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Comprehensive Integrated Psychiatric Assessment

Introduction

For the comprehensive, integrated psychiatric assessment of a child or adolescent, it is essential to gather the appropriate information that considers confidentiality and consent from the parent or appointed guardian. Obtaining a clinical history, presentation of symptomatology, and forming a therapeutic alliance are the main objectives for a case formulation that will ultimately guide the appropriate intervention and treatment (Srinath et al., 2019). This assignment will review and assess the case presentation based on a YMH Boston Vignette 5 video of an adolescent with symptoms of depression and anxiety.

What Did the Practitioner Do Well?

The patient is a male adolescent of unreported age, referred to the social worker by his medical provider due to concerns about symptoms relating to depression and anxiety. The social worker’s tone and demeanor were adequate, and she asked questions in simple terms and used appropriate eye contact. The social worker also primed the patient to talk about his anger and stated, “We can talk more about that,” however, she was careful not to pressure the patient at any time during the assessment. The social worker summarized the patient’s symptoms, leading to the development of trust and a therapeutic alliance with the patient.

In What Areas Can the Practitioner Improve?

In my opinion, the social worker can improve by introducing herself. Although she did ask the adolescent patient if he had a sense of why he was there, he answered the reason for being there was because his medical doctor sent him; however, he had feeble insight regarding the purpose of the evaluation. Furthermore, the social worker should have included the reasons and objectives of the assessment before starting the interview process. The social worker could have assessed the patient’s thought process, thought content, perception disturbance, cognition, and insight (Voss & Das, 2022). In my opinion, the provider could have touched more on the thought content and further assessed suicidal ideation, whether it was passive or active, with or without an actual plan (Voss & Das, 2022).

Point In the Clinical Interview with Compelling Concerns.

The point during the clinical interview that was concerning was the lack of interest in obtaining collateral information. I also noticed that the social worker asked the patient if he had been thinking of doing something to hurt himself and ended with an open-ended question asking him to tell her more about that. The statement that precedes this is when the patient states, “I do not even want to be alive.” This is the point most concerning to me because it requires a more aggressive screening strategy regarding suicidal ideation.

What Would be Your Next Question and Why?

My next question would be central after the patient’s thought content involved endorsing suicidal ideation. I would then ask do you have a plan? It is vital to assess for passive or active suicidal ideation. If a plan is in place, it will alert the clinician to use collateral information to prevent the patient from accessing resources and not allow him to follow through with a suicide plan (Sisler et al., 2020).

Why Is a Thorough Psychiatric Assessment of a Child or Adolescent Essential?

A thorough psychiatric assessment within the patient population is critical because the patient may not have the insight, desire, or willingness to open up during the evaluation. The adolescent may not necessarily agree they need help. For this reason, the need to inquire about collateral information is vital, and the clinician should use multiple sources if possible (Srinath et al., 2019).

Two Symptom Rating Scales That are Appropriate for Children and Adolescents.

The Beck Depression Inventory-II is the revised version to fit the criteria for depression in the DSM-IV. The BDI-II has evidence-based research and is widely used for adults and adolescents. It is a 21-item self-reporting tool that follows the DSM-IV criteria; the total score is considered with the higher the score, the higher values, meaning the increasing level of depressive symptoms. The BDI-II is used in inpatient and outpatient settings and is valid and reliable (Garca-Batista et al., 2018).

The Reynolds Adolescent Depression Scale is a self-report 30-item created to assess the severity of depressive symptoms in adolescents, and it is used in schools and the clinical environment. The RADS also shows validity and reliability and has substantial evidence-based research (Ortuo-Sierra, 2017).

Describe Two Psychiatric Treatment Options for Children and Adolescents but not for Adults

Play therapy plays a significant role in treating multiple mental health disorders in children. Sometimes, when the child has experienced a traumatic event, the child no longer shows improvement; the therapist may use a superhero play therapy intervention to push through the stagnation period caused by the anxiety of the trauma sequelae. The superhero theme is called into action, allowing the child to feel empowered and move through any stagnation period (Stauffer, 2021).

Another type of intervention used exclusively with children is cognitive behavior play therapy (CBPT). This modality can be applied using CBT strategies but incorporates play-based interactions. The aspects of traditional adult CBT can help with a child who is not engaged, such as with the inclusion of activity scheduling (Bhide & Chakraborty, 2020)

The Role Parents or Guardians Play in Assessment.

Parents are instrumental when assessing a child, not only from a legal perspective, since requiring consent is a mandatory part of the process. The main objective is to obtain as much information as possible regarding the presenting symptoms, past medical and psychiatric history, allergies, and so on to give a proper diagnosis and treatment. Besides inquiring about collateral information, there are instances where the child holds back information or is afraid to talk; furthermore, there are instances where the parent or guardian may benefit from the clinician’s advice, as the treatment is a process, and it takes time, for symptoms to dissipate, allowing the parent or guardian to gain insight into the biopsychosocial perspective (Srinath et al., 2019).

Peer Review Articles Explanation

Peer-reviewed articles are sources of evidence that experts have evaluated. They help to improve the quality, integrity, and validity of studies. Researchers need to determine whether sources are peer-reviewed as it acts as a filter to ensure that only reliable sources are used. Bhide and Chakraborty (2020) is a peer-reviewed article written by experts in psychiatry. The article is also published in the Indian Journal of Psychiatry which is a reputable medical journal. Garcia-Batista et al. (2018)s study is considered to be peer-reviewed based on its approach. The article is written in a systematic manner and engages in scholarly research. In addition, Ortuo-Sierra et al. (2017)s study is scholarly as its authors are experts in healthcare. The articles title is also specific to the topic of study. In addition, Sisler et al. (2020)s study is considered scholarly as it is published on a credible psychiatric journal and is also accessed on the PubMed Library.

Srinath et al. (2019)s study provides guidance in psychiatry practice. Its approach depicts that the authors are experts in the field. This shows that it was written with the aim of reaching academic audiences. Stauffer (2021) is considered to be peer-reviewed as it is supported by The American Psychological Association. The feature shows the information provided in the article can be used as a standard for the management of trauma-related issues. Voss and Das (2021)s article is also peer-reviewed. Its authors are associated with the Imperial College Healthcare in London and the LSU Health Shreveport. Its objectives are also academic in nature. For instance, one of the objectives is to identify what a mental health status examination entails and how it can be applied in psychiatric practice. YMH Boston (2013) video is not considered to be peer-reviewed as it is published on YouTube, which is not an academic website. However, its content provides scholarly insight regarding psychiatric practice.

References

Bhide, A., & Chakraborty, K. (2020). General principles for psychotherapeutic interventions in children and Adolescents. Indian journal of psychiatry, 62(Suppl 2), S299S318.

Garca-Batista, Z. E., Guerra-Pea, K., Cano-Vindel, A., Herrera-Martnez, S. X., & Medrano, L. A. (2018). Validity and reliability of the Beck Depression inventory (BDI-II) in general and hospital population of Dominican Republic. PloS one, 13(6), e0199750.

Ortuo-Sierra, J., Aritio-Solana, R., Inchausti, F., Chocarro de Luis, E., Lucas Molina, B., Prez de Albniz, A., & Fonseca-Pedrero, E. (2017). Screening for depressive symptoms in adolescents at school: New validity evidences on the short form of the Reynolds Depression Scale. PloS one, 12(2), e0170950.

Sisler, S. M., Schapiro, N. A., Nakaishi, M., & Steinbuchel, P. (2020). Suicide assessment and treatment in pediatric primary care settings. Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 33(4), 187200.

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). . Indian Journal of Psychiatry, 61(2), 158175.

Stauffer, S. D. (2021). Overcoming trauma stuckness in play therapy: A superhero intervention to the rescue. International Journal of Play Therapy, 30(1), 1427.

Voss RM, M Das J. Mental Status Examination. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

YMH Boston. (2013, May 22). [Video]. YouTube.