Week 10: Neurocognitive and Neurodevelopmental Disorders
The human brain only constitutes approximately 2% of an individual’s total body weight, a percentage that pales in comparison to the brain’s level of importance in human development (Koch, 2016). Although externally protected by layers of membranes as well as the skull, the brain is not very resistant to damage. Damage to the brain may compromise its functionality, which may, in turn, lead to neurodevelopmental disorders in childhood and adolescence or neurocognitive disorders for any number of reasons across the lifespan.
This week, you practice assessing and diagnosing neurocognitive and neurodevelopmental disorders across the lifespan.
Reference: Koch, C. (2016, January 1). Does brain size matter? Scientific American. https://www.scientificamerican.com/article/does-brain-size-matter1/
Learning Objectives
Students will:
· Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
· Formulate differential diagnoses using DSM-5 criteria for patients with neurocognitive and neurodevelopmental disorders across the lifespan
Learning Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Neurocognitive disorders. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 591–644). Author.
American Psychiatric Association. (2013). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
· Chapter 21, Neurocognitive Disorders
· Chapter 31, Child Psychiatry
Document: Comprehensive Psychiatric Evaluation Template
Document: Comprehensive Psychiatric Evaluation Exemplar
Required Media (click to expand/reduce)
Classroom Productions. (Producer). (2016). Neurocognitive disorders [Video]. Walden University.
Classroom Productions. (Producer). (2016). Neurodevelopmental disorders [Video]. Walden University.
MedEasy. (2016). Progressive neurocognitive disorders. | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=KdcjyHvaAuQ
Video Case Selections for Assignment (click to expand/reduce)
Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders
Photo Credit: Getty Images
Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a 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 brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.
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.
· 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.
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.
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?
· 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.).
Week(enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
CC (chief complaint):
HPI:
Past Psychiatric History:
· General Statement:
· Caregivers (if applicable):
· Hospitalizations:
· Medication trials:
· Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
· Current Medications:
· Allergies:
· Reproductive Hx:
ROS:
· GENERAL:
· HEENT:
· SKIN:
· CARDIOVASCULAR:
· RESPIRATORY:
· GASTROINTESTINAL:
· GENITOURINARY:
· NEUROLOGICAL:
· MUSCULOSKELETAL:
· HEMATOLOGIC:
· LYMPHATICS:
· ENDOCRINOLOGIC:
Physical exam: if applicable
Diagnostic results:
Assessment
Mental Status Examination:
Differential Diagnoses:
Reflections:
References
© 2020 Walden University
Page 1 of 3
Training Title 50 Name: Harold Griffin Gender: male Age:58 years old T- 98.8 P- 86 R 18 134/88 Ht 5’11 Wt 180lbs Background: Has bachelor’s degree in engineering. He is homosexual and dates casually, never married, no children. Has one younger sister. Sleeps 4-6 hours, appetite good. Denied legal issues; MOCA 27/30 difficulty with attention and delayed recall; ASRS-5 20/24; denied hx of drug use; enjoys one scotch drink on the weekends with a cigar. Allergies Morphine; history HTN blood pressure controlled with losartan 100mg daily, angina prescribed ASA 81mg po daily, metoprolol 25mg twice daily. Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg po bedtime.
Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-50
Translate
00:00:00
TRANSCRIPT OF VIDEO FILE:
00:00:00
______________________________________________________________________________
00:00:00
BEGIN TRANSCRIPT:
00:00:00
[sil.]
00:00:15
OFF CAMERA So, you told your supervisor you were having difficulty with concentration, and then it was your supervisor who set up this appointment, right, is it?
00:00:25
HAROLD Yeah, I, I work at this large architectural engineering firm and it’s all great. Except, they’ve accelerated the deadlines now and it just puts a lot of pressure on. And I, I just can’t concentrate. I mean, everyone else is, doesn’t have a problem with it. But, but I just, I just can’t seem to be able to do the same job they’re doing.
00:00:50
OFF CAMERA Okay, tell me about your problem with concentration.
00:00:55
HAROLD Well, um, you know it’s just… Perfect example is, is they wanted me to design um, air ducts.
00:01:05
OFF CAMERA Right.
00:01:05
HAROLD Air ducts, simple. But I designed them through solid wall, a fire wall, and a supporting wall and I didn’t even realize what I was doing.
00:01:15
OFF CAMERA Uh-huh.
00:01:15
HAROLD You know, I mean, um, I’m making silly mistakes like that because, another time we had these windows, we already bought them, design, beautiful, they’re going to be in this entire building.
00:01:30
OFF CAMERA Right.
00:01:30
HAROLD Every floor. Well, I drew the window opening way too small. Now, I mean, if that would have gone ahead, it would have cost millions. I just, it’s, it’s just silly things like that.
00:01:45
OFF CAMERA Uh-huh, is this a new kind of problem for you?
00:01:45
HAROLD Well, I mean, I didn’t seem to have a problem when everything was relaxed, and the deadlines were normal.
00:01:50
OFF CAMERA Right.
00:01:55
HAROLD I could do the job. Everything was fine. But now we’re on these, these ridiculously tight deadlines and, and I just, can’t seem to do it. Everyone else can. It’s, there’s not a problem for them. And I end up like I’m not pulling my weight.
00:02:10
OFF CAMERA Uh-huh.
00:02:10
HAROLD And they think that and it’s true, I’m not.
00:02:10
OFF CAMERA Now did you have these, uh, similar kind of problems back in school?
00:02:15
HAROLD Well, yeah, I mean, in school everyone would go to the library to cram for big exams, so, I mean.
00:02:20
OFF CAMERA Right.
00:02:20
HAROLD That was a normal thing. And, yeah, I’d go but I’d end up looking out the window. Look it’s snowing, oh, it’s spring time. I’ll go for a walk. And, and if someone is whispering in a library well, I have to go to the other side. All my friends could study anywhere.
00:02:35
OFF CAMERA Uh-huh, but, what other kind of difficulties do you seem to have?
00:02:40
HAROLD Well, at the job we have, these uh, lectures, you know.
00:02:45
OFF CAMERA Right.
00:02:45
HAROLD We’d get together, it’s groups. This is the lectures by the chief of the department gets together with all the architects and engineers and he talks about the mission of the day. What we’re trying to work for, our goals.
00:02:55
OFF CAMERA Right.
00:03:00
HAROLD Do I listen? I’m thinking, maybe, my dog needs a bath. Or what am I going to have for lunch? Or, you know, anything other than what he’s saying.
00:03:05
OFF CAMERA Mm-hmm.
00:03:10
HAROLD And because of that, you know, it’s not a good idea.
00:03:15
OFF CAMERA So, so, is it difficult to sit and listen?
00:03:20
HAROLD Yeah, I mean, okay, we were suppose to be designing this other, on top of this penthouse, this, kind of, a patio, party area.
00:03:30
OFF CAMERA Right.
00:03:30
HAROLD And the gutters around it just to make sure everything was very comfortable for everyone. Well, I got up there and I’m designing and the gutters are here, and no, wait a minute, there’s Italian, tile floor. Doesn’t look like it’s tilted the correct way. So I started studying that and there were already two people assigned to study that. To fix that problem, not me.
00:03:50
OFF CAMERA Mm-hmm.
00:03:55
HAROLD I got in a lot of trouble for that one.
00:03:55
OFF CAMERA Do you have any problems organizing?
00:04:00
HAROLD At home or the office?
00:04:00
OFF CAMERA Uh, either.
00:04:05
HAROLD I’m a bit of a mess. I mean, and I’m messy. I will forget my shoes, my socks, my phone, my jacket, I, I can’t find them. I’m not that organized. And I have a calendar. One of my coworkers, actually bought me a calendar to motivate me.
00:04:20
OFF CAMERA Yeah.
00:04:25
HAROLD To get more organized. So, I started writing down all the important dates and events, but then do I ever look at that calendar? No, I don’t. So, it’s a complete waste of time.
00:04:35
OFF CAMERA What about problems paying bills?
00:04:40
HAROLD Bills, I mean, yeah they get paid. After two or three times of the threatening calls or letters. And then I have to pay the penalties.
00:04:50
OFF CAMERA Hmm, what about hyperactivity?
00:04:50
HAROLD You know, I mean, I’m, sometimes I’m a little more uncomfortable in a chair or you know. But I don’t think that’s that big a deal. I mean, I used to be a lot worse. I mean, uh, there was a time when I was in school, I would get marked down for citizenship because I never raised my hand and I talked out of class and, and I just, couldn’t seem to stay focused. But I’m a lot better now.
00:05:20
OFF CAMERA Mm-hmm, were you ever um, treated with medications or behavioral therapies for ADHD?
00:05:25
HAROLD No, no. My mother threatened that one time, but I was never evaluated. Never went, uh, I’m kind of amazed she never just dragged me into a doctor’s office, but she never did.
00:05:40
OFF CAMERA Do you drink any caffeinated drinks?
00:05:45
HAROLD Coffee, soda, you know, once in a while. But when I was a kid, my mother said no caffeine, no sugar, cause you’ll climb the walls. I was already doing it anyway and so she, I uh, once and a while I’ll have a little caffeine now and it kind of helps me focus a little but, sugar, I stay away from that. It’s just not a good idea.
00:06:05
END TRANSCRIPT
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Select Grid View or List View to change the rubric’s layout.
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List View
Excellent |
Good |
Fair |
Poor |
|
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. |
18 (18%) – 20 (20%) The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. |
16 (16%) – 17 (17%) The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. |
14 (14%) – 15 (15%) The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. |
0 (0%) – 13 (13%) The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing. |
In the Objective section, provide: |
18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. |
16 (16%) – 17 (17%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. |
14 (14%) – 15 (15%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. |
0 (0%) – 13 (13%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing. |
In the Assessment section, provide: |
23 (23%) – 25 (25%) The response thoroughly and accurately documents the results of the mental status exam. |
20 (20%) – 22 (22%) The response accurately documents the results of the mental status exam. |
18 (18%) – 19 (19%) The response documents the results of the mental status exam with some vagueness or innacuracy. |
0 (0%) – 17 (17%) The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing. |
Reflect on this case. Discuss what you learned and what you might do differently. 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.). |
9 (9%) – 10 (10%) Reflections are thorough, thoughtful, and demonstrate critical thinking. |
8 (8%) – 8 (8%) Reflections demonstrate critical thinking. |
7 (7%) – 7 (7%) Reflections are somewhat general or do not demonstrate critical thinking. |
0 (0%) – 6 (6%) Reflections are incomplete, inaccurate, or missing. |
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old). |
14 (14%) – 15 (15%)
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. |
12 (12%) – 13 (13%) The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. |
11 (11%) – 11 (11%) Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. |
0 (0%) – 10 (10%) Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based. |
Written Expression and Formatting—Paragraph development and organization: |
5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. |
4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. |
3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. |
0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. |
Written Expression and Formatting—English writing standards: |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors |
4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors |
3 (3%) – 3 (3%) Contains several (three or four) grammar, spelling, and punctuation errors |
0 (0%) – 2 (2%) Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding |
Total Points: 100 |
Name: NRNP_6635_Week10_Assignment_Rubric
The criteria are met for major or mild neurocognitive disorder.
There is insidious onset and gradual progression.
There is clinically established Huntington’s disease, or risk for Huntington’s disease based on family history or genetic testing.
The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.
Coding note: For major neurocognitive disorder due to Huntington’s disease, with behavioral disturbance, code first 333.4 (G10) Huntington’s disease, followed by 294.11 (F02.81) major neurocognitive disorder due to Huntington’s disease, with behavioral disturbance. For major neurocognitive disorder due to Huntington’s disease, without behavioral disturbance, code first 333.4 (G10) Huntington’s disease, followed by 294.10 (F02.80) major neurocognitive disorder due to Huntington’s disease, without behavioral disturbance.
For mild neurocognitive disorder due to Huntington’s disease, code 331.83 (G31.84). (Note: Do not use the additional code for Huntington’s disease. Behavioral disturbance cannot be coded but should still be indicated in writing.)
Progressive cognitive impairment is a core feature of Huntington’s disease, with early changes in executive function (i.e., processing speed, organization, and planning) rather than learning and memory. Cognitive and associated behavioral changes often precede the emergence of the typical motor abnormalities of bradykinesia (i.e., slowing of voluntary movement) and chorea (i.e., involuntary jerking movements). A diagnosis of definite Huntington’s disease is given in the presence of unequivocal, extrapyramidal motor abnormalities in an individual with either a family history of Huntington’s disease or genetic testing showing a CAG trinucleotide repeat expansion in the HTT gene, located on chromosome 4.
Depression, irritability, anxiety, obsessive-compulsive symptoms, and apathy are frequently, and psychosis more rarely, associated with Huntington’s disease and often precede the onset of motor symptoms(
Duff et al. 2007
).
Neurocognitive deficits are an eventual outcome of Huntington’s disease; the worldwide prevalence is estimated to be 2.7 per 100,000. The prevalence of Huntington’s disease in North America, Europe, and Australia is 5.7 per 100,000, with a much lower prevalence of 0.40 per 100,000 in Asia(
Pringsheim et al. 2012
).
The average age at diagnosis of Huntington’s disease is approximately 40 years, although this varies widely(
Foroud et al. 1999
). Age at onset is inversely correlated with CAG expansion length(
Lee et al. 2012
). Juvenile Huntington’s disease (onset before age 20) may present more commonly with bradykinesia, dystonia, and rigidity than with the choreic movements characteristic of the adult-onset disorder. The disease is gradually progressive, with median survival approximately 15 years after motor symptom diagnosis(
Roos et al. 1993
).
Phenotypic expression of Huntington’s disease varies by presence of motor, cognitive, and psychiatric symptoms. Psychiatric and cognitive abnormalities can predate the motor abnormality by at least 15 years(Duff et al. 2007;
Stout et al. 2011
). Initial symptoms requiring care often include irritabity, anxiety, or depressed mood. Other behavioral disturbances may include pronounced apathy, disinhibition, impulsivity, and impaired insight, with apathy often becoming more progressive over time(
Thompson et al. 2012
). Early movement symptoms may involve the appearance of fidgetiness of the extremities as well as mild apraxia (i.e., difficulty with purposeful movements), particularly with fine motor tasks. As the disorder progresses, other motor problems include impaired gait (ataxia) and postural instability. Motor impairment eventually affects speech production (dysarthria) such that the speech becomes very difficult to understand, which may result in significant distress resulting from the communication barrier in the context of comparatively intact cognition. Advanced motor disease severely affects gait with progressive ataxia. Eventually individuals become nonambulatory. End-stage motor disease impairs motor control of eating and swallowing, typically a major contributor to the death of the individual from aspiration pneumonia.
The genetic basis of Huntington’s disease is a fully penetrant autosomal dominant expansion of the CAG trinucleotide, often called a CAG repeat in the huntingtin gene. A repeat length of 36 or more is invariably associated with Huntington’s disease, with longer repeat lengths associated with early age at onset. A CAG repeat length of 36 or more is invariably associated with Huntington’s disease(
Groen et al. 2010
).
Genetic testing is the primary laboratory test for the determination of Huntington’s disease, which is an autosomal dominant disorder with complete penetrance. The trinucleotide CAG is observed to have a repeat expansion in the gene that encodes huntingtin protein on chromosome 4. A diagnosis of Huntington’s disease is not made in the presence of the gene expansion alone, but the diagnosis is made only after symptoms become manifest. Some individuals with a positive family history request genetic testing in a presymptomatic stage. Associated features may also include neuroimaging changes; volume loss in the basal ganglia, particularly the caudate nucleus and putamen, is well known to occur and progresses over the course of illness. Other structural and functional changes have been observed in brain imaging but remain research measures.
In the prodromal phase of illness and at early diagnosis, occupational decline is most common, with most individuals reporting some loss of ability to engage in their typical work. The emotional, behavioral, and cognitive aspects of Huntington’s disease, such as disinhibition and personality changes, are highly associated with functional decline(
Beglinger et al. 2010
). Cognitive deficits that contribute most to functional decline may include speed of processing, initiation, and attention rather than memory impairment(
Peavy et al. 2010
). Given that Huntington’s disease onset occurs in productive years of life, it may have a very disruptive effect on performance in the work setting as well as social and family life. As the disease progresses, disability from problems such as impaired gait, dysarthria, and impulsive or irritable behaviors may substantially add to the level of impairment and daily care needs, over and above the care needs attributable to the cognitive decline. Severe choreic movements may substantially interfere with provision of care such as bathing, dressing, and toileting.
Early symptoms of Huntington’s disease may include instability of mood, irritability, or compulsive behaviors that may suggest another mental disorder. However, genetic testing or the development of motor symptoms will distinguish the presence of Huntington’s disease.
The early symptoms of Huntington’s disease, particularly symptoms of executive dysfunction and impaired psychomotor speed, may resemble other neurocognitive disorders (NCDs), such as major or mild vascular NCD.
Huntington’s disease must also be differentiated from other disorders or conditions associated with chorea, such as Wilson’s disease, drug-induced tardive dyskinesia, Sydenham’s chorea, systemic lupus erythematosus, or senile chorea. Rarely, individuals may present with a course similar to that of Huntington’s disease but without positive genetic testing; this is considered to be a Huntington’s disease phenocopy that results from a variety of potential genetic factors(
Wild et al. 2008
).
Beglinger LJ , O’Rourke JJ , Wang C , et al: Earliest functional declines in Huntington disease. Psychiatry Res 178(2):414–418, 2010 10.1016/j.psychres.2010.04.030
Duff K , Paulsen JS , Beglinger LJ , et al: Psychiatric symptoms in Huntington’s disease before diagnosis: the predict-HD study. Biol Psychiatry 62(12):1341–1346, 2007
Foroud T , Gray J , Ivashina J , Conneally PM : Differences in duration of Huntington’s disease based on age at onset. J Neurol Neurosurg Psychiatry 66(1):52–56, 1999
Groen JL , de Bie RMA , Foncke EM , et al: Late-onset Huntington disease with intermediate CAG repeats: true or false? J Neurol Neurosurg Psychiatry 81(2):228–230, 2010 10.1136/jnnp.2008.170902
Lee JM , Ramos EM , Lee JH , et al: CAG repeat expansion in Huntington disease determines age at onset in a fully dominant fashion. Neurology 78(10):690–695, 2012 10.1212/WNL.0b013e318249f683
Peavy GM , Jacobson MW , Goldstein JL , et al: Cognitive and functional decline in Huntington’s disease: dementia criteria revisited. Mov Disord 25(9):1163–1169, 2010 10.1002/mds.22953
Pringsheim T , Wiltshire K , Day L , et al: The incidence and prevalence of Huntington’s disease: a systematic review and meta-analysis. Mov Disord 27(9):1083–1091, 2012 10.1002/mds.25075
Roos RA , Hermans J , Vegter-van der Vlis M , et al: Duration of illness in Huntington’s disease is not related to age at onset. J Neurol Neurosurg Psychiatry 56(1):98–100, 1993
Stout JC , Paulsen JS , Queller S , et al: Neurocognitive signs in prodromal Huntington disease. Neuropsychology 25(1):1–14, 2011 10.1037/a0020937
Thompson JC , Harris J , Sollom AC , et al: Longitudinal evaluation of neuropsychiatric symptoms in Huntington’s disease. J Neuropsychiatry Clin Neurosci 24(1):53–60, 2012 10.1176/appi.neuropsych.11030057
Wild EJ , Mudanohwo EE , Sweeney MG , et al: Huntington’s disease phenocopies are clinically and genetically heterogeneous. Mov Disord 23(5):716–720, 2008 10.1002/mds.21915
Monica Castelao
on Thu, Feb 17 2022, 10:40 PM
85% highest match
Submission ID: 597b5343-e0aa-4458-bd84-1333c7ed07db
Week10NeuroAssignmentMonica.Castelao.extention
Word Count: 811
Attachment ID: 5221604362
85%
1
Another student’s paper
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https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1556-3
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https://www.science.gov/topicpages/e/early+huntington+disease
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Week (10): Psychiatric Evaluation
Monica Castelao
1
College of Nursing-PMHNP, Walden University
Suspected Entry: 100% match
Uploaded – Week10NeuroAssignmentMonica.Castelao.extention
College of Nursing-PMHNP, Walden University
Source – Another student’s paper
College of Nursing-PMHNP, Walden University
NRNP 6635:
1
Psychopathology and Diagnostic Reasoning
Suspected Entry: 100% match
Uploaded – Week10NeuroAssignmentMonica.Castelao.extention
Psychopathology and Diagnostic Reasoning
Source – Another student’s paper
Psychopathology and Diagnostic Reasoning
Assignment Due Date NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
Suspected Entry: 84% match
Uploaded – Week10NeuroAssignmentMonica.Castelao.extention
Assignment Due Date NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
Source – Another student’s paper
NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
CC (chief complaint):
Suspected Entry: 100% match
Uploaded – Week10NeuroAssignmentMonica.Castelao.extention
CC (chief complaint)
Source – Another student’s paper
CC (chief complaint)
Harold Griffins confirms he had visited a supervisor.
Suspected Entry: 80% match
Uploaded – Week10NeuroAssignmentMonica.Castelao.extention
Harold Griffins confirms he had visited a supervisor
Source – Another student’s paper
Harold confirms that he had initially visited a supervisor
He is a male aged fifty-eight years with bachelor’s degree engineering. He is a homosexual, has never married, and has no children.
HPI:
1
Harold is referred to the psychiatric evaluation due to his lack of concentration at work and home.
Suspected Entry: 100% match
Uploaded – Week10NeuroAssignmentMonica.Castelao.extention
Harold is referred to the psychiatric evaluation due to his lack of concentration at work and home
Source – Another student’s paper
Harold is referred to the psychiatric evaluation due to his lack of concentration at work and home
He reports difficulty with attention and delayed recall.
1
The lack of concentration problem dates back to when he was at school, as he could hardly concentrate while his peers crammed for big exams in the library.
Suspected Entry: 100% match
Uploaded – Week10NeuroAssignmentMonica.Castelao.extention
The lack of concentration problem dates back to when he was at school, as he could hardly concentrate while his peers crammed for big exams in the library
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The lack of concentration problem dates back to when he was at school, as he could hardly concentrate while his peers crammed for big exams in the library
His mother tried to take him to the hospital but failed because Harold was unwilling.
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His mother tried to take him to the hospital but failed because Harold was unwilling
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His mother tried to take him to the hospital but failed because Harold was unwilling
Past Psychiatric History:
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Past Psychiatric History
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Past Psychiatric History
· General Statement: Harold, an architect-engineer, has difficulty with attention and delayed recall · Caregivers (if applicable):
1
Based on the case video transcript, Harold’s primary caregiver was his mother while he was still schooling.
Suspected Entry: 95% match
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Based on the case video transcript, Harold’s primary caregiver was his mother while he was still schooling
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Based on the case video, Harold’s primary caregiver was his mother while he was still schooling
· Hospitalizations:
1
The client has no history of hospitalizations in the past.
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The client has no history of hospitalizations in the past
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The client has no history of hospitalizations in the past
The examination also reveals that he has never attempted any act such as committing suicide or being aggressive · Medication trials:
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The examination also reveals that he has never attempted any act such as committing suicide or being aggressive · Medication trials
Source – Another student’s paper
The examination also reveals that he has never attempted any act such as committing suicide or being aggressive · Medication trials
He has taken some medications in past including losartan, fenofibrate, metoprolol and tamsulosin.
1
· Psychotherapy or Previous Psychiatric Diagnosis:
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· Psychotherapy or Previous Psychiatric Diagnosis
Source – Another student’s paper
· Psychotherapy or Previous Psychiatric Diagnosis
The client has had no psychotherapy or psychiatric diagnosis before.
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The client has had no psychotherapy or psychiatric diagnosis before
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The client has had no psychotherapy or psychiatric diagnosis before
Substance Current Use and History:
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Substance Current Use and History
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Substance Current Use and History
Harold has no history of illegal drug abuse.
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Harold has no history of illegal drug abuse
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Harold has no history of illegal drug abuse
He enjoys one scotch drink on the weekends with a cigar.
1
Family Psychiatric/Substance Use History:
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Family Psychiatric/Substance Use History
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Family Psychiatric/Substance Use History
Based on the information shared, his family has no history of drug and alcohol abuse.
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Based on the information shared, his family has no history of drug and alcohol abuse
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However, based on the information shared, his family has no history of drug and alcohol abuse
Psychosocial History: Difficulties with concentrate and memory
Medical History:
He has initially been diagnosed with HTN blood pressure, angina and Hypertriglyceridemia.
· Current Medications: Currently has BPH and takes tamsulosin 0.4mg before bedtime · Allergies:
2
Morphine · Reproductive Hx:
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Morphine · Reproductive Hx
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NKDA · Reproductive Hx
He is a homosexual, has never married and has no children.
ROS:
· GENERAL:
1
Accelerated deadlines at the workplace increased his lack of concentration problem.
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Accelerated deadlines at the workplace increased his lack of concentration problem
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Accelerated deadlines at the workplace increased his lack of concentration problem
· HEENT:
1
There are no illnesses associated with the eyes, ears, nose, and throat.
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There are no illnesses associated with the eyes, ears, nose, and throat
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There are no illnesses associated with the eyes, ears, nose, and throat
· SKIN:
1
No irritation, rashes, or itching reported · CARDIOVASCULAR:
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No irritation, rashes, or itching reported · CARDIOVASCULAR
Source – Another student’s paper
No irritation, rashes, or itching reported · CARDIOVASCULAR
Has received medication for HTN · RESPIRATORY: Harold has received medication for angina · GASTROINTESTINAL:
1
No stomach aches, vomiting, and other related symptoms.
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No stomach aches, vomiting, and other related symptoms
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No stomach aches, vomiting, and other related symptoms
· GENITOURINARY:
1
Not documented · NEUROLOGICAL:
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Not documented · NEUROLOGICAL
Source – Another student’s paper
Not documented · NEUROLOGICAL
Reports decreased concentration, memory, and sometimes difficulties sitting and eating.
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Reports decreased concentration, memory, and sometimes difficulties sitting and eating
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Reports decreased concentration, memory, and sometimes difficulties sitting and eating
· MUSCULOSKELETAL:
1
The muscles could have some challenges because Harold is troubled sitting and eating.
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The muscles could have some challenges because Harold is troubled sitting and eating
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The muscles could have some challenges because Harold is troubled sitting and eating
· HEMATOLOGIC: Hypertriglyceridemia · LYMPHATICS:
1
No history of swelling · ENDOCRINOLOGIC:
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No history of swelling · ENDOCRINOLOGIC
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No history of swelling · ENDOCRINOLOGIC
No history of uncontrolled swearing
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No history of uncontrolled swearing
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No history of uncontrolled swearing
Physical exam:
1
A physical examination was not done.
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A physical examination was not done
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A physical examination was not done
Diagnostic results:
1
Harold’s challenges cannot be linked to a specific disease or disorder.
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Harold’s challenges cannot be linked to a specific disease or disorder
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Harold’s challenges cannot be linked to a specific disease or disorder
Consequently, an additional examination is required.
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Consequently, an additional examination is required
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Consequently, an additional examination is required
Assessment:
1
Mental Status Examination:
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Mental Status Examination
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Mental Status Examination
Harold presents himself for examination on time and sits in the client’s seat.
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Harold presents himself for examination on time and sits in the client’s seat
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Harold presents himself for examination on time and sits in the client’s seat
He keeps smiling while the evaluation goes on and seems to react when talking and listening.
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He keeps smiling while the evaluation goes on and seems to react when talking and listening
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He keeps smiling while the evaluation goes on and seems to react when talking and listening
However, he appears not to concentrate much on the evaluation process.
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However, he appears not to concentrate much on the evaluation process
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However, he appears not to concentrate much on the evaluation process
Differential Diagnoses: One of the disorders Harold could be suffering from is Huntington’s disease. Its symptoms include difficulty in concentrating, memory loss and mood swings which Harold reports (Beglinger et al., 2007). The second disorder he may be suffering from is major or mild vascular NCD. The condition is characterized by early impairment of executive function and attention, slowed motor performance, and slowed processing of information (Beglinger et al., 2007). The client has challenges performing executive functions at work and has difficulty with concentration. The third differential diagnosis is chorea (Benign Hereditary Chorea (BHC)). It is characterized by lung infections, involuntary muscle paints and respiratory diseases (Duff et al., 2007). Harold suffers from HTN, angina and HTN blood pressure which makes chorea a differential diagnosis. Based on the symptoms presented, he will be diagnosed for Huntington’s disease as the primary diagnosis because he shows most of the symptoms of Huntington’s disease.
Reflections:
1
The interaction with Harold has bolstered my understanding of hows social workers can deal with patients, conduct evaluations and determine possible mental disorders affecting the client.
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The interaction with Harold has bolstered my understanding of hows social workers can deal with patients, conduct evaluations and determine possible mental disorders affecting the client
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The interaction with Harold has bolstered my understanding of hows social workers can deal with patients, conduct evaluations and determine possible mental disorders affecting the client
I have also l discovered that social workers could help patients identify their challenges by determining their behaviors during examination (Moos, 2017).
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I have also l discovered that social workers could help patients identify their challenges by determining their behaviors during examination (Moos, 2017)
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I have also l discovered that social workers could help patients identify their challenges by determining their behaviors during examination (Moos, 2017)
The psychiatric evaluation has also shown the importance of good interpersonal skills when interacting with clients.
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The psychiatric evaluation has also shown the importance of good interpersonal skills when interacting with clients
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The psychiatric evaluation has also shown the importance of good interpersonal skills when interacting with clients
I am confident that the knowledge obtained from the case video will be essential in my practice.
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I am confident that the knowledge obtained from the case video will be essential in my practice
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I am confident that the knowledge obtained from the case video will be essential in my practice
References
Beglinger LJ , O’Rourke JJ , Wang C , et al:
3
Earliest functional declines in Huntington disease.
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Earliest functional declines in Huntington disease
Source – https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1556-3
earliest functional declines in Huntington disease
Psychiatry Res 178(2):414–418, 2010 10.1016/j.psychres.2010.04.030
Duff K , Paulsen JS , Beglinger LJ , et al:
4
Psychiatric symptoms in Huntington’s disease before diagnosis:
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Psychiatric symptoms in Huntington’s disease before diagnosis
Source – https://www.science.gov/topicpages/e/early+huntington+disease
Longitudinal Psychiatric Symptoms in Prodromal Huntington’s Disease
3
the predict-HD study.
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the predict-HD study
Source – https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1556-3
the predict-HD study
Biol Psychiatry 62(12):1341–1346, 2007
Moos, R. H.
1
(2017, October 31).
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(2017, October 31)
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(2017, October 31)
Evaluating Treatment Environments:
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Evaluating Treatment Environments
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Evaluating Treatment Environments
The Quality of Psychiatric and Suh.
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The Quality of Psychiatric and Suh
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The Quality of Psychiatric and Suh
Retrieved from https://www.taylorfrancis.com/books/mono/10.4324/9781351291804/evaluatingtreatment-environments-rudolf-moos © 2020 Walden University
Suspected Entry: 91% match
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Retrieved from https://www.taylorfrancis.com/books/mono/10.4324/9781351291804/evaluatingtreatment-environments-rudolf-moos © 2020 Walden University
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Retrieved from https://www.taylorfrancis.com/books/mono/10.4324/9781351291804/evaluatingtreatment-environments-rudolf-moos
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Page 6 of 6
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