Walden University NURNP 6650 Psychiatric Mental Health Nurse

Walden Universitynrnp 6650 Psychiatric Mental Health Nurse Pr

Identify the key clinical features, assess the risk factors, and develop a comprehensive management plan for a 15-year-old male presenting with self-injurious behavior, depression, low self-esteem, disturbed peer relationships, and recent suicidal ideation, based on the detailed psychiatric evaluation and history provided.

Paper For Above instruction

The case of a 15-year-old Native American male presenting with self-injurious behavior and suicidal ideation encapsulates the complex interplay of psychological, social, and developmental factors that influence adolescent mental health. Managing such a case requires a comprehensive understanding of the clinical features, risk assessment, therapeutic interventions, and ongoing management strategies rooted in evidence-based psychiatric practices.

The patient exhibits several key clinical features characteristic of adolescent depression and self-harm behaviors. He reports a recent incident of intentionally cutting himself at school due to feelings of abandonment by his boyfriend, which underscores the presence of emotional distress and interpersonal conflicts. His history reveals ongoing self-injurious behavior over the past 10 months, with multiple wounds on his upper arm, and two prior suicide attempts using acetaminophen—a serious indicator of suicidal ideation and intent. The recent hospitalization followed a suicidal gesture with bleeding, highlighting both imminent risk and the urgent need for intervention.

The patient’s mood appears depressed, with a constricted affect, and he reports feelings of low self-esteem and low energy levels. The history of diminished interest in previously enjoyed activities, such as participation in the school band, supports a diagnosis of depression. Sleep disturbances, primarily difficulty falling asleep, further exacerbate his emotional state, and mood dysregulation is compounded by conflicts with his mother, who reports behavioral outbursts, disrespect, and emotional disengagement. These familial interactions often influence adolescent psychological health, especially in cases involving poor communication and perceived lack of emotional support.

Assessment of risk factors is crucial in such cases. The patient demonstrates several risk elements, including prior suicide attempts, current suicidal thoughts, self-harm behaviors, and impulsivity evidenced by limited impulse control. The recent academic decline and loss of peer relationships contribute to feelings of social isolation and low self-esteem, increasing vulnerability to further self-harm or suicidal actions. The fact that the patient is pansexual and currently dating a male peer introduces considerations regarding the impact of sexual identity and peer acceptance on mental health, although he reports no current feelings of discrimination or violence based on his orientation. His minimal familial contact and parental conflict compound feelings of loneliness and abandonment, heightening the risk of worsening depression and suicidal behavior.

Evaluating his mental status reveals an alert and oriented adolescent with intact memory and cognitive functioning. He displays coherent thought processes, though his thoughts are distress-related, centered on peer relationships and self-image. His speech is quiet but regular, and he denies perceptual disturbances, indicating no psychosis. The absence of current hallucinations or delusions suggests that psychotic features are not predominant, but his mood and affect highlight significant emotional distress.

Management of this patient necessitates a multifaceted approach. Immediate risk mitigation involves close monitoring in a hospital setting, ensuring safety from self-harm or suicidal attempts. A multidisciplinary team involving psychiatrists, psychologists, and social workers should collaborate on developing a personalized treatment plan. Pharmacologic intervention may be considered, particularly antidepressants such as selective serotonin reuptake inhibitors (SSRIs), given the depression and self-harm history, with careful monitoring for side effects. Evidence shows that SSRIs, when used cautiously, can effectively reduce depressive symptoms and suicidal ideation in adolescents (Bridge et al., 2007).

Psychotherapeutic interventions are essential. Cognitive-behavioral therapy (CBT) can address maladaptive thought patterns, improve coping skills, and foster emotional regulation (Kowalski et al., 2016). Dialectical behavior therapy (DBT), originally designed for borderline personality disorder, has demonstrated efficacy in reducing self-harming behaviors and suicidal ideation in adolescents (Miller et al., 2012). Family therapy should also be integrated to improve communication, address familial conflict, and strengthen the support system, especially considering the mother’s expressed frustration and difficulty understanding her son's behavior (Robin & Amiot, 2008).

Long-term management involves continued psychiatric follow-up, psychoeducation about mental health, and strategies to foster resilience. School-based interventions can support academic achievement and social integration, addressing the decline in grades and peer relationships. Additionally, addressing the adolescent’s sexual orientation and ensuring a supportive environment can reduce minority stress and promote mental well-being (Russell & Fish, 2019).

Monitoring risk factors, including ongoing assessment of suicidal ideation, self-injury frequency, and emotional status, should be performed regularly. Safety planning involves collaborating with the patient to develop coping strategies, identifying warning signs, and establishing emergency contacts. Use of community resources, peer support groups, and educational programs about mental health are vital components of a comprehensive care plan.

In conclusion, managing a teenage patient exhibiting severe depression, self-harm, and suicidality requires a coordinated, evidence-based approach emphasizing safety, psychotherapy, pharmacotherapy, and family involvement. Addressing both the psychological and social determinants of his mental health will enhance recovery and foster resilience, ultimately reducing the risk of future self-harm and ensuring a pathway to improved functioning and well-being.

References

• Bridge, J. A., et al. (2007). Clinical review: Antidepressants and suicide risk: A meta-analysis. Journal of Child Psychology and Psychiatry, 48(3), 269-279.
• Kowalski, J., et al. (2016). Cognitive-behavioral therapy for adolescent depression: A review of efficacy and implementation. Child and Adolescent Mental Health, 21(4), 185-192.
• Miller, A., et al. (2012). Dialectical behavior therapy for suicidal adolescents: A review of efficacy and adaptations. Journal of Clinical Child & Adolescent Psychology, 41(4), 445-458.
• Robin, A., & Amiot, C. E. (2008). Family therapy and adolescent mental health: Review and new directions. Family Process, 47(4), 507-526.
• Russell, S. T., & Fish, J. N. (2019). Sexual orientation and mental health: A review of research and clinical implications. Journal of Clinical Psychology, 75(4), 722-737.
• Holt, R. M., et al. (2014). Mental health and youth suicide prevention strategies. Journal of Youth and Adolescence, 43(8), 1168-1182.
• National Institute of Mental Health. (2021). Depression in adolescents. https://www.nimh.nih.gov/health/topics/depression/index.shtml
• American Academy of Child & Adolescent Psychiatry. (2018). Practice parameters for the assessment and treatment of youth with depression. Guidelines and Recommendations.
• Szabo, S., et al. (2015). Self-injury in adolescents: A review of risk factors and interventions. Journal of Adolescent Health, 57(3), 269-278.
• Walsh, F. (2012). Strengthening family resilience. Guilford Publications.