Comprehensive Integrated Psychiatric Assessment Sample Paper
Psychiatric interviews largely depend on established rapport between the client and the clinician. Set up of the environment, communication skills and ethical principles determine the effectiveness of the interview. In the Vignette 5, the clinician provides comfort for the patient, facilitating and maintaining rapport. Their face to face sitting position allows for observation of nonverbal cues. The clinician allows the client to fully express himself without unnecessary interference. The tone is calm and conducive to assure trust and care towards the client’s concerns. The clinician also has controlled participation in the interview, giving time for the client to speak freely. However, the clinician seemed to use some open-ended questions such as “Have you had any thoughts of injuring yourself,” which limits the level of input given by the client. Open-ended questions while exploring sensitive and ambiguous topics helps the client to take a lead in their thoughts.
The interview is superficial in exploring every topic. The clinician is brief, and transits from topic to topic, rather than following the leads provided by the patient. This mode of interview exempts crucial information necessary in making a clinical decision. The question on use of drugs was direct and leading, and the client seemed to find it uncomfortable. Use of indirect statements, as observed by Srinath et al. (2019), tends to patients feel at ease when responding to questions. Further, the physician fails to follow up on the client’s breakup and possible withheld pain. Ideally, Tony sounds to have been heavily affected by the break-up, an aspect that poses a threat to his wellbeing, and possibly life.
Physicians recommend psychiatric assessment for children and adolescents who present with emotional or behavioural problems. A thorough and comprehensive assessment may take hours or days. To adequately diagnose a child, the clinician needs to relate with the child by examining the patient’s psychosocial background and identify the uncommon presentations. This is however not consistent, continuous and collaborative within the assessment schedules. Establishing an alliance with a child is time conscious. An assessment also guides the parents in developing a personalised plan of care based on a clearer understanding of the child’s needs.
Early and correct diagnostic tests are recommended on need basis to prevent further deterioration, and to enable early treatment. DSM-V guidelines provide over 160 different scales for use by clinicians in diagnosing different psychotic disorders. Attention-Deficit/Hyperactivity Disorder Test (ADHDT) tool, often filled by clinicians, teachers or parents, helps identify present symptoms of ADHD in children. The scale assesses hyperactivity, impulsivity and inattention. The assessor rates against every listed symptom (35) as no problem, mild problem or severe. Another scale used to assess children and adolescents is Anorectic Behaviour Observation Scale (ABOS) (van Noort et al., 2018). Often, parents have the responsibility of filling this scale to assess for eating disorder in children or adolescents. The items assessed correspond to items present in the self-reporting tool and the clinician-filled tool.
Treatment plans for psychiatric disorders are either psychotherapy or pharmacological, or both. Psychotherapy takes many forms depending on the issue and age of the client. Some of the forms of therapy specific to children include parent child interaction therapy (PCIT), and mentalization based therapy (MBT) used among children and teens (Griffiths et al., 2019). The former is used to support families experiencing disconnection between the child and the parent, guiding them towards achieving positive relationships. The latter form works on teens that have difficulties with self-identity. The therapy helps such patients grow into their better selves. Assessment conducted on children and teens is largely dependent on subjective details provided by the parent. Presence of the symptoms assessed borrows from behaviours observed over time. In this case, the caregiver is the child’s spokesperson.
References
- Griffiths, H., Duffy, F., Duffy, L., Brown, S., Hockaday, H., Eliasson, E., Graham, J., Smith, J., Thomson, A. & Schwannauer, M. (2019). Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial. BMC Psychiatry, 19(1), 167–170. doi:10.1186/s12888-019-2158-8
- Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for Assessment of Children and Adolescents. Indian Journal of Psychiatry, 61(Suppl 2), 158–175. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18
- van Noort, Betteke Maria; Lohmar, Sylvie Katharina; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Winter, Sibylle Maria; Kappel, Viola (2018). Clinical characteristics of early onset anorexia nervosa. European Eating Disorders Review, 26(5), 519-525. https://doi.org/10.1002/erv.2614