Comprehensive Psychiatric Assessment 5

Comprehensive Psychiatric Assessment 5

Comprehensive Psychiatric Assessment 5

Comprehensive Psychiatric Assessment #5 (please do it on conduct disorder)
1) History of Present Illness
2) Non-HPI Assessment
3) Objective Assessment
4) Diagnosis based on DSM-5 & Treatment Plan
5) Formulation: Neurobiology & Clinical Decision Making

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Comprehensive Psychiatric Assessment: Conduct DisorComprehensive Psychiatric Assessment: Conduct Disorder

            The prevalence of psychiatric conditions has increased significantly due to demographic shifts Richter et al. (2019).  The society is not making an effort to understand the causes of the high rate of mental illnesses. Consequently, the rise in mental illnesses has become a major public mental health concern. Psychiatrists are focusing in treating these conditions to improve the well-being and quality of life of individuals diagnosed with this condition. This discussion will focus on the treatment of a patient diagnosed with conduct disorder. It will focus on history of present illness, non-HPI assessment, objective assessment, diagnosis and treatment plan, and the formulation.

History of Present Illness

M is a six-year-old who is accompanied by his mother to the family medicine clinic during the initial visit. His mother reveals that M’s aggressive and destructive behavior has been persistent for a lone period since his childhood. He was suspended four times during kindergarten for initiating physical fights. The mother added that he sometimes becomes “uncontrollable” at home and break several furniture and dishes. He is also very cruel to others, including his parents and siblings. He frequently holds the family dog by tail and pulls it around. M also likes playing with dangerous weapons such as knifes without, thus putting others at risk. The mother has difficult time controlling him since his father is a long-haul truck driver who comes home after four weeks. He lies to his father anytime he is around to avoid being punished for mistakes committed when he was away. The visit to the family clinic has been necessitated by a dramatic increase in his aggressive and destructive behavior.

Non-HPI Assessment

This assessment focus on gathering information to enhance diagnosis and treatment process. His denies any history of psychiatric conditions in the family. She also denies history of any previous hospitalization nor psychotherapy. The client is not under any medication and does not have a history of allergic reactions towards drugs. However, he has substance use history; he has been taking alcohol for the last two years when he goes out with his friends.

Objective Assessment

This assessment focus on obtaining client’s objective information to enhance diagnosis and treatment processes. It is conducted in the form of a diagnostic interview, which is conducted to the client. The professional can ask the client the following questions during the interview. First, the client can be asked if he has been ever involved in physical fights and the circumstances surrounding the fight. Secondly, the client is asked if has ever been suspended or expelled from school. Another major question asked to the client is whether he drinks alcohol, smokes, or uses any other drug specifying the duration and frequency of using these drugs. According to Reavy et al. (2014), a close connection exists between conduct disorder and substance use. The psychiatrist will use client’s responses to semi-structured interview questions to determine if he is currently experiencing the symptoms of conduct disorder based on DSM diagnoses. Additionally, the psychiatrist can check symptoms of other mental illnesses that accompany conduct disorder, including depression and ADHD.

Diagnosis and Treatment Plan

Diagnosis

DSM-5 points out symptoms that are usually present in children and adolescents with conduct disorder. First, individuals with conduct disorder demonstrate aggression or threats of harming people or animals. This symptom is evident in the client since he was suspended four times during kindergarten for initiating physical fights. Additionally, he holds the family dog by tail and pulls it around. Another major symptom of conduct disorder is damage or destroying property deliberately. Client M destroys furniture and breaks dishes deliberately. Furthermore, individuals with conduct disorder lie persistently to avoid being punished for their mistakes. M lies to his father anytime he is around to avoid being punished for mistakes committed when he was away. According to DSM-5, a client should portray a minimum of three symptoms of conduct behaviors for at least six months to be diagnosed with this condition. Therefore, having demonstrated a minimum of three symptoms of this condition for more than six months indicates that the client has conduct disorder.

Treatment Plan

The treatment plan for this client will include both pharmacological and psychotherapy interventions. Psychotherapy will focus on improving the relationship between the parents and the child. The parents will be educated on how to communicate clearly to the child to avoid confusion. A verbal reminder should be initiated if the child does not adhere to the instructions within five seconds. Additionally, parents will be educated about the significance of rewarding the child anytime he does something good to encourage him continue with the current behavior. On the other hand, pharmacological intervention will involve the use of drugs to manage the symptoms of conduct disorder. Methylphenidate 5mg orally three times will be given to the client. This drug is preferred due to its efficacy and safety in treating conduct disorder in children and adolescents (Storebø et al., 2015). However, medication efficacy depends on various features, including medication release system, titration technique, dosage, time of measurement, and trial duration (Kortekaas-Rijlaarsdam, 2018).

Neurobiology and Clinical Decision-Making

Conduct disorder has an impact on the neuro-cognitive systems. First, this condition impairs various temporal regions, thereby causing temporal cortex dysfunction in these brain regions. Structural deficits in these regions are consistently depicted by several structural imaging studies (Blair, 2018). Additionally, this condition leads to a decrease in right dorsolateral prefrontal activation among individuals with conduct problems. Consequently, people with this disorder have poor frontal top-down cognitive control over emotion processing. Clinical decisions involve using both pharmacological and psychotherapy interventions to reduce the severity of conduct disorder, thereby preventing these impairments.

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References

Blair, R, J. (2018). The neurobiology of disruptive behavior disorder. Am J Psychiatry; 173(11): 1073–1074.doi: 10.1176/appi.ajp.2016.16080971.

Kortekaas-Rijlaarsdam, A, F et al. (2018). Does methylphenidate improve academic performance? A systematic review and meta-analysis. European Child & Adolescent Psychiatry; 28: 55–164.

Reavy, R., Stein, L, A., Quina, K., & Paiva, A, L. (2014). Assessing Conduct Disorder: A New Measurement Approach. J Correct Health Care; 20(1): 4–17. doi: 10.1177/1078345813505448.

Richter, D., Wall, A., Bruen, A., & Whittington, R. (2019). Is the global prevalence rate of adult mental illness increasing? Systematic review and meta‐analysis. Actia Psyachatricia Scandinavica; 40 (5): 393-407. https://doi.org/10.1111/acps.13083

Storebø, O, J., Ramstad, E., Krogh, H, B., & Gerner, T. (2015). Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane database of systematic reviews (Online) 11(11):CD009885. DOI:10.1002/14651858.CD009885.