide, A., & Chakraborty, K. (2020). General Principles for Psychotherapeutic Interventions in Children and Adolescents. Indian journal of psychiatry62(Suppl 2), S299–S318. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_811_19

Mullen, S. (2018). Major depressive disorder in children and adolescents. The mental health clinician8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

Murphy, J. M., Bergmann, P., Chiang, C., Sturner, R., Howard, B., Abel, M. R., & Jellinek, M. (2016). The PSC-17: Subscale Scores, Reliability, and Factor Structure in a New National Sample. Pediatrics138(3), e20160038. https://doi.org/10.1542/peds.2016-0038

Salcedo, S., Chen, Y. L., Youngstrom, E. A., Fristad, M. A., Gadow, K. D., Horwitz, S. M., … & Findling, R. L. (2018). Diagnostic efficiency of the Child and Adolescent Symptom Inventory (CASI-4R) depression subscale for identifying youth mood disorders. Journal of Clinical Child & Adolescent Psychology47(5), 832-846. https://doi.org/10.1080/15374416.2017.1280807

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for Assessment of Children and Adolescents. Indian journal of psychiatry61(Suppl 2), 158–175. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18

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