Health assessment
1) ?Health assessment would include mental health and specific consideration for suicidal ideations. With the patient admitting to suicidal thoughts immediate intervention is warranted. Referring the patient to the emergency department for emergency psychiatric care would be warranted. Safety is of the upmost importance and with suicidal thought safety would need to be ensured.
2) My interdisciplinary approach would be primary care along with psychiatry and mental health services. We would want recommendations from the psychiatrist to treat the patient properly. With us sending the patient to the ER we would get psychiatry recommendations while they are there. If the patient is needing inpatient care then we would want to follow up with the patient upon discharge from the mental health facility. This child would require close monitoring and follow up.
3) Social detriments of health for this child include home life, school life, and social life. I would assess them by probing into different parts of the detriments. More information is needed.
Home: We would want to know who she lives with? Is this a stable, caring, supportive environment? Does she feel safe at home?
School: School appears to be an area of stress for this patient. Are there any happy parts to school for the child or is it all stressful and filled with bullying? Does she have any friends at school? Is the school supportive through the bullying? Is there any repercussions for the bullies to hopefully stop these actions from them in the future? Is a better option home schooling or transferring schools (even just short term)? Does she feel safe at school?
Social life: Does she hang out with anyone outside of school? Does she have any friends that she has trust and friendship in? Does she feel safe with any friends?
4) We can use a generalized tool for all patients. This is called a pediatric symptom checklist (Massachusetts General Hospital, 2024). This tool is a generalized tool that can be used to identify psychosocial issues in children and adolescents. I would use the PHQ-9 screening tool to assess this patient (Bloomfield, 2024). There is a tool that is modified for teens and adolescents. The PHQ-9 is a questionnaire to assess for depression. To screen for anxiety a SCARED screening tool can be used (Bloomfield, 2024). This is the Screen for Child Anxiety Related Disorders. We would also want to complete the Ask Suicide-Screening Questions (Bloomfield, 2024). This is used to assess for suicidal thoughts and ideas. All of these questionnaires and screenings can be very helpful in determining mental health disorders in pediatrics. Sometimes the screenings can open the conversation. A child or teen could have been having thoughts but not sharing them with the parents and the screening helped them to express it.
5) The top three differential diagnosis would include Depression (F32.A), Anorexia (F50.00), and Anxiety (F41.1). Emily is presenting with clear depression due to the bullying and mistreatment from her peers. With the bullying being weight based she has developed anorexia. With all of the issues at school it would also be possible that Emily has anxiety related to going to school or even being in social settings.
Massachusetts General Hospital, (2024), Pediatric Symptom Checklist, https://www.massgeneral.org/psychiatry/treatments-and-services/pediatric-symptom-checklist
Bloomfield, D., (Accessed 2024), Pediatric Mental Health Mini Series, https://www.aap.org/en/patient-care/mental-health-minute/screening-tools/
Glassgow, A. E., Wilder, J., Caskey, R., Munoz, G., Van Voorhees, B., & Kim, S. (2020). Mental Health Diagnoses among Children and Adolescents with Chronic Medical Conditions in a Large Urban Cohort. Journal of behavioral health, 9(4), 1–8.
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