Child Mental Status Exam

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A) mental illness in pediatrics

Mental illness is common and results in significant morbidity and mortality. Uniquely, in children, psychiatric disorders impact development and therefore have profound long term consequences. The potential for effective treatment makes early diagnosis for children with new onset mental illness essential in order to maximize clinical outcomes.

You will come across children on the ward or in the ED who may present with serious mental health issues in addition to their medical illness. What do you do if a ten-year old girl with chronic kidney disease tells you she’s hopeless and wants everything to end? How might you react to a teenage boy recovering from cardiac surgery who hears voices commanding him to flee the hospital? When should you consult psychiatry? How do you best interview the patient?

It is rare to have very young children present with these conditions. For younger children, you are more likely to see Pervasive Developmental Disorders like Autism or Asperger’s, as well as common entities like ADHD. These disorders are often seen by primary care physicians or pediatricians and are unlikely to present in an emergent fashion.

b) suicide

About 10% of teenagers between 14 and16 years of age experience thoughts about suicide. The background for children who attempt suicide is often one marked by an increased prevalence of psychiatric illness, social isolation, and family problems such as discipline issues or problems communicating feelings or needs. Suicide is a serious problem in adolescents and can be prevented. The HEADSSS assessment (link) is one useful screening tool to identify suicidal tendencies in adolescents

Remember that suicidal thoughts may be spurned on by medical ailments or underlying psychiatric conditions. While most children in hospital often exhibit energy and playfulness, depression and emotional turmoil exist in all people who are suffering significant illness. The prevalence of mood disorders like depression is in the range of 20-40% in hospitalized children compared to 5% of kids in the community.

Outlined in this module are ways to approach a child with mental health concerns with a focus on those patients expressing suicidal concerns.

Presentation

Younger children with thoughts of suicide may present with mood congruent auditory hallucinations, somatic complaints, a withdrawn or sad appearance, and poor self-esteem.

Adolescents with the same feelings often appear more similar to depressed adults with anhedonia, severe psychomotor retardation, delusions, and a sense of hopelessness. A sense of hopelessness is a red flag.

Interview

a) where to interview

If possible, interview patients and their families in their own room. In the ED setting you will likely have a ‘quiet room’ away from the rest of the department to conduct your thorough interview.

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Q&A

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how to give up child to state of texas for institutionalization for mental health? | Yahoo Answers

The child needs to be seen by a psychiatrist. Only a doctor and a judge can decide these things.
Giving up a child to be institutionalized is an extremely serious matter.

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