Assignment:  NRNP 6635 Week 10 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders 

Assignment:  NRNP 6635 Week 10 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Assignment:  NRNP 6635 Week 10 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders
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, 2022). 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.

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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
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.).
Rubric Detail
Name: NRNP_6635_Week10_Assignment_Rubric
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS–

Excellent 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.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.–

Excellent 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.
In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.–

Excellent 23 (23%) – 25 (25%)
The response thoroughly and accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
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!),
social determinates of health, 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.).–

Excellent 9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.
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).–

Excellent 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.
Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.–

Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation–
Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Total Points: 100
Training Title 50
Name: Harold Brown
Gender: male
Age:60 years old
T- 98.8 P- 74 R 18 134/70 Ht 5’10 Wt 170lbs
Background:
Has bachelor’s degree in engineering. He dates casually, never married, no children. Has one
younger brother. Sleeps 7 hours, appetite good. Denied legal issues; MOCA 28/30 difficulty with
attention and delayed recall; ASRS-5 21/24; denied hx of drug use; enjoys one scotch drink on
the weekends with a cigar. Allergies Dilaudid; history HTN blood pressure controlled with
Cozaar 100mg daily, angina prescribed ASA 81mg po daily, valsartan 80mg 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

TRANSCRIPT OF VIDEO FILE:
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

Assignment: NRNP 6635 Week 10 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Sample

CC (chief complaint): “Concentration difficulties.”

HPI: Harold Brown is a 60-year-old male who presented for psychiatric evaluation due to concentration difficulties. Brown reported to his supervisor about the concern, and the supervisor arranged a psychiatric assessment appointment for him. The client works in an architectural engineering firm where they have been experiencing tight deadlines and pressure. He is concerned about the concentration difficulties since he is not delivering quality work due to stupid mistakes that can heavily cost the organization. Brown associates the concentration difficulties with the tight deadlines and work pressure since he did not have the problem before that when the workflow was smooth. Back in school, the client had difficulties concentrating in the library due to distractions like looking out the window, taking walks, and whispers. Furthermore, he gets distracted during work lectures held by the chief of the department and hardly sits or listens. He gets distracted when working and tends to lose focus on his colleagues’ work. In addition, he reports being disorganized and forgetting where he puts his things and paying bills. Brown was hyperactive in school, but this has improved over time. He takes caffeine to improve his concentration.

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Past Psychiatric History:

• General Statement: The client’s hyperactivity dates back to his school days.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: None.
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: The client reports taking a scotch drink on weekends with a cigar but denies a history of drug use.

Family Psychiatric/Substance Use History: None.

Psychosocial History: Brown has a bachelor’s degree in engineering and works in an architectural engineering firm. He is not married nor has children but dates casually. He has one younger brother. He reports sleeping about 7 hours daily and has a good appetite. The client denies a history of legal issues.

Medical History:

• Current Medications: Cozaar 100mg OD; ASA 81mg PO daily; Valsartan 80mg OD; Fenofibrate 160mg OD; Tamsulosin 0.4mg PO QHS.
• Allergies: Allergic to Dilaudid.

• Reproductive Hx: Denies history of STIs.

ROS:

• GENERAL: Denies weight changes, fever, or diminished energy.
• HEENT: Denies eye pain, vision changes, ear discharge, ear pain, nasal discharge, or sore throat.
• SKIN: Denies discoloration, bruises, or lesions.
• CARDIOVASCULAR: Denies palpitations, chest pain, or SOB.
• RESPIRATORY: Denies wheezing, cough, or sputum.
• GASTROINTESTINAL: Denies heartburn, abdominal pain, diarrhea, or constipation.
• GENITOURINARY: Denies urinary symptoms.
• NEUROLOGICAL: Denies paralysis, headache, or numbness.
• MUSCULOSKELETAL: Denies muscle pain, joint pain, or joint stiffness.
• HEMATOLOGIC: Denies bruising or history of anemia.
• LYMPHATICS: Denies lymph node enlargement.
• ENDOCRINOLOGIC: Denies increased sweating, urine production, hunger, or thirst.

Physical exam:

Vital Signs: BP- 134/70; HR- 74; RR- 18; Temp-98.8; Ht 5’10; Wt 170lbs

Diagnostic results: No tests were ordered. 

Assessment

Mental Status Examination:

A male client in his 60’s, is alert and appears anxious. The client is well-groomed and dressed appropriately for the weather. He has a normal gait and posture and positive facial expressions. His self-reported mood is nervous, and affect is appropriate. The speech has a normal rate and volume and is goal-directed. He has a coherent, logical, and goal-directed thought process. No apparent delusions, hallucinations, obsessions, or suicidal thoughts. His memory is intact, his judgment is good, and his insight is present.

MOCA: 28/30 difficulty with attention and delayed recall. ASRS-5: 21/24.

Differential Diagnoses:

Attention-Deficit/Hyperactivity Disorder Combined (ADHD): ADHD is marked by an enduring pattern of inattention and/or hyperactivity and impulsivity that impairs development and functioning. Persons with ADHD have an enduring pattern of intention, hyperactivity, or impulsivity (Prakash et al., 2021). Inattention is characterized by difficulties staying on task, sustaining focus, and being organized. Adults with hyperactivity have extreme restlessness, talk too much, move about constantly in inappropriate situations, and excessively fidget. Individuals with impulsivity act without thinking and have difficulty with self-control (Song et al., 2021). The client has combined ADHD as evidenced by symptoms of inattention, like concentration difficulties, and hyperactivity, like difficulties remaining still in the library and during work lectures.  

Generalized Anxiety Disorder (GAD): GAD entails a constant feeling of anxiety or fear, which interferes with functioning. Symptoms include: Difficulty controlling worry/ anxiety; Feeling restless or wound-up; Easy fatigue; Concentration difficulties; Irritability; Sleeping problems; Physical symptoms like headaches, muscle aches, and abdominal pain (Slee et al., 2021). GAD is a differential diagnosis owing to the client’s distractibility, concentration difficulties, and self-reported mood of nervousness. Nonetheless, anxiety or worry is not the primary symptom, ruling out GAD as a primary diagnosis.

Major Depression: Depression presents with a depressed, sad, or tearful mood and/or lack of interest in pleasurable activities. The condition usually interferes with a person’s functioning. Persons with depression have difficulty remembering, concentrating, or making decisions (Maj et al., 2020). The client reported having difficulties remembering and concentrating, making major depression a differential diagnosis. However, the client has no sad mood or reduced interest, making depression an unlikely primary diagnosis.

Reflections:

The assignment has enlightened me on ADHD in adults, a condition often thought of as a childhood developmental disorder. I have learned that ADHD has three types: ADHD Predominantly Inattentive, ADHD Predominantly Hyperactive, and ADHD Combined (Cubbin et al., 2020). Besides, a significant number of adults with ADHD had ADHD in childhood. In a different situation, I would use the Copeland Symptom Checklist for Adult ADHD since it assesses a broad range of ADHD symptoms in the emotional, cognitive, and social aspects (Cubbin et al., 2020). SDOH related to this client includes insurance coverage, which will determine his ability to access healthcare services for ADHD treatment. Health promotion should include educating the patient on ADHD symptoms and available psychotherapy treatments and coping mechanisms.   

References

Cubbin, S., Leaver, L., & Parry, A. (2020). Attention deficit hyperactivity disorder in adults: common in primary care, misdiagnosed, and impairing, but highly responsive to treatment. The British journal of general practice: the journal of the Royal College of General Practitioners, 70(698), 465–466. https://doi.org/10.3399/bjgp20X712553

 Maj, M., Stein, D. J., Parker, G., Zimmerman, M., Fava, G. A., De Hert, M., … & Wittchen, H. U. (2020). The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry, 19(3), 269-293. https://doi.org/10.1002/wps.20771

Prakash, J., Chatterjee, K., Guha, S., Srivastava, K., & Chauhan, V. S. (2021). Adult attention-deficit Hyperactivity disorder: From clinical reality toward conceptual clarity. Industrial psychiatry journal, 30(1), 23–28. https://doi.org/10.4103/ipj.ipj_7_21

Slee, A., Nazareth, I., Freemantle, N., & Horsfall, L. (2021). Trends in generalized anxiety disorders and symptoms in primary care: UK population-based cohort study. The British journal of psychiatry: the journal of mental science, 218(3), 158–164. https://doi.org/10.1192/bjp.2020.159

Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health, 11, 04009. https://doi.org/10.7189/jogh.11.04009