Assignment: Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders

Assignment: Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders

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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.).

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

· Please save your Assignment using the naming convention “WK10Assgn+last name first initial. (extension)” as the name.

· Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.

· Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.

· Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.

· If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.

· Click on the Submit button to complete your submission.

Note: choose 1 Case Study

Week 10 Neurocognitive and Neurodevelopmental Disorders

Training Title 48

Name: Sarah Higgins

Gender: female

Age: 9 years old

T- 97.4 P- 62 R 14 95/60 Ht 4’5 Wt 63lbs

Background:

no history of treatment, developmental milestones met on time, vaccinations up

to date. Sleeps 9hrs/night, meals are difficult as she has hard time sitting for meals, she does

get proper nutrition per PCP.

Symptom Media. (Producer). (2017).

Training title 48 [Video}

https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/training-title-48

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).

https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/training-title-50

Week 10 Neurocognitive and Neurodevelopmental Disorders

Training Title 48

Name: Sarah Higgins

Gender: female

Age: 9 years old

T- 97.4 P- 62 R 14 95/60 Ht 4’5 Wt 63lbs

Background:

no history of treatment, developmental milestones met on time, vaccinations up

to date. Sleeps 9hrs/night, meals are difficult as she has hard time sitting for meals, she does

get proper nutrition per PCP.

Symptom Media. (Producer). (2017). Training title 48 [Video].

https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-48

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

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

Subjective:

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:

Objective:

Physical exam: if applicable

Diagnostic results:

Assessment:

Mental Status Examination:

Differential Diagnoses:

Reflections:

References

Appearance: 25-year-old African American female, appears stated age, wearing paper hospital scrubs that have been cut to reveal abdomen with vertical abdominal scar visible, and multiple tattoos of various names visible on forearms bilaterally.

Behavior: Not in acute distress, difficult to redirect for interviewing, inappropriately laughing and smiling

Motor Activity: Minimal psychomotor agitation present. Regular gait. Regular posturing. No tics, tremors, or EPS present.

Speech: Hyperverbal, fluent, pressured rate, regular rhythm, regular volume, happy tone

Mood: “Fantastic”

Affect: Elated, inappropriate, congruent

Thought Process: Flight of ideas

Thought Content: Denies suicidal ideations, denies homicidal ideations. Grandiose delusions elicited of being “an angel on a mission.”

Perceptions: Endorses auditory hallucinations of God commanding her to go to California. Denies visual hallucinations. Does not appear to be actively responding to internal stimuli.

Cognition: 

Sensorium/orientation: Alert and oriented to person, place, and date 

Attention/concentration: Poor. Unable to spell WORLD forward and backward.

Memory: Able to recall 3/3 objects immediately and after 1 minute. Recent memory – Intact to breakfast this morning. Long-term memory – Intact to what high school she attended.

Abstract reasoning: Intact with the ability to identify a bird and tree as both living.

Insight: Poor

Judgment: Poor

Name: Ms. Jess Cunningham Gender: female Age: 28 years old T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs Background: Jess is brought for evaluation by her 2 roommates who are concerned with behaviors that began 12 days after Jess’s younger brother committed suicide in front of her via GSW after his girlfriend broke up with him. She is estranged from her parents and her brother was her only sibling. She is only sleeping 1–2 hours/24hrs; she will only canned foods. She smokes cannabis daily since she was 16, goes out on weekdays 2–3 times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg twice daily as needed by her PCP for 15 days. She works as a bartender. Symptom Media. (Producer). (2016). Training title 24 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-24

Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

Assessing patients’ moods

Subjective;

Cc; chief complaint; “I can’t stop crying. All the time.”

L.T. is indeed a 32-years African American woman who is seeking psychiatric help. Since the baby’s delivery two months ago, the patient has been in a melancholy mood virtually every day. She admits that dealing with a newborn baby is difficult for her, so the child’s nursing is stressful. The client testifies to sleeplessness, including difficulty sleeping after birth. She also alleges a poor appetite and dissatisfaction with her looks, body size or form, shame, and avoidance of talking to friends, mainly if the newborn is crying. She describes her disagreeable disposition by saying, “Things simply bother her.” She also says to be disinterested in activities like writing, which she enjoyed. Although the client confessed to having suicidal ideation, he did not act on them. She insists that she has never considered hurting the child. For the time being, no psychotropic medications are indicated for the client.

Psychiatric History

· General Statement: The client never had a mental health evaluation or treatment.

· Hospitalizations: the client was just hospitalized for regular childbirth.

· Psychotherapy or Prior Psychiatric Treatment Was never medicated for mental health conditions and therefore had no history of mental health diseases.

Current and Past Uses of the Substance: The patient stated that he did not drink or use drugs. Psychiatric/Substance Abuse History in Her Household: Her uncle committed suicide with the help of a GSW. Uncle had been a heroin addict.

Patient’s psychosocial history: she is currently in a relationship with two kids and resides with her spouse. She worked retail for five years before becoming a stay-at-home mum. She only has one sibling and was brought up with both mother and father in Omaha, Nebraska. She does have a physics bachelor. She worked as a researcher math teacher for five years when her child was born. 2 months ago, L.T’s first kid was born. The customer has no prior legal experience.

L.T.’s past medical history is hypertension.

Medications in Use: Labetalol (100 mg) for HTN; acknowledges accidentally leaving dosages.

Allergies: Codeine

Reproductive Hx: L.T delivered a few months ago and is still breastfeeding. She is presently contraceptive-free. The woman does not have any sexual interaction since the baby’s delivery. She asserts that she has no interest in sexual activity.

ROS: There is no loss of weight, cold, fever, or weariness in general

HEENT: No vision alterations, doubled vision, or hepatitis in the eyes. No modifications in vision, rhinorrhea, congestion, and sore throat inside the ears, throat nose.

Skin: The tint of the body has remained unchanged. There is no itching and rash.

Cardiovascular: There is no soreness or discomfort in the chest, no beats, and no edema.

There is no cough, dyspnea, or sputum production.

Gastrointestinal: There has been a decrease in appetite. L.T wants weight reduction after the baby is born. There is no anorexia, vomiting, or diarrhea. In the belly, there seems to be no pain.

Genitourinary: No burning, hesitation, or urgency when urinating. The color and texture of the pee remain unchanged.

Neurological: Seizure’s numbness, no headaches or tingling in the extremities, and paralysis are all symptoms of epilepsy.

Musculoskeletal:  L.T didn’t get any stiffness or soreness in her back.

Hematologic: Anemia or bleeding does not appear to be a problem.

Lymphatics: There was no splenectomy, and there were swollen nodes in the backdrop.

Endocrinologic: no sweating, fever, or chill intolerance reported. Polyuria and polydipsia were not present.

Objective:

Signs of life: “T-97.6, P-97, R-22, BP-149/98, Ht 5’3 Wt 245lb”

Not Applicable for a physical examination

diagnostic results are Not Applicable

Assessment:  Examining L. T’s Mental Health Status: The patient is dressed suitably for the occasion and the weather. She’s a beautiful person.  Vigilant and focused on an individual, a location, and a time. Her recollection appeared to have remained intact throughout the experience. She is polite, yet she seems to be aloof in the evaluation. Her words are apparent, and she uses low tones when speaking. Her disposition is gloomy. The effect has suffocated no hallucinations or delusions. Suicide or suicide attempt thoughts are reported. She has had visions of death, but she has not acted on them.

Differential Diagnosis (Differential Diagnosis)

Postpartum depression; postpartum disorder is a type of depression that begins four weeks after a baby is born and lasts for four weeks. Symptoms of insomnia include depressive moods, increased anxiety, weight fluctuations (Sadock et al., 2015). Numerous signs of major depression, such as diminished enjoyment in activities, are common among people with depressive symptoms, such as feelings of improper guilt or lack of sound, as well as feelings of worthlessness and death of endangering the child (Mullins, 2021). Given that, that’s the most frequent symptom. The patient meets the signs and clinical diagnosis for major depression. It began four weeks after the birth of the child. The patient is melancholy and often weeps every day. The client describes being unhappy and sobbing practically every day, as well as having trouble sleeping, a diminished appetite, feelings of guilt, low self-esteem and inadequacy, a disinterest in pleasure activities, and suicidal ideas without the need for a plan.

MDD is defined by a depressed mood and perhaps a lack of enjoyment in activities. Feelings of grief or anxiousness, a lack of interest or pleasure in actions, hypersomnia, losing weight, energy dissipation, feelings of helplessness or unworthiness, improper guilt, common suicidal thoughts or fatality, decreased energy, and difficulty concentrating or indecisiveness (Sadock et al., 2015). Although, L.T exhibits the majority of these signs.

A brief mood illness characterized by a low mood or symptoms of mild depression is postpartum blues. Signs of Depression include dysphoria, mood instability, tearfulness, weeping, insufficient sleep, irritability, and diminished focus (Sadock et al., 2015). According to Mullins (2021), 30 to 50 percent of people have the disorder. Mothers who have recently given birth must meet the diagnostic criteria of the ailment to be diagnosed. Arise within two weeks of childbirth and subside within 2-3 days after delivery. If the symptoms linger for a more extended period, The clinical diagnosis for primary depressive illness is met in less than two weeks (Sadock et al.,2015). Since the symptoms lasted longer than two weeks, that’s not the most common condition.

Reflections

I studied several psychological disorders that share the same symptoms based on the scenario given. In brief, I’ve learned about mental health illness, a depressed mood that develops 4-6 weeks just after the baby is born. Other mental illnesses I’ve heard of include severe depression and postpartum blues, both of which have symptoms comparable to those of postpartum depression. Examining aspects associated with stressors and anxiety and depression disorder catalysts is necessary to provide an accurate diagnosis. (Wolters Kluwer et al., 2015). Drug safety, especially in the case of a baby, is a regulatory factor to be considered during the patient’s care. When a breastfeeding woman decides to take medicine, she should consider the drug’s possible benefits and the risks to her child. While all drugs pass via the breastmilk, their degree varies (Frieder et al.,2019). Furthermore, because individuals with depressive symptoms have suicidal thoughts and injure the infant, it is critical to inquire about such ideas to identify whether they are delusional or obsessive behavior and assure the mother and baby’s safety.

References

Frieder, A., Fersh, M., Hainline, R., & Deligiannidis, K. M. (2019). Pharmacotherapy of postpartum depression: current approaches and novel drug development. CNS drugs, 33(3), 265-282.

Mullins IV, C. H. (2021). Postpartum Blues. Patient Education and Counseling.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.).

Wolters Kluwer. Sherman, L. J., & Ali, M. M. (2018). Diagnosis of postpartum depression and timing and types of treatment received differ for women with private and Medicaid coverage. Women’s Health Issues, 28(6), 524-529.