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Discussion post reply # 1
A discussion based on the YMH Boston Vignette 5 video
What did the practitioner do well? In what areas can the practitioner improve?
The practitioner established a rapport with the client and ensured he was comfortable before asking him questions. Because of that, the patient felt more at ease being genuine and upfront during the examination. Before offering comments, the practitioner also provided questions encouraging the subject to articulate their perspective of the underlying issue. Throughout the examination, the practitioner effectively prompted the subject to reveal their perspective on the current situation, including his break up with his girlfriend and how he does not find a reason to live. The practitioner did not ask more questions about his family relations at home (YMH Boston, 2013,May 22). She can improve on that by concentrating on asking questions about his close associates at home and in school.
Do you have any compelling concerns at this point in the clinical interview? If so, what are they?
No, there are no compelling concerns at this point because the information provided was enough to come up with the right diagnosis for the patient
What would be your next question?
The next question would be if his parents are aware of what is going on in his life. Parents tend to be more concerned about their children, which would help recommend medications.
Why is it important to do a thorough psychiatric assessment of a child/adolescent
A complete psychiatric examination for children and adolescents is critical since it assists in the early diagnosis and intervention of mental health concerns. Such examinations take into account psychological, emotional, and social factors, allowing for more precise diagnosis and tailored treatment planning. Early intervention can avert long-term consequences and increase general well-being. Understanding developmental complexities also provides targeted care, promoting healthy growth and a higher quality of life throughout these critical years.
Appropriate symptom rating scales for a child/adolescent during psychiatric assessment
The two appropriate symptom rating scales include the Child Behavior Checklist (CBCL), a parent-reported measure used to assess various emotional and behavioral disorders in children and adolescents. The other one is the Children’s Depression Inventory (CDI), a self-report questionnaire used to assess depressed symptoms in children of this age (Park et al., 2022). Both scales give useful information about a child’s mental health, assisting professionals in correct assessment and therapy planning.
Two psychiatric treatment options for children and adolescents
The two treatment options for children and adolescents include play therapy, a technique tailored for children that uses play to help them express feelings and handle psychological difficulties, as they may not speak as successfully in traditional talk therapy (Lebowitz et al., 2020). The other is Family-Based Treatment (FBT), mostly among teenagers with teenage eating disorders. FBT engages the entire family in therapy to address familial dynamics contributing to the disorder’s genesis and maintenance. Adult-focused therapies sometimes do not include as much family participation (Lebowitz et al., 2020).
The role of parents/guardians during the assessment
Parents/guardians play an important part in child and adolescent evaluations by offering vital information about the individual’s behavior, emotions, and development. Their feedback assists physicians in gaining a thorough grasp of the children’s everyday lives, obstacles, and abilities. Collaboration with parents/guardians improves diagnostic accuracy, treatment plan development, and overall therapy success since they are major sources of information and crucial collaborators in the evaluation process (MacMullin et al., 2021).
Discussion post reply # 2
Studies have shown that the prevalence of depression in children is low, however as I have seen in clinicals it seems to be becoming a worsening problem. It does appear that the most affected is adolescents. “Depression in adolescents is a major risk factor for suicide, the second-to-third leading cause of death in this age group,4 with more than half of adolescent suicide victims reported to have a depressive disorder at time of death” (Thapar et al., 2012).
Depression can also cause an adolescent to preform poorly at school and they may withdrawal from friends, or even being to use alcohol or drugs. “Individuals who are currently depressed have diminished academic achievement and occupational functioning, experience more interpersonal conflict, and are more likely to be afflicted with comorbid conditions” (Chang & Kuhlman, 2022).
YMH Vignette 5 Questions
In this video the practitioner actively listened and interacted with Tony. The practitioner did not introduce herself or let the patient introduce himself. She seemed rehearsed. The rapport did not feel genuine between them. She should have talked with him about privacy and what information would need to be shared. I have several concerns that were not addressed appropriately. She asked Tony if he knew why he was there and he stated that his doctor referred him. At this point she should ask; can you tell me what you told your doctor that made him concerned? She also asked open-ended questions but then made suggestions for the answers. Asking a male if he has been crying would probably not get an honest answer. Asking if he has been irritable or angry would probably be a better option. When he said that he felt angry and felt like fighting someone, she should have explored this instead of saying that she would get back to that. Also, when he stated that he didn’t want to live, she should have asked if he had a plan. She asked if he thought about hurting himself but did not talk about the specifics of his suicidal thoughts. “Early identification of depression represents an important opportunity to prevent the morbidity and mortality associated with depression and suicide” (Fallucco et al., 2015).
Explain why a thorough psychiatric assessment of a child/adolescent is important.
According to Stanford Medicine a comprehensive psychiatric evaluation may help diagnose any number of emotional, behavioral, or developmental disorders (2023). The psychiatric interview is the most crucial element in the evaluation of adolescents. A comprehensive assessment of children and adolescents allows providers to gather the necessary information to seek interprofessional collaboration and develop a patient (Sadock et al. , 2015 ) .
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
One scale that I would use is the PHQ-9, this scale is a 9-item questionnaire based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV. This can be used in adolescents 12 and older. This scale can be completed in a few minutes by the patient and is scored by the psychiatrist in the office. Scores of 15 or greater usually indicated major depression (APA, 2011). Another scale I would use would be The Child Behavior Checklist (CBCL) it is a component of the Achenbach System of Empirically Based Assessment (ASEBA). The ASEBA is used to detect behavioral and emotional problems in children and adolescents (APA, 2015).
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Two types of therapy that can be used in children and adolescents is art therapy and play therapy. Art therapy is “a form of psychotherapy that uses art media as its primary mode of expression and communication” (Hu et al., 2021). Art therapy can help the patient to communicate their feelings without putting them into words. Play therapy is used primarily in children but can be used in adolescents. Play therapy helps the child to express feelings with toys instead of words. “Play therapy is an alternative proposal of intervention on important issues related to children” (Koukourikos et al., 2021). “Play therapy is widely used to treat emotional problems and behavioral disorders of children because it fully meets their unique developmental needs” (Koukourikos et al., 2021).
Explain the role parents/guardians play in assessment.
Parents/guardians are usually the first point of contact. Obtaining the history and what behaviors they have noticed comes from the parents/guardians. An initial consultation also allows the therapist to explain the process of play therapy and how it works. One method I like is meeting with parents 10 min before session starts and then play therapy for 45 minutes. This allows the therapist to address concerns the parents may have or any new behaviors. This also allows for “helping parents recognize the child’s goals of misbehavior and teach the parents how they can “(Homeyer & Bennett, 2023)