Neurocognitive and Neurodevelopmental Assessment Essay

Neurocognitive and Neurodevelopmental Assessment Essay

Subjective.

Biodata: Harold Griffin, a 58-year-old male with a bachelor’s degree in engineering and works at a large architectural engineering firm.

Chief Complaint (CC): Troubling concentrating.

H.P.I: Harold Griffin is a 58-year-old male patient who presents with difficulty concentrating at the workplace. He says that everything was going on well until recently when deadlines at the firm he works in were accelerated. Earlier on, when things were more relaxed, he hardly ever made any mistakes. Now that deadlines are much tighter, he has difficulty concentrating and makes silly mistakes that are very detrimental. This has happened on several occasions. He also has difficulty concentrating during presentations at the workplace, with his mind drifting off to his dog or what he will have for lunch. Harold also has trouble in organization and is quite messy often forgetting where he placed his keys or jacket. He also has difficulty paying his bills and often pays after receiving several warning calls ending up paying penalties. He has difficulty sitting still but points out that that is not such a big deal. The condition began when he was much younger. He had difficulty concentrating as he studied in the library with his mind wandering off as he looked out the window.

Past Psychiatric History: Not known. Her mother had once threatened to take him for evaluation, but it never happened.

Family History: He grew up with his mother, who was very strict regarding the consumption of caffeine and other caffeine-containing substances saying that they would make him overly active. He has one younger sister.

Social History: Harold has a bachelor’s degree in engineering. He is a homosexual who dates casually. He strongly denies any legal issues. He denies any drug use but usually has one scotch every weekend alongside a cigar.

Medical History.

• Past Medical History: The patient has a history of hypertension, angina, BPH and hypertriglyceridemia.
• Current Medication: The patient is currently on 100mg of losartan daily, ASA 81mg PO daily and metoprolol 25mg twice daily. He is also on 160mg of fenofibrate daily and BPH prescribed tamsulosin 0.4mg PO bedtime.
• Allergies: Harold is allergic to morphine.

ROS:

• GENERAL: Alert. Well oriented to person, place, and time.
• HEENT: Normal vision, visual fields normal; mucous membranes moist, no lymphadenopathy, neck supple.
• SKIN: No lesions or rashes
• CARDIOVASCULAR: S1 and S2 heard, no murmurs.
• RESPIRATORY: CTA bilaterally
• GASTROINTESTINAL: No nausea, vomiting; no constipation, diarrhea, or abdominal pain.
• GENITOURINARY: No hematuria.
• NEUROLOGICAL: No fainting; no paralysis or seizures; or weakness; no tremors or memory changes.
• MUSCULOSKELETAL: No joint stiffness or pains;
• HEMATOLOGIC: No bleeding, bruising, or anemia;
• LYMPHATICS: No lymphadenopathy

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Objective:

Physical exam: The patient weighs 180 lbs. and is 5’11” tall. His pulse rate is 86 beats per minute; his blood pressure is 134/88 mmHg with a temperature of 98.8.

Assessment:

The client acknowledges that he has difficulty concentrating though he says that the recent tight deadlines have contributed to his current state. It was his supervisor who booked this session with the counselor.

Mental Status Examination:

Harold has a MOCA score of 27/30 with difficulty paying attention and delayed recall. He also has an ASRS-5 score of 20/24. The patient has impaired speech with pauses observed during the interview. Harold is also visibly restless in his chair, constantly adjusting his position and always moving his arms during the interview. He also has difficulty concentrating. He is well oriented to time, place and person. His memory is intact, both short-term and long-term memory. His mood and affect are congruent.

Primary diagnosis:

                Attention Deficit Hypersensitivity Disorder (ADHD) is a pervasive neurodevelopmental disorder commonly observed in childhood. It is often diagnosed while one is a child and often prolongs into adulthood. Individuals with this condition have trouble concentrating, are overactive and often have impulsive tendencies (Weibel et al., 2020). DSM-5 criteria for diagnosis of ADHD in adults requires the occurrence of five or more episodes of lack of concentration and/or five or more symptoms of overactivity, usually lasting for a period equal to or greater than six months. It also requires the presence of symptoms such as hyperactivity and lack of concentration long before the age of twelve years. These symptoms should also greatly impact the affected individual’s overall social or occupational life.

In this scenario, the patient has repeated episodes of lack of concentration at the workplace. These episodes have recently increased following tightened deadlines at the workplace. These lapses in concentration have significantly impacted the overall performance at the workplace. The patient has often caused errors that have greatly affected the overall quality of his work. The patient also finds it difficult to pay attention during board meetings. He is also hyperactive and tends to be messy, easily displacing his personal belongings. This condition began long when the patient was a child. He was overly active, and his mother often threatened to have him evaluated though it never happened. These symptoms and the fact that the condition began when our patient was still a child means that the most likely diagnosis is ADHD. Pertinent negatives associated with this condition include social isolation, inability to form lasting bonds, depression, and increased risk-taking tendencies (Wyler et al., 2021). our patient clearly has trouble forming lasting bonds as we are told that he has been dating casually and has never been married.

Differential Diagnoses.

                Anxiety disorders are a group of disorders that can often mimic ADHD. There are several anxiety disorders. DSM-5 criteria for diagnosis of anxiety disorders require excessive anxiety and worry lasting most days for a period of at least six months. The feelings of anxiety and worry are often accompanied by symptoms such as restlessness, difficulty concentrating, irritability, easy fatiguability, muscle tension, and sleep disturbances (Johnson et al., 2019). The anxiety may often interfere with the individual’s overall performance at the workplace or other daily activities. The patient in this scenario may be anxious regarding the new deadlines resulting in reduced performance at the workplace. However, the other symptoms, such as hyperactivity, rule out anxiety disorders.

Major Depressive Disorder (MDD) is another key differential. Dsm-5 diagnostic criteria for MDD requires depressed mood or loss of interest in normal daily activities for a two-week period. These two symptoms should be accompanied by other symptoms, including trouble concentrating, feelings of fatigue and diminished energy levels, suicidal ideation, among other symptoms (Zuckerman et al., 2018). Despite difficulty concentrating and paying attention, the other symptoms, such as hyperactivity, rule out the diagnosis of major depressive disorder.

Reflections.

If I were to conduct the interview again, I would ask about the patient’s family history. A history of similar symptoms in any close family member would go a long way in enhancing the diagnosis of the condition. I would also exercise greater patience with the patient and not rush him to answer questions during the interview. The patient’s consent and confidentiality are key ethical considerations to consider. In addition to these, autonomy is a crucial consideration (Fiske et al., 2019). The health care practitioner should acknowledge that the patient is an adult capable of making well-informed decisions regarding his care. Beneficence is another critical consideration. The health care provider must act for the patient’s benefit at all times and ensure that no harm befalls the patient throughout the whole process. Health promotion and disease prevention in this patient entails encouraging and promoting physical activity and exercise, proper nutrition, and adequate sleep (Brandley et al., 2020). It is also important to ensure that the patient is fully aware of his condition and any factors in his immediate environment that may be triggering the condition so as to act accordingly.

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References.

Brandley, E. T., & Holton, K. F. (2020). Breakfast Positively Impacts Cognitive Function in College Students With and Without ADHD. American Journal Of Health Promotion: AJHP, 34(6), 668–671. https://doi.org/10.1177/0890117120903235

Fiske, A., Henningsen, P., & Buyx, A. (2019). Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy. Journal Of Medical Internet Research, 21(5), e13216. https://doi.org/10.2196/13216

Johnson, S. U., Ulvenes, P. G., Øktedalen, T., & Hoffart, A. (2019). Psychometric Properties of the General Anxiety Disorder 7-Item (GAD-7) Scale in a Heterogeneous Psychiatric Sample. Frontiers In Psychology, 10, 1713. https://doi.org/10.3389/fpsyg.2019.01713

Weibel, S., Menard, O., Ionita, A., Boumendjel, M., Cabelguen, C., Kraemer, C., Micoulaud-Franchi, J. A., Bioulac, S., Perroud, N., Sauvaget, A., Carton, L., Gachet, M., & Lopez, R. (2020). Practical considerations for the evaluation and management of Attention Deficit Hyperactivity Disorder (ADHD) in adults. L’Encephale, 46(1), 30–40. https://doi.org/10.1016/j.encep.2019.06.005

Wyler, H., Liebrenz, M., Ajdacic-Gross, V., Seifritz, E., Young, S., Burger, P., & Buadze, A. (2021). Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions. BMC Psychiatry, 21(1), 237. https://doi.org/10.1186/s12888-021-03236-9

Zuckerman, H., Pan, Z., Park, C., Brietzke, E., Musial, N., Shariq, A. S., Iacobucci, M., Yim, S. J., Lui, L., Rong, C., & McIntyre, R. S. (2018). Recognition and Treatment of Cognitive Dysfunction in Major Depressive Disorder. Frontiers In Psychiatry, 9, 655. https://doi.org/10.3389/fpsyt.2018.00655

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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.).
https://video.alexanderstreet.com/watch/training-title-50?account_id=14872&usage_group_id=95102
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-5