NRNP 6665 Comprehensive Integrated Psychiatric Assessment Paper

NRNP 6665 Comprehensive Integrated Psychiatric Assessment Paper

NRNP 6665 Comprehensive Integrated Psychiatric Assessment Paper

Comprehensive Integrated Psychiatric Assessment
A comprehensive and integrated psychiatric assessment is key to improved diagnosis and treatment of patients with various mental illnesses or challenges since carrying out a comprehensive psychiatric assessment enhances the chances of accurate diagnosis. The implication is that the PMHNPs should use appropriate knowledge and skills to carry out assessments as also directed by the patient’s identity (Geddes& Andreasen, 2020). Even though carrying out psychiatric assessments for adults can be easier, it is more complicated to carry out psychiatric assessments for children and adolescents; hence professionals should have such knowledge. The purpose of this assignment is to formulate a critique of the strategies used by mental health professionals while carrying out a psychiatric assessment for a patient in an assigned video.

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What the Practitioner Did Well and Areas of Improvement
The practitioner conducted a psychiatric assessment on a patient, Tony, who had been referred by his social worker after depressive symptoms. One of the things which the professional did well was display of professionalism. She asked Tony open-ended and friendly questions, which enabled the patient to give precise answers since he was relaxed. She was also able to maintain eye contact with the patient for any non-verbal cues so as to respond appropriately. The practitioner also showed good communication skills since she allowed the patient to talk when he needed to. On the other hand, there are areas in which the practitioner did not do well and hence needed improvement. She did not introduce herself, nor did she greet the patient. Such an action can be considered rude, hence hindering an appropriate therapeutic relationship.
The Compelling Concerns and Possible Questions to Ask
One of the most compelling concerns in this assessment is the confessions made by the patient. Tony, the patient, indicates that his school grades have been dropping at an alarming rate for the past two months. Such a phenomenon can be an indication that his condition is deteriorating. He, therefore, confessed that he does not like school anymore. It was also evident that the patient currently broke up with his girlfriend, which is also a concern. However, there is a possibility of the existence of other factors which have not been known and, therefore, should be considered for better outcomes. As such, one of the questions I would ask at that point is the kind of relationship existing between the patient, his teachers, other students, his friends, and caregivers/parents. An answer to the question would help plan for the necessary social support.
The Importance of a Thorough Psychiatric Assessment of a Child/Adolescent
Performing a psychiatric assessment on children and adolescents can be a challenge, implying that effective strategies should be used to perform the assessment. One reason for the need for a thorough assessment is that adolescents and children are less psychologically minded. Hence they lack the necessary insights into themselves as opposed to adults (Radez et al., 2021). The implication is that such a shortcoming can only be overcome through a comprehensive psychiatric assessment to help get the necessary information that can support an appropriate treatment plan.
Symptom Rating Scales for Children and Adolescents
Symptoms rating scale help in the evaluation of how severe the psychiatric symptoms are. While some of the symptom ratings can be used across the lifespan, others can only be used in children and adolescents. One of the symptoms rating scales is Child Anxiety-Related Emotional Disorders (SCARED). This scale is applied when assessing generalized anxiety disorder among adolescents and children. The other rating scale is Children’s Depression Rating Scale-Revised (CDRS-R), which has widely been applied to assess depression and ASD severity among children (DeFilippis, 2018)
Psychiatric Treatment Options for Children and Adolescents That May Not Be Used For Adult
There are various psychiatric treatment options used among children and adolescents, but they are not appropriate for the adult population. One such treatment option is play therapy. This approach involves giving the children particular materials and objects, such as games, drawings, puppets, and blocks which enhances their chances of identifying and verbalizing their feelings (Brefort et al., 2022). The other treatment strategy is the commitment therapy approach. This approach is widely used to help patients identify and recognize their inner emotions for the major purpose of staying positive.
The Role of Parents/Guardians in Assessment
Parents and guardians play a critical role in assessing children and adolescents. One of the roles is giving consent since children and adolescents are minors. The consent is to give the professionals the go-ahead and perform the psychiatric assessment within the existing ethics and laws (Geddes& Andreasen, 2020). They can also give important information about the patient, such as mental health history and history of hospitalizations.
Conclusion
Psychiatric assessment of children and adolescents requires that the practitioners have adequate knowledge of the right thing to do. Parents and guardians can play key roles, such as consenting and giving psychiatric histories. A comprehensive, integrated psychiatric assessment helps in the correct diagnosis and subsequent formulation of treatment and management plans as appropriate.

References
Brefort, E., Saint-Georges-Chaumet, Y., Cohen, D., & Saint-Georges, C. (2022). Two-year follow-up of 90 children with autism spectrum disorder receiving intensive developmental play therapy (3i method). BMC Pediatrics, 22(1), 1-13. https://doi.org/10.1186/s12887-022-03431-x
DeFilippis, M. (2018). Depression in children and adolescents with autism spectrum disorder. Children, 5(9), 112. https://doi.org/10.3390/children5090112
Geddes, J. R., & Andreasen, N. C. (2020). New Oxford textbook of psychiatry. Oxford University Press, USA.
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

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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.

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!

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NRNP_6665_Week1_Discussion_Rubric

NRNP_6665_Week1_Discussion_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning Outcome Main Posting:Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

44 to >39.0 pts

Excellent

Thoroughly responds to the Discussion question(s)… Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources… No less than 75% of post has exceptional depth and breadth… Supported by at least three current credible sources

39 to >34.0 pts

Good

Responds to most of the Discussion question(s)… Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module… 50% of the post has exceptional depth and breadth… Supported by at least three credible references

34 to >30.0 pts

Fair

Responds to some of the Discussion question(s)… One to two criteria are not addressed or are superficially addressed… Is somewhat lacking reflection and critical analysis and synthesis… Somewhat represents knowledge gained from the course readings for the module… Post is supported by fewer than two credible references

30 to >0 pts
Poor

Does not respond to the Discussion question(s)… Lacks depth or superficially addresses criteria… Lacks reflection and critical analysis and synthesis… Does not represent knowledge gained from the course readings for the module… Contains only one or no credible references

44 pts

This criterion is linked to a Learning Outcome Main Posting:Writing

6 to >5.0 pts

Excellent

Written clearly and concisely… Contains no grammatical or spelling errors… Adheres to current APA manual writing rules and style

5 to >4.0 pts
Good

Written concisely… May contain one to two grammatical or spelling errors… Adheres to current APA manual writing rules and style with minor errors

4 to >3.0 pts

Fair

Written somewhat concisely… May contain more than two spelling or grammatical errors… Contains some APA formatting errors

3 to >0 pts

Poor

Not written clearly or concisely… Contains more than two spelling or grammatical errors… Does not adhere to current APA manual writing rules and style

6 pts

This criterion is linked to a Learning Outcome Main Posting:Timely and full participation

10 to >8.0 pts

Excellent

Meets requirements for timely, full, and active participation… Posts main Discussion by due date

8 to >7.0 pts

Good

Posts main Discussion by due date… Meets requirements for full participation

7 to >6.0 pts

Fair

Posts main Discussion by due date

6 to >0 pts
Poor

Does not meet requirements for full participation… Does not post main Discussion by due date

10 pts

This criterion is linked to a Learning Outcome First Response:Post to colleague’s main post that is reflective and justified with credible sources

9 to >8.0 pts

Excellent

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.

8 to >7.0 pts

Good

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

7 to >6.0 pts

Fair

Response is on topic, may have some depth.

6 to >0 pts

Poor

Response may not be on topic, lacks depth.

9 pts

This criterion is linked to a Learning Outcome First Response:Writing

6 to >5.0 pts

Excellent

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.

5 to >4.0 pts

Good

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.

4 to >3.0 pts

Fair

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.

3 to >0 pts

Poor

Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.

6 pts

This criterion is linked to a Learning Outcome First Response:Timely and full participation

5 to >4.0 pts

Excellent

Meets requirements for timely, full, and active participation… Posts by due date

4 to >3.0 pts

Good

Meets requirements for full participation… Posts by due date…

3 to >2.0 pts

Fair

Posts by due date

2 to >0 pts

Poor

Does not meet requirements for full participation… Does not post by due date

5 pts

This criterion is linked to a Learning Outcome Second Response:Post to colleague’s main post that is reflective and justified with credible sources

9 to >8.0 pts

Excellent

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.

8 to >7.0 pts

Good

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

7 to >6.0 pts

Fair

Response is on topic, may have some depth.

6 to >0 pts

Poor

Response may not be on topic, lacks depth.

9 pts

This criterion is linked to a Learning Outcome Second Response:Writing

6 to >5.0 pts

Excellent

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.

5 to >4.0 pts

Good

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.

4 to >3.0 pts

Fair

Response posed in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited.

3 to >0 pts

Poor

Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited.

6 pts

This criterion is linked to a Learning Outcome Second Response:Timely and full participation

5 to >4.0 pts

Excellent

Meets requirements for timely, full, and active participation… Posts by due date

4 to >3.0 pts

Good

Meets requirements for full participation… Posts by due date

3 to >2.0 pts

Fair

Posts by due date

2 to >0 pts

Poor

Does not meet requirements for full participation… Does not post by due date

5 pts

Total Points: 100