NRNP 6665 WEEK 1: Comprehensive Integrated Psychiatric Assessment

NRNP 6665 WEEK 1: Comprehensive Integrated Psychiatric Assessment

Mental illnesses negatively impact patient’s lives, hence the need for a comprehensive psychiatric assessment which can help formulate a relevant and appropriate treatment and management plan. Even though it is important, carrying out a psychiatric assessment of a child can be challenging as children are less psychologically minded (Radez et al.,2021). As such, this discussion focuses on critiquing the assessment methods applied by a mental health professional in carrying out a psychiatric assessment of an adolescent, as observed in an assigned video. Based on the psychiatric assessment completed by the practitioner, there are aspects done well and areas which the practitioner may need to improve. One such aspect that the practitioner did well was maintaining eye contact with the patient throughout the session, which is an important strategy if the practitioner has to know the most relevant question to ask by assessing the patient’s non-verbal signals. The practitioner also used friendly and open-ended questions to obtain relevant information from the patient (“YMH Boston”, 2013). She also demonstrated good communication skills as she took her time to listen and only asked questions when necessary.

It is evident that the practitioner did many actions correctly. However, there are also a few areas that can still be improved. For instance, the professional failed to introduce herself to the client and also did not greet him. The actions can be viewed as arrogance by a client, which can then hinder a successful and appropriate therapeutic process (Varcarolis & Fosbre, 2020). Among the compelling concerns regarding this patient’s case is how has deteriorated within a short time. The depressive symptoms have made the patient’s school grades considerably go down, and he doesn’t feel like going to school anymore (“YMH Boston”, 2013). As such, I would inquire more about how he relates with teachers in addition to issues surrounding his recent break-up with his girlfriend. Such questions would help explore further the aspects surrounding the patient’s depressive symptoms.

Conducting a thorough psychiatric assessment of a child or adolescent is important for various reasons. This group of patient is less psychologically minded and, hence, may lack adequate insight regarding their symptoms and current condition (Radez et al.,2021). Conducting a thorough psychiatric assessment can play a key role in obtaining the relevant information for accurate diagnosis and formulation of the plan. Carrying out a psychiatric assessment of a child or an adolescent may require symptom rating scales. One such scale is a child-adolescent suicidal potential index (CASPI) applied in the assessment of suicidal behavior risk (de Carvalho Araújo et al.,2023). The other rating scale is the Brief Psychiatric Rating Scale for Children, which has widely been used in assessing various symptoms among children (Hirdes et al.,2020).

As earlier indicated, mental illnesses have various negative impacts, hence a need to appropriately treat them. However, it is important to note that the treatment modality may vary depending on whether the patient is a child, an adolescent, or an adult. As such, there are treatment modalities that can be used for children and adolescents but can not be used for adults. An example is acceptance and commitment therapy, used to help children understand and accept their inner emotions and be more positive. The other example is play therapy, which involves using aspects such as blocks, puppets, and games to help the patient recognize feelings (Varcarolis & Fosbre, 2020). It is important to explore the role of parents/guardians in assessment. One of them is giving consent, as children can not. The professionals can then ask appropriate questions. They can also give relevant information regarding the patient that can help the professional make appropriate decisions during the assessment. The sources used in this discussion are scholarly since they are peer-reviewed.

References

de Carvalho Araújo, A. L., Martins, P. S., Alvarenga, M. A. S., & Mansur-Alves, M. (2023). Adaptation and validity evidence of the Child-Adolescent Perfectionism Scale to Brazilian Portuguese. Psicologia: Teoria e Prática, 25(3), 1-22. https://doi.org/10.5935/1980-6906/ePTPPA15444.en

Hirdes, J. P., Van Everdingen, C., Ferris, J., Franco-Martin, M., Fries, B. E., Heikkilä, J., … & Van Audenhove, C. (2020). The interRAI suite of mental health assessment instruments: an integrated system for the continuum of care. Frontiers In Psychiatry, 10, 926. https://doi.org/10.3389/fpsyt.2019.00926

Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry, 30, 183–211. https://doi.org/10.1007/s00787-019-01469-4

Varcarolis, E. M., & Fosbre, C. D. (2020). Essentials of psychiatric mental health nursing-E-book: A communication approach to evidence-based care. Elsevier Health Sciences.

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

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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.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

• Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health

• Links to an external site.. American Psychiatric Association Publishing.
  • Chapter 1, “Introduction”
  • Chapter 4, “The 15-Minute Pediatric Diagnostic Interview”
  • Chapter 5, “The 30-Minute Pediatric Diagnostic Interview”
  • Chapter 6, “DSM-5 Pediatric Diagnostic Interview”
  • Chapter 9, “The Mental Status Examination: A Psychiatric Glossary”
  • Chapter 13, “Mental Health Treatment Planning”
• Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents

• Links to an external site.. Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18
• Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
  • Chapter 32, “Clinical assessment and diagnostic formulation”

Required Media

• Symptom Media. (2014). Mental status exam B-6

• Links to an external site.. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series
• Western Australian Clinical Training Network. (2016, August 4). Simulation scenario-adolescent risk assessment
• Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=wNF1FIKHKEULinks to an external site.
• YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointment

• Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

Optional Resources

• Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
  • Chapter 1, “Examination and Diagnosis of the Psychiatric Patient”
    • Section 1.2, “Children and Adolescents” (pp. 74-87)

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.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

NRNP_6665_Week1_Discussion_Rubric