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Based on the YMH Boston Vignette 5 video, post answers to the following questions
Comprehensive Integrated Psychiatric Assessment
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 vide
o and take notes; you will use this video as the basis for your Discussion post.(LINK: https:/ /www.youtube.com/watch?v= Gm3FLGxb2ZU)
By Day 3 of Week 1
Based on the YMH Boston Vignette 5 vide
- 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
Expert Answer and Explanation
Comprehensive Integrated Assessment
To perform psychiatric assessment, a psychiatrist asks the client a range of questions including previous suicidal thoughts, and observes the client’s behaviors in order to make a diagnosis. If the client is a child or an adolescent, the psychiatrist may have to involve the client’s parent or guardian because the former may not be comfortable to respond to some questions (Stewart & Hamza, 2017). Because effective diagnosis of the patient depends on the gathered information, psychiatric assessment should be comprehensive, and a psychiatrist should use the correct symptom rating scale.
Reflecting on the interview between the psychiatrist and the patient, it is clear that the patient comfortably answered the questions he was asked. This is what went well about the whole scenario. However, the therapist may need to improve how she communicates with the client. For example, she should express sympathy towards the client’s problem. When interviewing the patient, I would want them to explain how they spend their day, just after waking up, and before going to bed. This is necessary to understand the patient’s symptoms (Stewart & Hamza, 2017).
The Importance of Thorough Psychiatric Assessment of a Child/Adolescent
When assessing a child/adolescent, the assessment should be thorough enough so that the psychiatrist can establish the need for additional screening or the need for treatment. Such assessment is necessary because it can help the psychiatrist tell if the child has developmental issues or behaviors which can affect their lives. By thoroughly assessing a patient, a psychiatrist can understand the patient’s concerns, fears, behaviors, and symptoms, and come up with appropriate intervention methods (Stewart & Hamza, 2017).
If one does not have adequate details about a child and an adolescent, they may misdiagnose the patient, and this can have negative effect on the quality of the treatment.
Symptom Rating Scales that can be useful in Psychiatric Assessment a Child/Adolescent
The Children’s Depression Inventory (CDI) is the symptom-specific tool that is appropriate for a child or an adolescent. The tool assesses up to 17 of the patient’s depression-based symptoms including sleep, crying, sadness and anger. The CDI incorporates a score of 1 to 5 with one denoting least severe to 5 being the most severe. By assessing the child or the adolescent across the 17 items, a psychiatrist can establish if client has cognitive deficiency or if they exhibit maladaptive behavior (Brent et al. 2020).
Other than the CDI, one can use Research Units on Pediatric Anxiety Rating Scale (PARS). This particular tool has a checklist for anxiety-based symptoms (Brent et al. 2020).
Psychiatric Treatment Options for Children and Adolescents that can also be used to treat Adults
The Interpersonal Therapy (IPT) and Cognitive Behavioral Therapy (CBT) are two of the interventions that support treatment of younger patients and adults. The former involves framing the interpersonal issues, and addressing these issues. With the latter, the therapist helps train the client to identify maladaptive thoughts, and train them how to cope with negative experiences or feelings that stem from maladaptive thoughts (Zhou et al., 2017).
The Role of Parents or Guardians play in Assessment
The parents spend time with children and they can provide crucial details about the patient’s relationships, behaviors and feelings. This information can support diagnosis of the patient. They are equally responsible of making the patient comfortable during the assessment, and this makes it easy for the patients to open up and share their concerns (Zhou et al., 2017).
In conclusion, parent’s participation in patient assessment can help a therapist gather sufficient details about the patient, and administer the appropriate intervention. Some of the tools one can use to diagnose a psychiatric condition include CDI and PARS. While the former is a 17-item scale, the latter includes a checklist that helps test for anxiety.
Brent, D. A., Porta, G., Rozenman, M. S., Gonzalez, A., Schwartz, K., Lynch, F. L., Dickerson, J. F., Iyengar, S., & Weersing, V. R. (2020). Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 59(7), 856–867. Doi: https://doi.org/10.1016/j.jaac.2019.06.009.
Stewart, S. L., & Hamza, C. A. (2017). The Child and Youth Mental Health Assessment (ChYMH): An examination of the psychometric properties of an integrated assessment developed for clinically referred children and youth. BMC health services research, 17(1), 82.Doi: https://doi.org/10.1186/s12913-016-1970-9.
Zhou, S. G., Hou, Y. F., Liu, D., & Zhang, X. Y. (2017). Effect of Cognitive Behavioral Therapy Versus Interpersonal Psychotherapy in Patients with Major Depressive Disorder: A Meta-analysis of Randomized Controlled Trials. Chinese medical journal, 130(23), 2844–2851. https://doi.org/10.4103/0366-6999.219149.
Alternative Expert Answer and Explanation
Comprehensive Integrated Psychiatric Assessment
What the Partitioner Did Well
Based on the YMH Boston Vignette 5 video, there are instances when the practitioner did well, but other areas could be improved efficiently. To begin with, Tony is suspected of having symptoms of depression and anxiety and has been referred to the practitioner. When asked why he has the session, Tony responds by saying that there was sent by the doctor. The practitioner was effective in helping the client to understand the issues that he has through self-reflection.
The guiding questions were very instrumental, and Tony was able to relate to the questions as they progressed further. When Tony reiterates that he does not understand the questions posed to him, the practitioners take a more simplistic angle to help him have a clear understanding and meaning to the question before responding. Be that as it may, there are various areas of improvement, with the key being creating a conducive environment for the juvenile.
The child seems agitated and not able to freely express his feelings. The practitioner also uses difficult-to-understand phrases that the client finds difficult to comprehend. Be that as it may, the patient is also presented with a series of questions without being informed of the essence of the question and what is expected of them in the form of answers and explanations.
At this point of the interview, there are a lot of compelling concerns with the session. The client is uncomfortable and finds it difficult to answer questions without knowing what is happening. The practitioners ask questions without informing the client of the reasons for his visit and why they need to participate in the process. To get the client to communicate, she asks questions to try and figure out the present symptoms associated with depression which makes the client unfordable or feels that his issues are being discussed.
The probable next question would ask would be, “Tell me about your relationship and how it was important to you?” The question is critical since it will help understand the anger and disappointment that the client is having concerning having depressive symptoms after partying with the girlfriend.
Importance of Thorough Psychiatric Assessment
It is important to carry out a thorough psychiatric assessment of a child or adolescent since they are still undergoing mental and psychosocial development, which might interfere with how thy interpret or respond to different stimuli (Copeland et al., 2018). The psychiatric assessment would help identify the best approach to use when offering mental care and trigger issues that can lead to the onset of unwanted outcomes.
Symptom Rating Scales
The two main symptom rating scales used for children and adolescents include the Young Mania Rating Scale (YMRS) and the Adolescent Psychopathology Scale (APS) (Lica et al., 2021). These scales are fairly easy to use and have fewer steps than those used for adult testing.
Psychiatric Treatment Options for Children and Adolescents
Concerning the psychiatric treatment options for children and adolescents, the two methods include acceptance and commitment therapy and Interpersonal Psychotherapy for Adolescents (IPT-A) (Mychailyszyn & Elson, 2018). These methods are more specific to the younger generation and would not be applied to adult patients.
Role Parents/Guardians Play in Assessment
While caring for younger patients, parents or guardians have a major role since they help provide consent and create a conducive environment for the child to be free in communication and express themselves (Kimonis et al., 2019). Parents or guardians can also help with clarifying the questions more clearly and facilitate proper and efficient communication.
Copeland, W. E., Shanahan, L., Hinesley, J., Chan, R. F., Aberg, K. A., Fairbank, J. A., van den Oord, E. J. C. G., & Costello, E. J. (2018). Association of Childhood Trauma Exposure with Adult Psychiatric Disorders and Functional Outcomes. JAMA Network Open, 1(7), e184493. https://doi.org/10.1001/jamanetworkopen.2018.4493
Kimonis, E. R., Fleming, G., Briggs, N., Brouwer-French, L., Frick, P. J., Hawes, D. J., … & Dadds, M. (2019). Parent-Child Interaction Therapy Adapted for Preschoolers with Callous-Unemotional Traits: An Open Trial Pilot Study. Journal of Clinical Child & Adolescent Psychology, 48(sup1), 1–15. https://doi.org/10.1080/15374416.2018.1479966
Lica, M. M., Papai, A., Salcudean, A., Crainic, M., Covaciu, C. G., & Mihai, A. (2021). Assessment of Psychopathology in Adolescents with Insulin-Dependent Diabetes (IDD) and the Impact on Treatment Management. Children, 8(5), 414. https://doi.org/10.3390/children8050414
Mychailyszyn, M. P., & Elson, D. M. (2018). Working through the blues: A meta-analysis on Interpersonal Psychotherapy for depressed adolescents (IPT-A). Children and Youth Services Review, 87, 123–129. https://doi.org/10.1016/j.childyouth.2018.02.011
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Depression vignette examples
Here is an example of a depression vignette:
John had been feeling down for several weeks. He was having trouble sleeping and found it difficult to concentrate at work. He was irritable with his wife and kids and had lost interest in his hobbies. John had always been a hard worker, but now he struggled to get out of bed in the morning. He felt like he was in a dark hole and couldn’t find his way out. John’s wife noticed the changes in him and encouraged him to see a doctor. After talking with his doctor, John was diagnosed with depression and started taking medication and attending therapy. Slowly but surely, he started to feel better and was able to regain control of his life.
Mental health vignette examples
Here are a few examples of mental health vignettes:
- Sarah had been feeling anxious for months. She worried constantly about things that most people would consider minor. She had trouble sleeping and found it difficult to focus on her work. Sarah’s friends and family noticed the changes in her and encouraged her to seek help. After talking with a therapist, Sarah was diagnosed with Generalized Anxiety Disorder and started attending therapy sessions. She learned coping strategies and found ways to manage her anxiety.
- Tom had been struggling with addiction for years. He had tried to quit on his own multiple times, but always found himself back at square one. Finally, Tom decided to seek professional help. He checked into a rehabilitation center and received therapy and medication to help him through the process. It was a difficult journey, but with the support of his family and the treatment he received, Tom was able to overcome his addiction.
- Emily had been experiencing symptoms of depression for a while. She felt sad and hopeless and had lost interest in her favorite activities. Emily’s parents were concerned about her and took her to see a psychiatrist. After a thorough evaluation, Emily was diagnosed with Major Depressive Disorder and prescribed medication and therapy. It took time, but eventually, Emily started to feel better and was able to resume the activities she enjoyed.
- Alex had been struggling with Obsessive-Compulsive Disorder (OCD) for years. He had to perform certain rituals in order to feel safe and secure. Alex’s friends and family had noticed the changes in his behavior and encouraged him to see a therapist. After receiving a diagnosis of OCD, Alex began attending therapy sessions and learned strategies to manage his symptoms. With time and practice, Alex was able to reduce the severity of his OCD and regain control of his life.