Adolescent Psychiatric Evaluation


Mental health illness is a potentially sensitive topic; hence, it is susceptible to factors affecting the reliability and validity of patient self-report. In this case, David appears to be anxious and withdrawn; thus, he will need considerable support in discussing his current problem(s). Therefore, there are specific communication techniques that should be used to enable David to be a more reliable historian. These include normalizing, and careful wording of questions, such as the use of close-ended questions, providing response choices, assuming the behavior is occurring, and careful word choice.

Social history

  • Where are you living currently?
  • Who are you living with currently?
  • Has your mood affected your friendships?
  • Are you able to socialize regularly with others?
  • Have you told anyone/friends/family regarding how you are feeling?
  • Has your mood affected your ability to study?

Family history

  • Has there been an incidence of psychiatric illness in the family?
  • Has there been an incidence of substance abuse in the family?
  • Has there been an incidence of suicide in the family?

Medical history

David’s medical history comprises of the presence of significant medical conditions and hospitalizations, types of prescribed medication or herbal remedies, duration of administration, allergies, and any recent changes to the dosage of his medications.

Other information obtained from David’s mother

  • Has there been a change in his appetite?
  • Has David had any counseling sessions before?

Questions asked to David when alone

  • Have you ever taken any drugs?
  • Are you sexually active currently?
  • Many people feel that life is no longer worth living when they feel down or depressed. Have you ever felt like this?
  • Many children find it difficult to talk about abuse. Have you ever seen or been a victim of abuse? Whether physical or verbal.
  • Do you have a good support system.

Evidence-based screening tool

The Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS) is an efficient tool used to assess mental health. It contains a string of diagnosis-specific short forms of DISC, as it explicitly constitutes of DISC items, which are most predictive of Diagnostic and Statistic Manual of Mental (DSM) IV criteria. It is recommended for children aged 8-18 years and takes approximately 10-20 minutes (Wiesner et al., 2015).

DPS has good validity and reliability, and high specificity and sensitivity (Wiesner et al., 2015). It is a test that can be administered in either a paper-based or computerized format and should be answered by a parent and their child. The DPS aims to evaluate symptoms associated with 18 mental disorders, each containing its distinct items. It also measures impairment with seven items inquiring parent reactions and limitations that are a resultant of the child’s feelings and behavior.

Each disorder is scored independently, and the aggregate score thus constitutes the sum of DPS symptomatology and impairment. A total score of 9 and above when general anxiety, social phobia, alcohol, marijuana, and other substances are present, indicates the presence of mental disorders. Thus, in case David has a score of ≥9, he needs to be referred to a mental health practitioner.

Health Promotions and Screening Recommendations

Since the DPS is a brief version of the DISC screening tool, it is essential that if an individual scores ≥9, they should be subjected to more specific screening assessments depending on the subscale that had the highest value.

Mental health promotion intervention objectifies to bolster an individual’s ability to control emotions, enhance resilience to adversities and stressful situations, increase alternatives to risk-taking behavior and promote supportive social environments (Das et al., 2016). Examples of these interventions include recommending the mother to the free National Alliance on Mental Illness’s Family-to-Family program to learn how to care for David in the case he has a mental illness.

References

Das, J. K., Salam, R. A., Lassi, Z. S., Khan, M. N., Mahmood, W., Patel, V., & Bhutta, Z. A. (2016). Interventions for adolescent mental health: An overview of systematic reviews. Journal of Adolescent Health, 59(4), 49-60. Web.

Wiesner, M., Windle, M., Kanouse, D., Elliott, M., & Schuster, A. (2015). DISC Predictive Scales (DPS): Factor structure and uniform differential item functioning across gender and three racial/ethnic groups for ADHD, conduct disorder, and oppositional defiant disorder symptoms. Psychological Assessment, 24(4), 1324-1336. Web.