2 REFERENCES
A comprehensive psychiatric assessment is a necessary element for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to provide the necessary treatment for a client with mental illness while establishing a criteria-based diagnosis (Sadock, Sadock & Ruiz, 2014). A comprehensive psychiatric assessment depends on the skills and training of the PHMNP to interact well with their client and gather the information that will guide them to an accurate diagnosis and course of treatment.
Classification of mental health diagnosis in a clinical setting for diagnosis, treatment, and evaluation for the child or adolescent depends on the availability of reliable and valid instruments such as standardized diagnostic interviews (SDIs). These SDIs include the Diagnostic Interview Schedule for Children, 4th ed. That takes 90-120 minutes to administer, and the Mini International Neuropsychiatric Interview for Children and Adolescents and takes about thirty-five minutes to administer, enabling the PMHNP to document the presence and severity of symptoms and diagnose a specific psychiatric disorder (Duncan et al., 2018).
These assessments will include background information regarding family, whom the client lives with if the parents are separated, and their relationship with family members—information of past mental health issues, inpatient or outpatient treatment, and current medication. The PMHNP will also need to know about any medical conditions the client may have, and there is a need for medication. The client will also give information about his or her social life, friends, school activities, how well they are doing in school, and favorite subject. All of this information helps to discuss goals and develop a treatment plan.
This discussion is based on the video by YMH Boston, 2013 where I am observing an initial interview between and the provider and a male adolescent give additional suggestions of improvement and concerns that may or may not have been addressed during the initial interview and any additional questions that may need to be asked.
Observation of what the Practitioner Did Well and Areas of Improvement
The practitioner addressed confidentiality issues and when confidentiality will be broken, and Shawn was receptive and understood. The practitioner was able to establish a rapport with Shawn and obtain some basic information. The practitioner was able to talk about school sports, favorite subjects, and identify two people who can relate.
When talking about Shawn’s relationship with his mother, the practitioner’s comment makes Shawn uncomfortable and defensive when Shawn does not understand why his mom sent him for therapy. Shawn also becomes defensive when the practitioner probes why Shawn’s mom wants him to come to this appointment. The practitioner could have asked more questions regarding the school and the reasons for Shawn not liking school, and how Shawn’s dad fit into the picture.
Compelling Concerns and Additional Questions
The concerns would be at the root of the anger and how Shawn’s father fits into the picture. Does he take an active role in Shawn’s life, and I would ask Shawn about his dad, especially when Shawn states that he can confide in his coach and sees him as a father figure. I would want to know more about the difficulties he has at school, and his mom is aware of these difficulties. How do these issues need to be addressed? How are his grades? Does he need a tutor or peer support for subjects such as English to keep his grades up so that he can continue to play basketball?
I would also want to know what makes him angry, are there any identifiable triggers? Does he threaten his mom physically or verbally? Does he need group therapy whose focus is on anger management? Once again, are his school issues overflowing into his relationship with his mom, causing these angry outbursts?
Conclusion
One possible diagnosis for Shawn based on the interview would be Disruptive Mood Dysregulation Disorder 296.99 (F34.81). Shawn states that he loses his temper nearly every day and that his angry mood and yelling cause problems at home and could be a possible cause at school. He clearly stated that he gets upset when his mom asks him questions, mostly about school that triggers him, and he starts yelling. He stated that his mom set up the appointment because she believes he needs help managing his anger.
I would want to know about anxiety or depression, but there was not enough information or screening questions to come to any other diagnoses.
Anger is a secondary emotion that the root cause can be due to various internal and external factors. These factors can be biological, psychological, and social, a particular personality trait, anxiety and depression, and the ability to problem-solve, leading to verbal and physical aggression. By helping Shawn to acknowledge his anger and learns more about his anger and ways to manage the triggers that cause his anger, he will see a decrease in aggressive behavior and an increase in communication skills (Farisandy & Hartini, 2020)
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Duncan, L., Comeau, J., Wang, L., Vitoroulis, I., Boyle, M. H., & Bennett, K. (2018). Research review: Test-retest reliability of standardized diagnostic interviews to assess child and adolescent psychiatric disorders: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 60(1), 16–29. https://doi.org/10.1111/jcpp.12876
Farisandy,E., & Hartini, N. (2020). The effect of anger manatment training toward aggressive
Behavior in adolescents. Jurnal Psikologi, 19(1),95-107. https://doi.org/10.14710/jp.19.1.95-107
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.
YMH Boston. (2013, May 22). Vignette 4 – Introductions to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE