Discussion response
Peer responses
Wilson Cruz
Discussion Week 1
The practitioner acquired essential questions about the mood, feelings, onset of the problem, the influence of drug/alcohol, and thought about hurting himself. Since the patient stated not wanting to be alive and had thoughts about hurting himself, my next question would be if he has suicidal thoughts (and plan).
The practitioner could take some time to establish boundaries of confidentiality instead of going straight to the questions. She could introduce herself and explain the nature of the interview, saying that she is used to helping young people with their problems (attitude to help); thus, she would like to do a few questions. The sequence of questions could be from broad and non-personal to a narrow direction; to ask “have you been crying a lot” at the beginning of the interview could intimidate the patient into talking about his feeling (ashamed to admit it). Not at the beginning of the interview, I would ask, “what you do when you are sad, stay in your room, don’t talk to anyone, cry.”
The practitioner listened to the patient’s problems, such as anger, school grades going down, and the patient’s girlfriend breaking up with him. Still, she did not demonstrate with few words an empathic or sensitivity to his condition, such as “you must have felt terrible not knowing the cause of she broke up with you.” Being sensitive and empathic helps develop rapport-building with a patient (Carlat, 2017).
The practitioner could explain the symptom expectation that a behavior is in some way normal or expected, such as the pain he feels about the broke up, not feeling the energy to play basketball, and unwillingness to do homework.
It is important to have a child or adolescent who presents a condition that parents or caregivers suspect a mental condition to be assessed by a clinician because psychotherapeutic interventions can change neurodevelopment (Wheeler, 2022).
Standardized diagnostic interviews provide a better approach to classifying child disorders than checklists, but most diagnostic interviews demand a lot of time from respondents and are expensive to implement. Self‐completed problem checklists (i.e., questionnaires) and standardized diagnostic interviews are the two most common assessment instruments used to measure psychiatric disorders in children (Angold cited by Boyle et al., 2017)
A child or adolescent presenting symptoms that could be a mental health condition may go through a screening to help determine the need for a deeper evaluation by a trained clinician. A preliminary screening can be the Child/Adolescent Psychiatry Screen (CAPS). The screening contains 85 questions that indicate the frequency of symptoms as none, mild, moderate, severe, and past (the child used to have significant problems with this behavior, but not during the past six months). The symptoms are arranged in sections, such as anxiety, depression, substance abuse, and learning disability, to help identify areas, it is the case, for discussion with the clinician.
The Children’s Depression Rating Scale-Revised (CDRS-R) is used to diagnose depression in children aged 6 to 12 but has also been shown to effectively assess and monitor adolescent symptomatology. It rates individuals on seventeen symptom areas, including dysfunction relating to schoolwork, interpersonal relationships, psychosomatic complaints, and other thoughts and feelings commonly presenting in depressed children and adolescents. Each item is rated on a scale of 1 to 7, with one being least severe to 7 indicating severe clinical difficulties. A total score of 85 or higher indicates a depressive disorder.
Parents have attachment relationships with their children. They provide the environment for their children to develop a mental representation of themselves and their future behavioral and emotional regulation (Bowlby cited by Bohr et al., 2018). Parents are the first to notice behavior and symptoms that may concern a mental condition; therefore, they have crucial importance to early intervention to benefit their children. Parents provide information about the history of the problem, treatment, and medical condition; they must be seen as partners in the assessment and treatment of the children.
Some specific psychiatric treatment options for children and adolescents are not used when treating adults. For example, play therapy involves the use of toys, blocks, dolls, puppets, drawings, and games to help the child recognize, identify, and verbalize feelings. Another example is that parent-child interaction therapy helps parents and children who struggle with behavior problems or connections through real-time coaching sessions. Parents interact with their children while therapists guide families toward positive interactions.
References
Bohr, Y., Dhayanandhan, B., Kanter, D., Holigrocki, R., Armour, L. & Baumgartner, E. (2018). Mapping the attributions of parents: a client-centered dynamic approach to assessing vulnerable caregivers and their young children. Person-Centered & Experimental Psychotherapies, 17(1), 54-69. Retrieved from https://doi.org/10.1080/14779757.2018.1431562
Boyle, M.H., Duncan, L., Georgiades, K., Bennett, K., Gonzales, A., Lieshout, R.J., Szatmari, P., MacMillan, H.L., Kata, A., Ferro, M.A., Lipman, E.L., & Janus, M. (2017). Classifying children and adolescents psychiatric disorder by problem checklists and standardized interviews. International Journal of Methods in Psychiatric Research. Doi: 10.1002/mpr.1544
Carlat, D.J. (2017). The Psychiatric Interview (4th ed.). Walters Kluer.
Wheeler, K. (2022). Psychotherapy for the Advanced Practice Psychiatric Nurse (3rd ed.). Springer.
CAPS.pdf (73.477 KB)
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Milad Boless
Week 1 Comprehensive Integrated Psychiatric Assessment
WEEK 1 Comprehensive Integrated Psychiatric Assessment
What did the practitioner do well? In what areas can the practitioner improve?
Although the interview between the client and the practitioner did not last more than two and half minutes, the practitioner did great work by asking many open questions and kept her eye contact during her interview, creating trust and building rapport so she could have the opportunity to have a complete and accurate assessment for her client (Dang et al.,2017).
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
With any group of people referred for evaluation for depression and anxiety, the first thing that comes to mind is the safety of the client. The provider asked the client about suicidal thoughts.
A new client in a clinic to see a new provider puts the client under stress and anxiety because the client does know what he/she is excepting from the visit to a provider. In our vignette 5, the provider did not give enough time to introduce herself to the client and her roles. Besides that, she did not mention the confident rights for the client to build trust.
What would be your next question, and why?
My following questions will be about suicidal thoughts and plan if he has a previous history of suicidal attempts. besides that, I will ask if he has homicidal thoughts and gets details because the safety of the client and others is the main goal for assessing the client during the process of reaching the appropriate diagnosis. (Li et al.,2017).
Explain why a thorough psychiatric assessment of a child/adolescent is important.
It is essential to do a mental assessment for a child/adolescent to determine psychological development and behavior difficulties (Sadock et al.,2015).
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
For our vignette #5, As a provider, I am going to use the child behavior checklist (CBCL) and Children’s Depression Inventory (CDI). Using the child behavior checklist (CBCL) is helpful in screening behavior of the children aged 6-18; it requires the parents to share in parent-completed measures of emotional, behavioral, and social problems in children (Havdahl et al.,2016). Children’s Depression Inventory (CDI) is a good tool for screening depression symptoms in a child/adolescents aged 7-17. According to Stumper et al.,2019 “it assesses five factors (anhedonia, negative mood, negative self-esteem, ineffectiveness, and interpersonal problems.”
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Play and Art therapy, According to Woollett et al.,2020 “play therapy is structured that builds on the normal communicative and learning processes of children. On the other hand, Art therapy is helpful to express emotions, decreasing the anxiety, and increase self-esteem”.
Explain the role parents/guardians play in assessment.
During mental health assessment, the provider got the information from the child, the parents, and other family members (Sadock et al.,2015). Parents are essential information sources about a chronological picture of a child’s growth and development. (Sadock et al.,2015). Very young age, children sometimes cannot express themselves, so the presence of parents will help get a full mental health assessment for the children. Sadock et al.,2015).
References
Li, H., Luo, X., Ke, X., Dai, Q., Zheng, W., Zhang, C., Cassidy, R. M., Soares, J. C., Zhang, X., & Ning, Y. (2017). Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population. PloS one, 12(10), e0186143. https://doi.org/10.1371/journal.pone.018614
Dang, B. N., Westbrook, R. A., Njue, S. M., & Giordano, T. P. (2017). Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC medical education, 17(1), 32. https://doi.org/10.1186/s12909-017-0868-5
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Woollett, N., Bandeira, M., & Hatcher, A. (2020). Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa. Child abuse & neglect, 107, 104564. https://doi.org/10.1016/j.chiabu.2020.104564
Havdahl, K. A., von Tetzchner, S., Huerta, M., Lord, C., & Bishop, S. L. (2016). Utility of the Child Behavior Checklist as a Screener for Autism Spectrum Disorder. Autism research: official journal of the International Society for Autism Research, 9(1), 33–42. https://doi.org/10.1002/aur.1515
Stumper, A., Olino, T. M., Abramson, L. Y., & Alloy, L. B. (2019). A Factor Analysis and Test of Longitudinal Measurement Invariance of the Children’s Depression Inventory (CDI) Across Adolescence. Journal of psychopathology and behavioral assessment, 41(4), 692–698. https://doi.org/10.1007/s10862-019-09746-x
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