Top of Form Main Post A comprehensive, integrated Psychiatric assessment entails gathering

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A comprehensive, integrated Psychiatric assessment entails gathering information about a patient from all possible sources. In the Pediatric population, a comprehensive assessment will involve getting information from the child and family members, caregivers, teachers, and school counselors. Sadock et al. (2015) noted that comprehensive, integrated Psychiatric assessment involved collecting data related to history, mental status examination, educational and developmental testing, and neurological examination. Apart from providing the information needs for the provider to make an informed diagnosis and treatment plan, the assessment provides the provider with a conducive environment to develop and build rapport with the patients (Sadock et al., 2015). 

This discussion is about critiquing the assessment of Tony (based on the YMH Boston Vignette 5 video), who was referred to a social worker for further evaluation of his depressive and anxiety symptoms. The client claimed his symptom started because his girlfriend broke up with him.

The practitioner did well with her exhibition of professionalism in communicating with the patient. She asked relevant questions that related to the anxiety and depressive symptoms. However, the practitioner needs to improve in using open-ended questions to elicit more information from the patient. Some of the information provided by the patient required further probing, which the provider did not do. There was no introduction, and informed consent was not obtained before the assessment. This is important to promote good rapport and avoid ethical issues.

One of my concerns was the missing information about the patient’s parents and guardians. Because the patient is a minor, there should be express consent from the guardian, which was not reflected in the video.

However, one of the compelling pieces of information I will have love to explore is if the patient has a plan to hurt his ex-girlfriend. He admitted having thought of hurting her but did not give detailed information about what the thoughts were. This is essential to protect the life of the girl and her new boyfriend. HIPAA Privacy Rule permits the disclosure of information when the provider has a good faith belief that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of the patient or others (US Department of Health and Human Services, n.d.)

Explain why a thorough psychiatric assessment of a child/adolescent is important.

A thorough psychiatric assessment of a child/adolescent is essential in making an appropriate diagnosis of the patient’s problems. It helps to differentiate if the patient has emotional, behavioral, or developmental problems and how the problem affects the child’s life (Srinath et al., 2019). Because children are dependent on their caretakers, it is important to conduct a thorough assessment to determine the influence of the different environments on the child’s problem. Genetics, family and peer stressors are some of the factors that could be identified with a proper assessment so that an appropriate treatment plan can be developed.

Two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

The Brief Psychiatric Rating Scale for Children (BPRS-C-9 [21]): BPRS-C-9 (21) is a rating tool used to assess childhood behavioral and emotional symptomatology (Hughes, 2008). The score is determined by measuring seven variables with three measured items in each variable. The variables measured include Behavior Problems, Depression, Thinking Disturbance, Psychomotor Excitation, Withdrawal, Anxiety, and Organicity. Information used to complete the scale can be obtained through clinical interviews, direct observation, reviews of medical records, and school reports. The rating scale is between 0 to 6, with 0 being Not present and 6 being extremely severe.

The Revised Children’s manifest Anxiety Scale (RCMAS): RCMAS is one of the most used self-reporting tools to assess the level and nature of anxiety for children/adolescent (White & Farrell, 2001). The RCMAS-2 Performance Anxiety cluster consists of 10 items rated on a yes/no scale format.

Two psychiatric treatment options for children and adolescents that may not be used when treating adults.

Interpersonal psychotherapy (IPT) is developed to treat depression in children. The development is based on the fact that depression occurs in the context of an individual’s relationship regardless of the biological or genetic component. Interpersonal psychotherapy for depressed adolescents (IPT-A) is evidence-based psychotherapy used to treat youth with temper outbursts and chronic irritability (Miller et al., 2016). It is also well established as effective for treating youths with depression.

Another treatment option is child-centered play therapy. This treatment option uses children’s appropriate materials (like Toys, blocks, dolls, puppets, paintings, and games) to assist them in communicating their feelings. By analyzing how the child plays and communicate with the materials, the therapist then guides the child to better understand and regulate their feelings and behavior through the play.

The role parents/guardians play in assessment.

Parents play a vital role in their children’s clinical assessment and treatment. Because the children are minors and dependents, their parents/guardians’ consents give the gateway for them to be assessed. Their parent is also handy for providing vital information concerning the child’s condition. The parents assist the clinician in comprehending the kid’s behavior and the functionality of the family, the persons, and the environment. However, the parent’s presence may cause anxiety in the child, and the provider may speak to the child alone with the child’s assent (Srinath et al., 2019).

In completing this discussion, four peer-review and evidence-based sources were used. They were considered scholarly articles because experts wrote them. The writers also used professional languages and made use of references.

Reference

Hughes, C. W. (2008). Guidelines for Administration and Use of the Brief Psychiatric Rating Scale for Children nine and 21-item versions. https://candapediatricmedicalhomes.files.wordpress.com/2017/02/bprsc-9_training_manual.pdf

Miller, L., Hlastala, S. A., Mufson, L., Leibenluft, E., & Riddle, M. (2016). Interpersonal Psychotherapy for Adolescents With Mood and Behavior Dysregulation: Evidence-Based Case Study.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915317/ 

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan and Sadock’s Synopsis of psychiatry: Behavioral Sciences/Clinical Psychiatry (11th. Ed) Wolters Kluwer.

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for Assessment of Children and Adolescents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345125/

US Department of Health and Human Services, (n.d). HIPAA privacy rules and sharing information related to mental health. https://www.hhs.gov/sites/default/files/hipaa-privacy-rule-and-sharing-info-related-to-mental-health.pdf

White, K. S.& Farrell, A. D. (2001). Structure of Anxiety Symptoms in Urban Children: Competing Factor Models of the revised Children’s manifest Anxiety Scale. http://www.billtrochim.net/research/cmliterature/White,2001,Structureofanxietysymptomsinurbanchildren.pdf

Bottom of Form

First Response:

Post to colleague’s main post that is reflective and justified with credible sources–

Excellent 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings

Responds to questions posed by faculty

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

Good 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Fair 7 (7%) – 7 (7%)

Response is on topic, may have some depth.

Poor 0 (0%) – 6 (6%)

Response may not be on topic, lacks depth.

First Response:
Writing–

Excellent 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in standard, edited English.

Good 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources

Response is written in standard, edited English.

Fair 4 (4%) – 4 (4%)

Response posted in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Poor 0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Responses to faculty questions are missing.

No credible sources are cited.

First Response:
Timely and full participation–

Excellent 5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation

Posts by due date

Good 4 (4%) – 4 (4%)

Meets requirements for full participation

Posts by due date

Fair 3 (3%) – 3 (3%)

Posts by due date

Poor 0 (0%) – 2 (2%)

Does not meet requirements for full participation

Does not post by due date

Symptom Media. (2014). Mental status exam B-6. [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 [Video]. YouTube. https://www.youtube.com/watch?v=wNF1FIKHKEU

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

Recommended Reading (click to expand/reduce)

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