Care Across The Lifespan I
Respond 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.
Please write a response for 1&2
1. Respond to this post
The patient has been referred to psychiatric care to evaluate the symptoms of depression and anxiety that he reported in his physical exam. The practitioner begins with open-ended questions and asks follow-up questions to gather more detail. The patient appears guarded and unsure of how to respond to some questions. The practitioner gives him words to describe his feelings. He can then identify that he is “angry” and wants to “fight.” She can determine that the patient is having difficulty with energy and feeling tired. She addressed drugs and alcohol. She also took the time to rephrase the patient’s concerns to ensure understanding. He indicates suicidal ideation before the video ends, which is concerning, to say the least. Care Across The Lifespan I
It is difficult to say what the practitioner could have done better in such a short clip. The initial interview should begin with building a therapeutic alliance (Carlot, 2017). The practitioner should establish a foundation of trust and encourage the child to relax with the interviewer (Thapar et al., 2018). Given the opportunity as a practitioner, I might start the interview by introducing myself and asking the patient to share a bit about himself. I would also explain the therapy process following the patient’s level of cognition. Once a comfortable dialogue has been established, I would ask the patient about the reasons for treatment.
For this patient, I would utilize the Colombia-suicide Severity Rating Scale (C-SSRS). Conway et al. (2017) found predictive validity of suicidal intensity, duration of ideation, and deterrent factors. All of these identified factors were noted as significantly relevant to the short-term risky behaviors indicating that the C-SSRS is an effective tool. Brown et al. (2020) suggest that a history of suicide attempt is a strong predictive risk factor. The Mood and Feelings survey is a self and parent reported scale that has been validated as effective (Thapar, 2017). This tool is available in a long and short versions. It allows the patient to score their perceptions and feelings while allowing input from the caregiver. Care Across The Lifespan I
The role of the parents in adolescent psychiatric care is highly dependent on the situation. Some parents may be very observant, involved, knowledgeable, and concerned. Other parents may contribute to the depression or anxiety of the child. The practitioner needs to be sensitive to the parent/child relationship. An involved parent offers valuable information related to the child’s situation, while an abuser may be deceitful or manipulative. Interviewing the child without outside influence may provide valuable insight into the patient’s situation and feelings.
Carlat, D. J. (2017). The psychiatric interview. Wolters Kluwer.
Conway, P. M., Erlangsen, A., Teasdale, T. W., Jakobsen, I. S., & Larsen, K. J. (2017). Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Archives of Suicide Research, 21(3), 455–469. https://doi.org/10.1080/13811118.2016.1222318 Care Across The Lifespan I
Brown, L. A., Boudreaux, E. D., Arias, S. A., Miller, I. W., May, A. M., Camargo, C. A., Jr, Bryan, C. J., & Armey, M. F. (2020). C-SSRS performance in emergency department patients at high risk for suicide. Suicide & Life-Threatening Behavior, 50(6), 1097–1104. https://doi.org/10.1111/sltb.12657
Thapar, A., Pine , D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor , E. (2017). Rutter’s child and adolescent psychiatry (6th ed.). Wiley-Blackwell.
Attachment: predictive validity of CSSRS .pdf (605.615 KB) Care Across The Lifespan I
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This week’s discussion is based on the YMH Boston Vignette 5 video. The patient was referred based on his symptoms of depression. I think she could have assessed his orientation and understanding. In the beginning, she just asked did he know why he was there being seen. She could have asked more leading questions to determine when his depression/ anger began. The client stated that he broke up with his girlfriend recently. So, it would be appropriate to understand if it was situational or if it began before his breakup so that he could come up with a possible reason for the breakup. This could help to reduce his anxiety. She also could have asked more questions regarding his anger such as what causes his anger and what he does to calm himself. Care Across The Lifespan I
At this point, I do have some compelling concerns. He has been feeling suicidal. He endorses that since his breakup months ago from his girlfriend he feels like he does not want to live any longer. At this point, he would need psychiatric intervention. I would refer him to the ER based on his plans to act. I would ask if he had an active plan. If so, what is his plan, and how does he plan to act on his plan? If his thoughts are not severe, I would consider starting an antidepressant in addition I would refer him to a therapist.
My next question would be to determine the severity of his depression and suicidal ideation. I would ask about his plan to act and if he has done anything to act on those plans. Those questions will determine the next steps either to proceed with the monotherapy medication regimen or if hospitalization is required for this patient to prevent imminent harm to himself or others. Care Across The Lifespan I
It is important to understand if there is an immediate risk of harm to themselves or others. Also, it is important to understand the details and nature of the risk in case child protective service needs to be contacted to intervene to possibly remove the child from the risk of harm or danger.
An assessment that can be used in pediatrics and adolescents is a Pediatric Symptom Checklist (PSC). PSC is an assessment used to identify and assess changes in emotional and behavioral problems in children aged group 4-17 in place of the PHQ-9 (Hilt & Nussbaum, 2016). PSC consists of 35 questions rating is “never, sometimes, or often”. A score of 28 or higher indicates psychological impairment for children 6-16 and for children 4 and five the cut of the score is 24. A PSC can be completed by the guardian and the child who is 13 years or older. A child that scores 15 points or greater should be referred to psychiatry for further treatment (Bergmann, Luke, Nguyen, Jellinek, & Murphy, 2020). Cross-Cutting Symptom Measure is completed before the initial evaluation by the caregiver or person seeking the assessment. According to Clarke & Kuhl (2014), The assessment tool was developed by the DSM-5 Task Force and work Group to serve as a “review of mental systems” in patients presenting for evaluation. Level 1 includes 25 questions measuring the presence and severity of symptoms over two weeks (Clark & Kuhl, 2014). Level assessment of anger, anxiety, depression, inattention, mania, repetitive thought and behaviors, sleep disturbance, somatic symptoms, and substance use (Hilt & Nussbaum, 2016). Both level 1 and 2 Cross-cutting Measure help to identify and characterize the present problems. Care Across The Lifespan I
Two types of treatment options for children and adolescents that may not be used when treating adults are Play therapy and parent-to-child interaction therapy. Play therapy has been used to treat abuse, developmental delay, and behavioral maladapted children (Jensen, Biesen, & Graham, 2017). A study done on the effectiveness of play therapy in reducing anxiety showed play therapy had no significate deviation in anxiety levels before and after play (Davidson, Satchi, & Venkatesan, 2017). Parent-to-child therapy was developed as 18- 20-week sessions to correct disruptive behavior in preschool. In a study of 229 parent-child pairs, those receiving intervention right away had a lower rate of depression after 18 weeks or less.
The role of the parent in the assessment process is to get consent for treatment, to obtain present and history, and to obtain family history and background info on current issues like symptoms. On a therapeutic level, parents can be used for calming purposes as well. Care Across The Lifespan I
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing
Bergmann, P., Lucke, C., Nguyen, T., Jellinek, M., & Murphy, J. M. (2020). Identification and utility of a short form of the Pediatric Symptom Checklist-Youth self-report (PSC-17-Y). European Journal of Psychological Assessment, 36(1), 56–64. https://doi.org/10.1027/1015-5759/a000486 Care Across The Lifespan I
Clarke DE, Kuhl EA. DSM-5 cross-cutting symptom measures: a step towards the future of psychiatric care? World Psychiatry. 2014 Oct;13(3):314-6. doi: 10.1002/wps.20154. PMID: 25273306; PMCID: PMC4219074.
Jensen, S. A., Biesen, J. N., & Graham, E. R. (2017). A meta-analytic review of play therapy with emphasis on outcome measures. Professional Psychology: Research and Practice, 48(5), 390–400. https://doi.org/10.1037/pro0000148
Davidson, B., Satchi, S.N., & Venkatesan, L. (2017). Effectiveness of Play Therapy upon Anxiety among Hospitalized Children. International Journal of Advance Research, Ideas, and Innovation in Technology, Volume 3, Issue 5. https://d1wqtxts1xzle7.cloudfront.net/55548843/Effectiveness_of_Play_Therapy_upon_Anxiety_among_Hospitalised_Children-with-cover-page-v2.pdf?Expires=1662005826&Signature=InF3QFywrHBLrk2j4EpGB-ShfTG00WqN92JdQ4hvr0HbimOGZkFsQJbC~KZNRZdgTLc9Ry3Kp53dkGVt3q1wpanjKrMMVLSykvMRWpkR~JWWYgAcVV~nMcolaAqdAY–KQ2ecQ1KHV0Y3zXBCXta3YazuE~nV6mqjZyyL4z8tvalUPsSf~xViGDD-Xp0Bz7CZ4ErWDGtgJje4ocsmcd5WWbxfKywnBN-NH5hNig8NV~bBj58SL8IlD4L4JrYuKYCeP2-I8a4TlVjD-QWq1EHkaWl82LUaKk4~uJmDXRLiGjoR2QuUjhdaQxOTjJoW2AJpvrYqVN-XJZu44adfwFJMw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA Care Across The Lifespan I
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