Improve is assessing problems at home, school, and other social issues during the opening phase.
Sharon Tipler
Main discussion post
COLLAPSE
Sharon Tipler’s main discussion post
Comprehensive integrated psychiatric assessment
A comprehensive, integrated psychiatric assessment is a vital part of mental health therapy. This assessment helps practitioners provide care to patients. Psychiatric mental health nurse practitioners (PMHNP) must be knowledgeable and thoroughly complete these assessments when caring for children/adolescents. The following paragraphs noted an observation of a mental health practitioner and patient in the YMH Boston vignette video four.
Areas that went well and needed improvement
The practitioner did several actions well during the video. At the beginning of the interview, he explained the confidentiality and privacy right that the patient had. The practitioner also was respectful and considerable. He understood that the patient had some issues with his mom. The practitioner’s ability to understand the client’s problems adds to developing a therapeutic patient to physician relationship. Mental health practitioners must have mentalizing attitudes to support this relationship (Carvalho, Goodman, & Ramires, 2019). One of the things that the practitioner could improve is assessing problems at home, school, and other social issues during the opening phase.
Compelling concerns and the next question
I have several concerns regarding the patient. One of my problems is, why is the patient so angry with his mom? During the opening phase, the psychiatrist should assess past experiences with parents and formulate problem-causing actions (2012a). Another concern is that I do not believe that the patient fully understands his mom’s role as his caregiver. My next question would be, what would it take for the patient to sit down and discuss his concerns with his mom?
References
American Academy of Children and Adolescent Psychiatry (AACAP)(2012a). Practice parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child and Adolescent Psychiatry, 51(5), 541-557. Retrieved from http://www.jaacap.com/article/50890-8567(12)00141-4/pdf
Carvalho, C., Goodman, G., & Ramires, V. (2019). Mentalization in child psychodynamic psychotherapy, British Journal of Psychotherapy, 35(3), 468-483. Doi:10.111/bjp.12483
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 5, “Examination and Diagnosis of the Psychiatric Patient” (pp. 192–289)
Amy Martin
Week 1 Discussion 1
COLLAPSE
In this video we are introduced to Shawn a 16-year-old male patient who presents for evaluation. His chief complaint being “I don’t know. My mom wanted me to come.” During the video I felt that the practitioner started off a little slow and had some challenges with connecting to the patient. As practitioners it is important that we approach subject with our patient’s in a way that is not judgmental or biased, but helps to illicit responses from the patient that paints and accurate picture. “Teens don’t want to hear from their doctor what they hear from their parents, which is, ‘Do you smoke? Quit. Do you drink? Don’t,'” Dr. Rappo says. “Most teens don’t say, ‘I’m smoking and I’m worried about it.’ The doctor has to approach such subjects carefully and say something like, ‘At your age, I imagine that some of your friends are starting to smoke,’ and then go from there” (Hugel, 1999, p. 24). When Shawn talked about not liking school the practitioner had an opening to further expand on this subject, considering the patient brought up his dislike for school a couple of different times during the conversation, it may have been an important concern for the patient. It also would have allowed a better insight into the patient’s attitude and behaviors at home since Shawn stated that his mother thinks he has issues with anger management.
I thought the practitioner did well when he was able to connect with Shawn towards the end of the video by rephrasing Shawn’s words and emphasizing about his need to be listened to, which he feels his mother is not good at doing. However, when the patient was discussing playing basketball with his friends, I think it this would have been a good area to assess for substance use by asking what him and his friends do outside of basketball, by making mention that at 16-year-old I imagine that there are some parties you get invited to, maybe help transition into a more open conversation about the patient’s substance use history.
Another important subject to bring up during this assessment is safety. We need to understand the patient’s affect, mood, and thought. We need to assess the patient for safety. The practitioner did indicate the confidentiality and when this would be overridden, but as practitioners we also need to expand on this by actually assessing for safety. “Depression is common among teens, and its consequences are volatile: suicide is the third leading cause of death for Americans between the ages of ten and twenty-four” (“R U There?”, 2015, p. 30). As practitioners we need to establish and open and honest communication with our patient’s or we will not be able to appropriately assess the patient effectively allowing us to accurately gage the patient’s safety, substance use history, as well as an accurate mental status exam.
References
Hugel, B. (1999). Is your doctor right for you? Scholastic Choices, 14(4), 24.
R U There? (2015). New Yorker, 90(47), 30–31.
YMH Boston. (2013c, May 22). Vignette 4- Introduction to a mental health assessment [Video file].
Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE
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