Nurs 6660-W1 Discussion – Comprehensive psychiatric assessment
Week 1 Discussion
Comprehensive psychiatric assessment is a complete evaluation of the patient/client’s appearance, behavior, and motor functions. This looks at exploring the client’s judgment, mood, affect, thought process, level of insight, speech, memory, and orientation. For children and adolescents, gaining a comprehensive evaluation is tied to the therapist’s ability to build a therapeutic relation based on confidentiality and the ability to adequately recognize and explore effectively, dysfunctions in the above mentioned areas.
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For this week’s discussion, we are asked to address the following questions based on the YMH Boston 4 video presented in this week’s course resource.
Question 1: What did the practitioner did well? In this video, the practitioner was able to connect with the client to establish a therapeutic relationship. The practitioner, through the series of questions, was able to get the client to open up about the cause of his anger issues with his mom which was linked to his negative experiences at school. The practitioner did retrieve from the client his areas of interest and the two people that he felt comfortable talking with. Nurs 6660-W1 Discussion – Comprehensive psychiatric assessment.
Question 2: What areas can the practitioner improve? The practitioner was trying hard to keep his connection with his client that he moved from exploring and gathering information on key elements relating to the things that the client is dealing with and started offering his own options of why the client was having a difficult time relating to this mom and why the client was able to relate comfortably with his coach and girlfriend. The practitioner was not able to control his thoughts and emotional transference to the case at hand. This could be due to his own past experiences as a teenager and how he felt about his interactions with his parents. Also, it felt like the practitioner was rushing through the interview, wanting to complete the series of questions he had and not focusing in on what the client was actually saying to him or trying to gather more information from the client at key moments when the client was reflecting on his struggles with school.
Question 3: At this point in the clinical interview, do you have any compelling concerns? If so, what are they? There are definite compelling concerns that are yet to be addressed with this client. One of these issues is what negative experiences about school is the client dealing with. The client mentioned that the only subject at school that he is doing well is Math but we do not understand what about this subject (teacher, availability of resources, time to complete assignments since he is involved with sports, or maybe someone is present or absent from this class etc) fuel his success as compared to the other subjects. Another compelling issue is to determine the content of his discussions with his mom, girlfriend, and coach. It might be possible that his mom might have obtained some important information about why the client is having a hard time at school which the client is not ready to talk about and the client has not disclosed this issue with his girlfriend or coach. The practitioner can never make assumptions that the client is getting the help he needed from the people he is comfortable speaking with. Another concern to explore is why the client (from the client’s perspective) feels comfortable to talk with his girlfriend and coach and not his mom. Lastly, I would like to address with the client when the anger issues with his mom started and what was going on at school and at home at that time. Nurs 6660-W1 Discussion – Comprehensive psychiatric assessment.
Question 4: What would be your next question, and why? My next question would be “tell me why you feel Math is your best subject?” “What about the course or class make it different from your other courses?” I hope to start the conversation about what negative experiences about school makes the client feel that “school sucks”. To start the conversation from this point will help to start revealing some of the difficulties that the client is experiencing and hopefully I can get information about his current and true thought processes, mood, and affect.
Week 1 Discussion
The purpose of the psychiatric interview is to elicit information from a patient to determine a diagnosis and subsequently, a treatment plan. According to Kaplan, Sadock, and Ruiz (2014) the interview can shape the patient- practitioner relationship and important aspects of the interview includes patient consent to an interview, explanation and follow through of confidentiality and privacy, providing the client with respect and consideration, developing a rapport with the client, while providing a safe and comfortable environment for the client (pp193-194).
What did the practitioner do well?
The provider did a great job providing a safe place for the client and explaining confidentiality and potential reasons why he would need to break that confidentiality. He gave his full attention to the client and asked questions to get a better understanding of the client’s answer. He asked if the client had someone he can talk to he can trust to assess support (YMH Boston, 2013). Nurs 6660-W1 Discussion – Comprehensive psychiatric assessment.
In what areas can the practitioner improve?
Twice the client stated he did not like school and the practitioner failed to ask why. According to Scher (2016) “academic functioning is a common concern” (para 4, Adolescent interview). I believe this may have been an opportunity to see if he was having trouble at school either in academics or with peers. School was also the area of contention with the mother. The practitioner also could improve by wording his sentences in a different manner. After he said “she must have a reason” the client seemed as though he did not want to talk about the issue further (YMH Boston, 2013, 1:52). The practitioner could have asked how long this has been occurring, how often, and what other symptoms the client may have.
What would your next question be and why?
I would ask the client to describe a typical day from the time he wakes up until he goes back to bed. This question would allow more insight into the client and his activities and I would be able to explore any other symptoms or patterns that the client does not recognize. For example, the client may reveal he stays up late talking to his girlfriend and he is too tired to focus in class. Further exploration will help guide the treatment plan. Nurs 6660-W1 Discussion – Comprehensive psychiatric assessment.
References
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.
Scher, L.M. (2016). Psychiatric interview. Retrieved from https://emedicine.medscape.com/article/1941476-overview#a14
YMH Boston. (2013). Vignette 4- Introduction to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE Nurs 6660-W1 Discussion – Comprehensive psychiatric assessment