Simulation Scenario - Adolescent Risk Assessement

Summary

In this video, Dr. Sarah interviews 14-year-old Heidi in the emergency department following concerns from Heidi's mother about her suicidal thoughts and self-harm. Through a structured psychiatric risk assessment, Dr. Sarah explores Heidi’s mood, thoughts, and behavior, uncovering the depth of her distress, including her plan to end her life. The assessment includes evaluating Heidi's self-harm tendencies, substance use, family dynamics, and support network. The video emphasizes the importance of thorough evaluation, collaboration with mental health specialists, and prompt intervention in ensuring the safety and well-being of at-risk adolescents.

Takeaways

• 😀 Dr. Sarah is conducting an adolescent psychiatric risk assessment on Heidi, a 14-year-old girl with a history of depression and self-harm.
• 😀 Heidi's mother is concerned that Heidi is planning to end her life that evening, prompting the need for an immediate risk assessment.
• 😀 Dr. Sarah gains informed consent from Heidi's mother and ensures the interview is conducted in a private and safe location within the emergency department.
• 😀 The doctor assesses Heidi's mood and behavior, observing that Heidi expresses feeling 'crap' and disinterested in daily activities.
• 😀 Heidi admits to having ongoing thoughts of suicide, specifically mentioning the plan to jump off a bridge near her house, and indicates that she is planning to do so tonight.
• 😀 Heidi has a history of self-harming, including cutting her legs every day, and has considered other ways to harm herself but has not yet acted on them.
• 😀 The doctor assesses Heidi's mental state, asking about disturbances in perception (e.g., hearing or seeing things), but Heidi denies any such experiences.
• 😀 Dr. Sarah evaluates Heidi's protective factors, noting that Heidi has a strained relationship with her mother but is close to her younger brother Jack.
• 😀 Heidi has a friend, Sophie, with whom she talks about her feelings, though Sophie also has suicidal thoughts but refuses to tell anyone.
• 😀 Dr. Sarah considers the potential influence of substances like alcohol and drugs on Heidi's mental state but finds that Heidi has not consumed any drugs or alcohol recently.
• 😀 After completing the assessment, Dr. Sarah refers Heidi to a mental health nurse for further evaluation, expressing concerns about Heidi's elevated suicide risk and potential impulsivity.

Q & A

What is the primary purpose of Dr. Sarah's interview with Heidi?

The primary purpose of Dr. Sarah's interview with Heidi is to assess Heidi's psychiatric risk, specifically evaluating her risk of suicide and self-harm, and determining the appropriate course of action for her care.

Why is it important for Dr. Sarah to conduct the interview in a private and safe location?

It is crucial to conduct the interview in a private and safe location to ensure Heidi feels comfortable and secure, facilitating an open and honest discussion about sensitive topics such as suicide and self-harm.

What is the significance of Dr. Sarah gaining consent from Heidi's mother before conducting the interview?

Gaining consent from Heidi's mother is necessary for legal and ethical reasons. It ensures that Heidi's mother is informed and involved in the process, and that the interview aligns with the family’s consent for medical treatment.

What are the key factors Dr. Sarah looks at when assessing Heidi's mood?

Dr. Sarah assesses Heidi's mood by observing her self-reported feelings (subjective mood) and her behavior (objective affect), including her eye contact, cooperativeness, and emotional expression during the interview.

How does Dr. Sarah assess Heidi's risk of suicide?

Dr. Sarah assesses Heidi's risk of suicide by evaluating the frequency, intensity, and duration of Heidi's suicidal thoughts, the presence of a specific plan, her intent to act on those thoughts, and any recent triggers or precipitants, such as family arguments.

What additional questions does Dr. Sarah ask to assess Heidi's self-harm behaviors?

Dr. Sarah asks about Heidi’s past and recent self-harm behaviors, specifically inquiring whether Heidi has engaged in other forms of self-harm (e.g., cutting or burning) and whether she has a clear intent to continue harming herself.

Why does Dr. Sarah ask Heidi about hearing or seeing things that others cannot?

Dr. Sarah asks this question to assess any potential disturbances in perception, such as auditory or visual hallucinations, which could be indicative of a psychiatric condition like psychosis, which might increase risk or affect the treatment approach.

What role does collateral history from family and caregivers play in the psychiatric risk assessment?

Collateral history from family and caregivers provides additional insight into the patient's history and current situation, helping to form a fuller understanding of the patient's risk factors and the support available to them, which is crucial in making a safe assessment.

How does Dr. Sarah assess the influence of drugs and alcohol on Heidi’s mental state?

Dr. Sarah inquires about Heidi’s use of alcohol or other drugs to assess whether substance use could be contributing to her psychiatric symptoms or risk of harm, as substance abuse can exacerbate mood disturbances and impulsive behaviors.

What does Dr. Sarah do after conducting the initial risk assessment with Heidi?

After completing the initial assessment, Dr. Sarah refers Heidi to a mental health nurse, John, who specializes in working with young people at risk of self-harm or suicide, for further evaluation and intervention, including determining whether Heidi requires hospitalization or community-based care.