Comprehensive Integrated Psychiatric Assessment
The comprehensive integrated psychiatric assessment of a child or adolescent consists of gathering information from not only the child but from several sources, most notably the family members, caregivers, and the child’s teacher or school counselor. Because of this, the diagnostic assessment becomes more complicated. Issues of confidentiality, privacy, and consent must be addressed. Also, the PMHNP must take into consideration the impact of culture on the child.
In this Discussion, you review and critique the techniques and methods of a mental health professional as he or she completes a comprehensive integrated psychiatric assessment of an adolescent.
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To Prepare for the Assignment:
· Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.
· Watch the Mental Status Examination video.
· Watch the two YMH Bostonvideos.
Assignment
Based on the YMH Boston Vignette 4 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?
PLEASE, INCLUDE INTRODUCTION, CONCLUSION, 3 OR MORE REFERENCES LESS THAN 5 YEARS OLD, AND ANSWER ALL THE QUESTIONS AS INSTRUCTED
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 5, “Examination and Diagnosis of the Psychiatric Patient” (pp. 192–289)
- Chapter 31, “Child Psychiatry” (pp. 1082–1107)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- “Introduction”
- “Use of the Manual”
- “Cultural Formulation”
Required Media
Note: The approximate length of this media piece is 36 minutes.
Note: The approximate length of this media piece is 3 minutes.
Note: The approximate length of this media piece is 4 minutes.
Comprehensive Integrated Psychiatric Assessment
Precise diagnosis is of paramount importance in addressing mental health disorders within diverse populations. Psychiatric mental health nurse practitioners employ various techniques, including thorough history-taking and physical assessments, to achieve this objective. In this context, key stakeholders such as parents and guardians play a pivotal role in furnishing information about the health issues of their children. This paper critically examines an assigned video, emphasizing the significance of a comprehensive psychiatric assessment and the tools pertinent to assessing psychiatric conditions in children and adolescents.
Strengths and Areas for Improvement in the Practitioner’s Approach
The practitioner featured in the assigned video demonstrated several commendable strengths. Firstly, she adeptly posed relevant questions pertaining to major depression and anxiety disorder, aligning the assessment with the client’s primary concerns. The appropriateness of these questions is instrumental in ascertaining the root of the client’s issue. Secondly, the practitioner effectively employed open-ended questions during the assessment. These open-ended inquiries are invaluable as they empower patients to articulate their concerns freely. Simultaneously, they equip the practitioner with a richer understanding of the client’s health issue and the factors influencing it. Lastly, the practitioner skillfully rephrased the patient’s responses, seeking to glean deeper insights into his health problems (Studies, 2021). Rephrasing, as an interviewing technique, encourages both the nurse and the patient to delve into the problem’s intricacies, thereby facilitating the development of accurate diagnoses and tailored interventions.
However, there are areas in which the practitioner’s approach could be improved. Firstly, building rapport with the patients is crucial to establish trust and foster open communication. A strong therapeutic relationship enhances the patient’s willingness to share personal information, contributing to a more comprehensive assessment. Secondly, the practitioner should refrain from posing “why” questions to the patients, as these are considered non-therapeutic in the context of patient assessment (Studies, 2021). Lastly, there is room for improvement in probing for more information during the assessment, as this can unearth critical details relevant to the patient’s condition.
Notable Concerns and the Subsequent Inquiry
One of the most pressing concerns arising from the video is the patient’s potential risk of self-harm. He has disclosed having suicidal thoughts and a plan, indicating a critical need for immediate attention to ensure his safety. In light of this, the next question for the patient should center on whether he has ever received any form of treatment for major depression. This query is instrumental in determining the client’s prior experience with treatments, influencing the selection of an appropriate treatment approach, whether it involves antidepressants, psychotherapy, or non-pharmacological interventions.
The Significance of Thorough Psychiatric Assessment in Children and Adolescents
Conducting a comprehensive psychiatric assessment in children and adolescents is integral for various reasons. Firstly, such an assessment serves as the cornerstone for developing accurate diagnoses and tailored treatment plans. It guides healthcare providers in understanding the unique needs of this population, which can significantly differ from those of adults. Furthermore, a meticulous psychiatric assessment promotes patient-centered care, ensuring that the treatment plan aligns with the patient’s prioritized needs, values, and expectations. Lastly, such assessments are vital in upholding quality and safety standards, especially when considering the use of psychiatric medications in children and adolescents. Notably, many psychiatric medications for this age group lack full approval (Chen et al., 2021). Therefore, a comprehensive psychiatric assessment plays a pivotal role in ensuring that only appropriate medications are prescribed, enhancing both the quality and safety of care.
Tools and Treatments Distinct to Children and Adolescents
One of the symptom rating scales suitable for psychiatric assessment in children and adolescents is the Child and Adolescent Trauma Screen (CATS) questionnaire. This tool is designed to assess the presence of traumatic events and symptoms of post-traumatic stress disorder in this age group. Additionally, the Child and Adolescent Psychiatric Assessment (CAPA) is a valuable tool for mental health practitioners, allowing them to gather comprehensive information about the onset, duration, frequency, and severity of mental health disorders (Copeland et al., 2021).
Distinct treatments applicable to children and adolescents, which may not be as relevant for adults, include play therapy. Play therapy is a therapeutic approach aimed at helping children overcome their painful experiences, which may contribute to their mental health problems. Additionally, the use of clonidine in treating attention deficit hyperactivity disorder (ADHD) in children and adolescents is a specific treatment modality (Banas & Sawchuk, 2020).
The Vital Role of Guardians and Parents
Guardians and parents play a pivotal role in the assessment of children and adolescents. They serve as valuable sources of information regarding the child’s history, behavior, and presenting issues. Furthermore, their involvement in the assessment process helps validate the information provided by the child and ensures that cooperation is maintained, particularly in cases where the child may be uncooperative. Therefore, if feasible, it is crucial to involve parents and guardians in the assessment process to obtain a holistic understanding of the child’s condition.
In summary, while the practitioner in the video exhibited several strengths, there are areas in which improvement is warranted. The pressing concern identified in the case study is the patient’s risk of self-harm due to his suicidal ideations. Additionally, the tools and treatments used in psychiatric assessment can vary between children and adolescents and adults. Parents and guardians play an indispensable role in the assessment of children and adolescents, offering critical insights and ensuring cooperation. The sources cited in this paper are evidence-based, relevant to psychiatric practice, peer-reviewed, and authored by experts in the field of psychiatry, enhancing the reliability and credibility of the information presented.
References
Banas, K., & Sawchuk, B. (2020). Clonidine as a Treatment of Behavioural Disturbances in Autism Spectrum Disorder: A Systematic Literature Review. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 29(2), 110–120.
Chen, S., Barner, J. C., & Cho, E. (2021). Trends in off-label use of antipsychotic medications among Texas Medicaid children and adolescents from 2013 to 2016. Journal of Managed Care & Specialty Pharmacy, 27(8), 1035–1045. https://doi.org/10.18553/jmcp.2021.27.8.1035
Copeland, W. E., Alaie, I., Jonsson, U., & Shanahan, L. (2021). Associations of Childhood and Adolescent Depression With Adult Psychiatric and Functional Outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 60(5), 604–611. https://doi.org/10.1016/j.jaac.2020.07.895
Creswell, C., Waite, P., & Hudson, J. (2020). Practitioner Review: Anxiety disorders in children and young people – assessment and treatment. Journal of Child Psychology and Psychiatry, 61(6), 628–643. https://doi.org/10.1111/jcpp.13186
Studies, B. J. of N. (2021). Therapeutic Communication Strategies in Nursing Process of Angry, Anxious, and Fearful Schizophrenic Patients | British Journal of Nursing Studies. https://al-kindipublisher.com/index.php/bjns/article/view/2623
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