Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental DisordersNeurocognitive and Neurodevelopmental Disorders

Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from very specific to general or global impairment, and often co-occur (APA, 2013). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities.

Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such as brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.

Neurocognitive and Neurodevelopmental Disorders
For this Assignment, you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder.
To Prepare:
Review this week’s Learning Resources and consider the insights they provide. Consider how neurocognitive impairments may have similar presentations to other psychological disorders.

Neurocognitive and Neurodevelopmental Disorders
Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.

Neurocognitive and Neurodevelopmental Disorders
By Day 7 of Week 10
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Neurocognitive and Neurodevelopmental Disorders
Incorporate the following into your responses in the template:
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment?

Neurocognitive and Neurodevelopmental Disorders
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis.

Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

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Solution

Neurocognitive and Neurodevelopmental Disorders

NRNP 6635: Psychopathology and Diagnostic Reasoning

Neurocognitive and Neurodevelopmental Disorders

Subjective:

CC (chief complaint):

HPI: The patient is a 58-year-old male that presents to the clinic for psychiatric evaluation of ADHD combined presentation A-3.

Past Psychiatric History: The patient exhibited signs of inattention and hyperactivity from early on but was never officially diagnosed.

  • General Statement: The patient has recently entered treatment after

The patient has a history of forgetting where he placed personal effectiveness, and organization, and only pays bills after several prompts.

The patient has a history of hypertension controlled by losartan 100mg daily, angina controlled by taking aspirin 81mg PO daily, and metoprolol 25mg twice a daily. He also has a history of hypertriglyceridemia, for which he was prescribed fenofibrate 160mg daily, and BPH prescribed tamsulosin 0.4mg PO bedtime. He has no history of any neurodevelopmental disorders.

  • Caregivers (if applicable): The patient has never been married, dates casually, and has no children.
  • Hospitalizations: The patient has no history of hospitalizations.
  • Medication trials: the patient has no history of psychiatric medication trials.
  • Psychotherapy or Previous Psychiatric Diagnosis: The patient has never been diagnosed with any neurodevelopmental or neurocognitive disorder. However, he has a history of difficulty with attention and delayed recall.

Substance Current Use and History:

The patient denies using illicit drugs but enjoys one scotch drink on the weekends with a cigar.

Family Psychiatric/Substance Use History:

The patient did not report any psychiatric or substance abuse history from family members.

Psychosocial History:

The patient has a bachelor’s degree in engineering. He is homosexual and dates casually.

Medical History: The patient scored 20/24 on the Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS-5) and 27/30 on the MOCA scale and was determined to have ADHD combined presentation A-3.

 

  • Current Medications: He is currently on losartan 100mg daily and metoprolol for hypertension, ASA 81mg daily for angina, fenofibrate 160mg daily for hypertriglyceridemia, and tamsulosin for benign prostatic hyperplasia.
  • Allergies: He is allergic to morphine
  • Reproductive Hx: The patient has no significant problems with his reproductive system aside from the tamsulosin prescription to treat symptoms of an enlarged prostate.

ROS:

  • GENERAL: No weight loss, fever, chills, weakness, or fatigue.
  • HEENT: Eyes: Visual presentation is without blemish, clear vision, 2020 vision, no yellow sclerae. Ears, Nose, Throat: perfect hearing, no airway issues like sneezing, congestion, runny nose, or sore throat
  • SKIN: No rash or itching
  • CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.
  • RESPIRATORY: No shortness of breath, cough, or sputum.
  • GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
  • GENITOURINARY: provider should examine.
  • NEUROLOGICAL: No headache, dizziness, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
  • MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.
  • HEMATOLOGIC: No anemia, bleeding, or bruising.
  • LYMPHATICS: No enlarged nodes. No history of splenectomy.
  • ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Neurocognitive and Neurodevelopmental Disorders

Objective:

Physical exam: The patient was taken through different diagnostic tests to determine his attention deficiency. He obtained a reading of above twenty on the ASRS-5 scale and 27 on the MOCA scale.

Neurocognitive and Neurodevelopmental Disorders

Diagnostic results:

The patient is diagnosed with ADHD combined presentation A-3.

Neurocognitive and Neurodevelopmental Disorders

Assessment:

Mental Status Examination:

The patient is a 58 years old caucasian male with a current medical history of hypertension, angina, hypertriglyceridemia, and benign prostatic hyperplasia. He sleeps for four to six hours and has difficulty with attention and working memory, presented as delayed recall. He cooperated during the examination and answered all questions as asked. He has dressed appropriately for the assessment.

Neurocognitive and Neurodevelopmental Disorders

Eye contact is fleeting. He does not appear worried though he is very expressive with his arms. His thought process is directed towards what was asked. Speech is normal, and affect is broad and congruent with mood. Insight and judgment are intact. He has had trouble concentrating on allocated tasks, staying still, or completing projects.

Differential Diagnoses:

ADHD is a mental health disorder where an individual has difficulty with attention or keeping calm (CDC, 2021). It could be either extreme or both. An individual with a combined form of ADHD has symptoms of both inattention and hyperactivity like getting easily distracted, difficulty in finishing tasks or assignments, difficulty in paying attention to detail, talking endlessly, difficulty with patience, and constant interruptions to other activities getting easily confused. It begins in childhood and precedes adulthood when left untreated.

Neurocognitive and Neurodevelopmental Disorders

Differential diagnoses for ADHD combined presentation include a diagnosis for developmental variations of neurologic conditions, emotional disorders, and sleep-wake disorders. All these disorders have similar symptoms that have to be ruled out by the psychiatrist before diagnosing a combined presentation of ADHD.

Neurocognitive and Neurodevelopmental Disorders

Treatment options include pharmacology using stimulant drugs. Non-stimulant drugs are used only when the stimulant variations do not work (CDC, 2021). However, stimulat drugs should be used with caution because the patient has a history of angina and hypertension. Psychotherapy, which involves cognitive behavioral therapy and behavioral therapy, also works to modify behaviors and manage the disorder. A combination of both psychotherapy and medication is usually preferred for optimum results.

Neurocognitive and Neurodevelopmental Disorders

Neurologic conditions or developmental conditions often occur independently or together with ADHD, and include consitions like communication disorders (CHADD, 2018). They are characterized by inattention, difficulty in following through with tasks and often tend to be inconsistent in performance. Similarly, adults with ADHD combined presentation may find it difficult to complete tasks or show inconsistency in performance.

Neurocognitive and Neurodevelopmental Disorders

Comprehensive neuropsychologic testing helps with diagnosis to distinguish this condition as individuals with ADHD have generally poor performance and those with developmental conditions have specific areas they are poor. Treatment ofen involve pharmacotherapy and psychotherapy.

Neurocognitive and Neurodevelopmental Disorders

Emotional and behavioral disorders like anxiety disorders, conductive disorder, obsessive compulsive disorders and adjustment disorders, to name a few, could occur together with ADHD or independently (CDC, 2021). They could also be mistaken for ADHD because they have similar symptoms. Diagnosis is by mental health professionals using broadband behavioral scales that distinguish the disorders from another. Treatment is also through psychotherapy and pharmacotherapy, and a combination of both is usually recommended by the providers.

Neurocognitive and Neurodevelopmental Disorders

Sleep-wake disorders often present as obstructive sleep apnea, restlessness, and lack of sleep. These conditions have symptoms similar to those of ADHD that occur periodically then disappear (CHADD, 2018). The difference in ADHD is that they occur throughout without ever stopping.

Neurocognitive and Neurodevelopmental Disorders

Reflections: The assessments follow the recommended formats for diagnosing neurodevelopmental disorders using the ASRS-5 rating scale. The results depict an individual with a combined type of adult ADHD. However, neurologic or developmental conditions, emotional disorders, and sleep-wake disorders have symptoms consistent with ADHD hence a healthcare provider should rule them all out before diagnosing ADHD.

Neurocognitive and Neurodevelopmental Disorders

Recommended treatment options are medications and psychotherapy or a combination of both. Treatment involves addressing all the baseline symptoms of difficulty with attention, working memory, and sleep.

I learned from this assessment that adults, too, have developmental disorders that were not addressed in childhood. Any neurodevelopmental disorder’s effect on adults gets compounded because of the serious situations adults engage in. I also learned that the disorder is not limited to age, gender, ethnicity, or even education level (CHADD, 2018).

Neurocognitive and Neurodevelopmental Disorders

Additionally, I learned that a psychological evaluation alone is not enough to make a definitive diagnosis regarding any disorder, and treatment options like behavioral therapy and cognitive-behavioral therapeutic options alleviate symptoms. I also learned that it is important to use evidence-based techniques because they have a track record of efficacy, safety, and tolerance from patients worldwide.

Neurocognitive and Neurodevelopmental Disorders

Legal and ethical considerations: The patient should be addressed with regard to his autonomy. The healthcare provider should respect him to make the right decision regarding treatment options once he has all the required information. The psychiatrist should also disclose stimulant medication to individuals with cardiovascular disorders because ADHD medications are potent stimulants of the sympathetic nervous system and are associated with adverse cardiovascular events; hence should be taken only after safer options have been tried (Zhang, 2020).

Neurocognitive and Neurodevelopmental Disorders

The psychiatrist should review medication side effects with the patient to ensure he is prepared. Additionally, the psychiatrist should also explain the risk factors associated with taking the medication. The patient should also get educated on healthy habits to ensure he recovers from the disorder. The patient should also be protected from the public, and his rights should be respected regardless of his sexual orientation. Ultimately, the healthcare provider should work within the ethical principles that dictate beneficence, justice, autonomy, and nonmaleficence.

Neurocognitive and Neurodevelopmental Disorders

References

CDC. (2021, September 21). Symptoms and diagnosis of ADHD. Centers for Disease Control and Prevention. Retrieved May 7, 2022, from https://www.cdc.gov/ncbddd/adhd/diagnosis.html

CHADD. (2018, May 24). Diagnosis of ADHD in adultshttps://chadd.org/for-adults/diagnosis-of-adhd-in-adults/

Zhang, Y. H. (2020). Faculty opinions recommendation of cardiac Calcitropes, Myotropes, and Mitotropes: JACC review topic of the week. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literaturehttps://doi.org/10.3410/f.735737350.793579132

Also check:  Week 7: Assignment – Part 3: Literature Review and Critical Appraisal

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