Week 1: Cellular Processes and the Genetic Environment

One of the more common biology analogies refers to cells as the “building blocks” of life. This rightfully places an emphasis on understanding cells, cellular behavior, and the impact of the environment in which they function.

Such an understanding helps explain how healthy cell activity contributes to good health. Just as importantly, it helps explain how breakdowns in cellular behavior and alterations to cells lead to health issues.

This week, you examine cellular processes that are subject to alterations that can lead to disease. You evaluate the genetic environments within which these processes exist as well as the impact these environments have on disease.

Learning Objectives

Students will:

Evaluate cellular processes and alterations within cellular processes

Evaluate the impact of the genetic environment on disease 

Scenario: The patient is a 38-year-old female who presents to the clinic with complaints of a wound to her right leg after a recent fall 5 days ago.  She reports that the area appeared to be healing and has now started getting red and has some dark colored drainage.  She denies any odor to the site.  She denies fever.  She has been cleaning the area with a wound spray and applying antibiotic ointment with a Band-Aid.  She reports that she has had some pain to the site 4/10 sharp at times. 

• For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts. 
• To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

By Day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

The role genetics plays in the disease.

Why the patient is presenting with the specific symptoms described.

• The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

The cells that are involved in this process.

As you establish your goals and objectives for this course, you are committing to an organized plan that will frame your practicum experience in a clinical setting, including planned activities, assessment, and achievement of defined outcomes. In particular, your plan must address the categories of clinical reasoning, quality in your clinical specialty, and interpersonal collaborative practice.

For this Assignment, you will consider the areas you aim to focus on to gain practical experience as an advanced practice nurse. Then, you will develop a Practicum Experience Plan (PEP) containing the objectives you will fulfill in order to achieve your aims. In this practicum experience, when developing your goals and objectives, be sure to keep PMHNP clinical skills in mind.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

TO PREPARE

Review your Clinical Skills Self-Assessment Form you submitted last week and think about areas for which you would like to gain application-level experience and/or continued growth as an advanced practice nurse. How can your experiences in the practicum help you achieve these aims?? 

Review the information related to developing objectives provided in this week’s Learning Resources.?Your practicum?learning objectives that you want to achieve during your practicum experience must be: 

Specific? 

Measurable? 

Attainable? 

Results-focused? 

• Time-bound
• Reflective of the higher-order domains of Bloom’s taxonomy (i.e., application level and above)? 

Note: Please make sure your objectives are individualized and outlined in your Practicum Experience Plan (PEP).?While you may add previous objectives to continue to work toward. You must have 3 new objectives for each class, each quarter. 

• Discuss your professional aims and your proposed practicum objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.  
• Select one nursing theory and one counseling/psychotherapy theory to best guide your clinical practice. Explain why you selected these theories. Support your approach with evidence-based literature.
• Create a timeline of practicum activities that demonstrates how you plan to meet these goals and objectives based on your practicum requirements.

Kirsis Perez 

YesterdayFeb 27 at 3:30pm

Comprehensive Integrated Psychiatric Assessment

 Introduction

                For the comprehensive, integrated psychiatric assessment of a child or adolescent, it is essential to gather the appropriate information that considers confidentiality and consent from the parent or appointed guardian. Obtaining a clinical history, presentation of symptomatology, and forming a therapeutic alliance are the main objectives for a case formulation that will ultimately guide the appropriate intervention and treatment (Srinath et al., 2019). This assignment will review and assess the case presentation based on a YMH Boston Vignette 5 video of an adolescent with symptoms of depression and anxiety.

What Did the Practitioner Do Well?

               The patient is a male adolescent of unreported age, referred to the social worker by his medical provider due to concerns about symptoms relating to depression and anxiety. The social worker’s tone and demeanor were adequate, and she asked questions in simple terms and used appropriate eye contact. The social worker also primed the patient to talk about his anger and stated, “We can talk more about that,” however, she was careful not to pressure the patient at any time during the assessment. The social worker summarized the patient’s symptoms, leading to the development of trust and a therapeutic alliance with the patient.

In What Areas Can the Practitioner Improve?

                In my opinion, the social worker can improve by introducing herself. Although she did ask the adolescent patient if he had a sense of why he was there, he answered the reason for being there was because his medical doctor sent him; however, he had feeble insight regarding the purpose of the evaluation. Furthermore, the social worker should have included the reasons and objectives of the assessment before starting the interview process. The social worker could have assessed the patient’s thought process, thought content, perception disturbance, cognition, and insight (Voss & Das, 2022). In my opinion, the provider could have touched more on the thought content and further assessed suicidal ideation, whether it was passive or active, with or without an actual plan (Voss & Das, 2022).

Point In the Clinical Interview with Compelling Concerns.

              The point during the clinical interview that was concerning was the lack of interest in obtaining collateral information. I also noticed that the social worker asked the patient if he had been thinking of doing something to hurt himself and ended with an open-ended question asking him to tell her more about that. The statement that precedes this is when the patient states, “I do not even want to be alive.” This is the point most concerning to me because it requires a more aggressive screening strategy regarding suicidal ideation.

What Would be Your Next Question and Why?

              My next question would be central after the patient’s thought content involved endorsing suicidal ideation. I would then ask do you have a plan? It is vital to assess for passive or active suicidal ideation. If a plan is in place, it will alert the clinician to use collateral information to prevent the patient from accessing resources and not allow him to follow through with a suicide plan (Sisler et al., 2020).

Why Is a Thorough Psychiatric Assessment of a Child or Adolescent Essential?

A thorough psychiatric assessment within the patient population is critical because the patient may not have the insight, desire, or willingness to open up during the evaluation. The adolescent may not necessarily agree they need help. For this reason, the need to inquire about collateral information is vital, and the clinician should use multiple sources if possible (Srinath et al., 2019).

Two Symptom Rating Scales That are Appropriate for Children and Adolescents.

          The Beck Depression Inventory-II is the revised version to fit the criteria for depression in the DSM-IV. The BDI-II has evidence-based research and is widely used for adults and adolescents. It is a 21-item self-reporting tool that follows the DSM-IV criteria; the total score is considered with the higher the score, the higher values, meaning the increasing level of depressive symptoms. The BDI-II is used in inpatient and outpatient settings and is valid and reliable (García-Batista et al., 2018).

           The Reynolds Adolescent Depression Scale is a self-report 30-item created to assess the severity of depressive symptoms in adolescents, and it is used in schools and the clinical environment. The RADS also shows validity and reliability and has substantial evidence-based research (Ortuño-Sierra, 2017).

Describe Two Psychiatric Treatment Options for Children and Adolescents but not for Adults

Play therapy plays a significant role in treating multiple mental health disorders in children. Sometimes, when the child has experienced a traumatic event, the child no longer shows improvement; the therapist may use a superhero play therapy intervention to push through the stagnation period caused by the anxiety of the trauma sequelae. The superhero theme is called into action, allowing the child to feel empowered and move through any stagnation period (Stauffer, 2021).

          Another type of intervention used exclusively with children is cognitive behavior play therapy (CBPT). This modality can be applied using CBT strategies but incorporates play-based interactions. The aspects of traditional adult CBT can help with a child who is not engaged, such as with the inclusion of activity scheduling (Bhide & Chakraborty, 2020)

The Role Parents or Guardians Play in Assessment.

        Parents are instrumental when assessing a child, not only from a legal perspective, since requiring consent is a mandatory part of the process. The main objective is to obtain as much information as possible regarding the presenting symptoms, past medical and psychiatric history, allergies, and so on to give a proper diagnosis and treatment. Besides inquiring about collateral information, there are instances where the child holds back information or is afraid to talk; furthermore, there are instances where the parent or guardian may benefit from the clinician’s advice, as the treatment is a process, and it takes time, for symptoms to dissipate, allowing the parent or guardian to gain insight into the biopsychosocial perspective (Srinath et al., 2019).

Peer Review Articles Explanation

         Peer-reviewed articles are sources of evidence that experts have evaluated. They help to improve the quality, integrity, and validity of studies. Researchers need to determine whether sources are peer-reviewed as it acts as a filter to ensure that only reliable sources are used. Bhide and Chakraborty (2020) is a peer-reviewed article written by experts in psychiatry. The article is also published in the Indian Journal of Psychiatry which is a reputable medical journal. Garcia-Batista et al. (2018)’s study is considered to be peer-reviewed based on its approach. The article is written in a systematic manner and engages in scholarly research. In addition, Ortuño-Sierra et al. (2017)’s study is scholarly as its authors are experts in healthcare. The article’s title is also specific to the topic of study. In addition, Sisler et al. (2020)’s study is considered scholarly as it is published on a credible psychiatric journal and is also accessed on the PubMed Library.

          Srinath et al. (2019)’s study provides guidance in psychiatry practice. Its approach depicts that the authors are experts in the field. This shows that it was written with the aim of reaching academic audiences. Stauffer (2021) is considered to be peer-reviewed as it is supported by The American Psychological Association. The feature shows the information provided in the article can be used as a standard for the management of trauma-related issues. Voss and Das (2021)’s article is also peer-reviewed. Its authors are associated with the Imperial College Healthcare in London and the LSU Health Shreveport. Its objectives are also academic in nature. For instance, one of the objectives is to identify what a mental health status examination entails and how it can be applied in psychiatric practice. YMH Boston (2013) video is not considered to be peer-reviewed as it is published on YouTube, which is not an academic website. However, its content provides scholarly insight regarding psychiatric practice.

please provide a positive feedback along with a reference for each post 

( Erica)

The social worker in the YMH Boston Vignette 5 Video did a great job engaging the client and making him more comfortable as the interview progressed. The patient was referred by his Primary Care Provider after reporting symptoms of depression and anxiety, however he denies those symptoms at this visit. The social worker did a great job asking about his symptoms in different ways that eventually resulted in the patient engaging and she also displayed reflective, empathic listening. He began disclosing the information she was soliciting as well as raising other symptoms. The social worker also did a great job both asking direct questions as well as open ended, providing multiple pathways for him to express his concerns. (YMH Boston, 2013).  

Multiple concerning issues were raised for this patient, including his decline in functioning as exhibited in his worsening school performance, as well as his reported suicidal ideation. My next questions would be to further understand his suicidal intent and if he has formulated a plan. I would ask if he has any history of suicidal ideation or attempt in the past as well as attempt to determine any additional risk factors or protective factors.

A detailed, thorough assessment of a child or adolescent is crucial to high quality psychiatric care. Correctly identifying the presenting illness guides treatment options and establishes a plan to reach optimal outcomes. (Srinath et al., 2019). There can be several barriers to accurate assessment of children and adolescents. These can be related to the patient not understanding compelling reasons or wanting to engage in care, decreased ability to mark the timing or duration or symptoms, decreased ability to identify and express their symptoms, or stigma and embarrassment related to their symptoms and obtaining care. When available, involving the patient’s parents or guardians can add greatly needed context and details to the assessment (Srinath et al., 2019).

Psychiatric screening tools can be used to capture more information. One of these tools that has been used for this population is the Childhood Anxiety Sensitivity Index (CASI), which is an 18-item scale used to reflect anxiety symptoms. A 2019 systematic review looked at 50 studies extending back to 1991, that were examining the efficacy of this tool. While this is the most widely used anxiety scale for children, their findings indicate the CASI did not yield consistent results. Alternative scales have been created but they have yet to be evaluated in the literature and is an important area for further analysis. (Francis et al., 2019). Another tool used in this population is the Children’s Social Behavioral Scale (CSBS) which is a 15-item scale that measures young children’s behavior with peers at school. A 2021 study looked at the reliability and validity of this scale in its use to evaluate aggressive behavior. They evaluated 3,102 youth and their caregivers across 6 different communities. They found this scale produced consistent results and has further use in both clinical and research environments. (Brandes et al., 2021).

Some approaches are appropriate for children or adolescents but are less useful in the adult population. An example would be play therapy, which is modeled around developmental stages and is used to facilitate expression in children (Frawley et al., 2023). Adults may benefit from other forms of recreational therapy, like art or dance therapy. Another treatment variation between the two age groups is the use of clonidine. While it is one of the first line options for ADHD in children, the decreased efficacy for adults, coupled with blood pressure side effects make it a better option for adjunct use.  (Geffen & Forster, 2018).

References:

Brandes, C. M., Reardon, K. W., Shields, A. N., & Tackett, J. L. (2021). Towards construct validity of relational aggression: An examination of the Children’s Social Behavior Scale. Psychological Assessment, 33(9), 855–870. https://doi.org/10.1037/pas0001005.supp (Supplemental)

Francis, S. E., Noël, V. A., & Ryan, S. L. (2019). A systematic review of the factor structure of anxiety sensitivity among children: Current status and recommendations for future directions. Child & Youth Care Forum, 48(5), 603–632. https://doi.org/10.1007/s10566-019-09502-yLinks to an external site.

Frawley, C., Lambie, G. W., Stickl Haugen, J., & Dillman Taylor, D. (2023). The Assessment of Play Therapy and Child Counseling Competencies (APTCCC). International Journal of Play Therapy. https://doi.org/10.1037/pla0000208Links to an external site.

Geffen, J., & Forster, K. (2018). Treatment of adult ADHD: a clinical perspective. Therapeutic advances in psychopharmacology, 8(1), 25–32. https://doi.org/10.1177/2045125317734977

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescentsLinks to an external site.Links to an external site.. Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatr…

( Tamara)

Comprehensive Integrated Psychiatric Assessment

Comprehensive, integrated psychiatric evaluation is a critical element for managing patients with various mental health issues. The comprehensive psychiatric evaluation comprises collecting information on different elements, including the history of present illness, family history, psychosocial history, past psychiatric history, substance use history, system review, physical exam, and diagnostic testing (Dreimüller et al., 2019). A mental health provider’s capacity to make accurate patient diagnoses and formulation of a patient-centered therapeutic plan is dependent on comprehensive psychiatric assessment. For children and adolescents, the comprehensive psychiatric evaluation should be completed in the presence of their parents or guardians, as they are critical to providing information and assisting in decision-making. The selected video for review, Vignette 5, is for a social worker completing the psychiatric assessment for an adolescent referred for depression evaluation.  

What the Practitioner Did Well

The practitioner did well in different areas during the evaluation of the adolescent. Foremost, the practitioner questioned relevant concerns relating to depressive symptoms. She asked most questions targeting to assess all depressive symptoms the patient may be having. She had insight into depressive symptoms that patients should be asked about, thus ensuring comprehensive evaluation. Furthermore, the practitioner demonstrated effective verbal and non-verbal communication skills. She maintained eye contact with the patient during the assessment and was audible enough, thus showing her interest in the patient’s case.

Areas the Practitioner Should Improve

The practitioner should improve on the following elements based on the evaluation. Foremost, she should improve her questioning skills by asking open-ended questions. Most of the questions asked were leading questions that did not allow the patient to offer a comprehensive response. Moreover, she should enhance her rapport-building skills. She needs to make a formal introduction of herself and establish the goals of the assessment with the client. Building rapport with the patient is essential to improving his comfort in sharing detailed information on his health concerns.

Compelling Concerns

The compelling concerns for the patient considering the assessment include. Foremost, more information on the patient’s plan about ending his life. The patient accepted that he was not willing to continue living and had suicidal thoughts. More evaluation of the patient’s plan for suicide should be collected, which will be essential to formulating appropriate suicide prevention initiatives. Moreover, details on the available social support for the patient. The patient’s depressive symptoms had been triggered by the breakup with his girlfriend. Assessing the available social support is essential for the patient to formulate an appropriate support system.

My Next Question

My next question for the patient will include the following. Foremost, details about the patient’s plan for committing suicide as he didn’t feel like living anymore. The patient should offer detailed information on his suicide plan, which is critical to formulating the most appropriate intervention. While evaluating his suicide plan, it is essential to question anyone else with whom he has shared his thoughts of committing suicide.

Significance of Thorough Comprehensive Assessment of a Child/Adolescent

Comprehensive psychiatric assessment for children and adolescents is critical for various reasons. Foremost, the comprehensive evaluation aids in understanding the factors contributing to psychiatric symptoms in children and adolescents (Shah et al., 2023). As interactions between the cognitive, educational, social, genetic, developmental, physical, and environmental factors lead to psychiatric disorders, comprehensive assessment aids in identifying the interacting factors. Moreover, comprehensive psychiatric assessment aids in identifying the precise psychiatric disorder the pediatric is having and illuminating other issues relating to the child (Shah et al., 2023). Comorbid disorders in pediatrics following psychiatric diagnosis can be recognized following a comprehensive evaluation. Furthermore, comprehensive psychiatric assessment assists in determining the most appropriate evidence-based intervention for managing pediatric psychiatric disorders. Accurate diagnosis for pediatric psychiatric mental health issues is critical to formulating patient-centered, evidence-based interventions.  

Symptoms Rating Scale

Various symptom rating scales are available for assessing pediatric psychiatric symptoms. Foremost, the Child PTSD Symptom Rating Scale (CPSS). The CPSS aids in evaluating post-traumatic stress disorder severity in pediatrics aged 8-18 years and is used as a patient self-report or clinician-administered interview (Hermosilla et al., 2020). Moreover, the Young Mania Rating Scale (YMRS). The YMRS is an eleven-item rating scale completed by parents and used by pediatricians to identify whether pediatrics who have suspected bipolar disorder need a referral to a mental health provider (Fristad et al., 2021).  

Psychiatric Treatment Options for Children and Adolescents

Pediatric psychiatric disorders should be managed using the following treatment options. Foremost is Acceptance and Commitment Therapy (ACT). ACT is used for managing pediatrics to help them understand and accept their inner emotions (Parmar et al., 2021). Therapists using ACT allow children and adolescents to use their deeper comprehension of emotional struggles to commit to moving forward positively. Moreover, Parent-Child Interaction Therapy (PCIT). PCIT assists parents and children with behavioral problems or difficulties through real-time coaching sessions (Campbell et al., 2023).  

Roles of Parents/Guardians in Assessment of Children and Adolescents

Parents or guardians have a significant role in assessing children and adolescents presenting with various psychiatric and mental health issues. Foremost, parents/guardians offer additional information on behavioral changes in children and adolescents. Parents stay with pediatrics most of the time, which allows them to have more details on how their behavioral changes occurred (Sharma et al., 2019). Moreover, the parent/guardian offers details on the family, environmental, and developmental history. The information can aid in identifying childhood experiences likely to contribute to mental health issues. Moreover, parents/guardians participate in decision-making during pediatric assessment. Parent’s consent is vital to completing comprehensive psychiatric evaluation in pediatrics and formulating their treatment plans.

All the articles used to support ideas in this paper are scholarly since they were published in the last five years, have reference lists and in-text citations, are published by recognized journals, and are peer-reviewed.