NRNP PRAC 6635 Week 10 Assignment: Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders – Comprehensive Psychiatric Assessment

NRNP PRAC 6635 Week 10 Assignment: Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders – Comprehensive Psychiatric Assessment

NRNP PRAC 6635 Week 10 Assignment: Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders – Comprehensive Psychiatric Assessment

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.

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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.).

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Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders – Comprehensive Psychiatric Assessment

Subjective:

CC (chief complaint): The patient is an 8 year-old female who is brought by her father and mother with complainst of innatention, distractibility, poor memory, and problems with arthmetc, reading, and spelling at school. The parents bring her with a filled “Connor’s Teacher Rating Scale – Revised” form.

HPI: The patient is an 8 year-old Caucasian female child who presents with the above symptoms. The parents deny a past history of her symptoms and also deny that her developmental milestones were abnormal. This is in contrast to what the teachers have been observing at school. The onset of the symptoms is definitely months ago and the location of the symptoms is the child’s mind that wanders around. The duration of the symptoms is indefinite as the teachers say they observe them all the time.charactersitically the symptoms of inattention, distractibility, and forgetfulness amongst others are persistent and everpresent. They are aggravated by scolding and somewhat relieved by being friendly to the child. There isn no specific timing for the symptoms as they can occur at any time. On a scale of 1-10, the teachers rate her symptoms in the form they filled at 6/10.  

Past Psychiatric History:

• General Statement: The paient has never had any psychiatric treatment or diagnosis before now.
• Caregivers (if applicable): She is functional but may require a caregiver to look after her so that she does not harm herself.
• Hospitalizations: She has never been hospitalized for any psychiatric condition.
• Medication trials: No medication has been tried on the chld for the current or other psychiatric symptoms she may have or may have had.
• Psychotherapy or Previous Psychiatric Diagnosis: There is no history of a psychiatric diagnosis or psychotherapy for the same.

Substance Current Use and History: The patient is a minor and has never used any banned substance.

Family Psychiatric/Substance Use History: There is no psychiatric history in the family.

Psychosocial History: The patient is in grade 4 and lives with both of her parents. She routinely only concentrates on what pleases her at school and avoids or disregards the other activities her peers are engaged in, even it they are educational in nature.

Medical History:

• Current Medications: She is currently not on any medication.
• Allergies: She has no known allergies.

• Reproductive Hx: She is still a minor who has not even reached puberty.

ROS:

• GENERAL: Denies fever, chills, weight loss, or fatigue.
• HEENT: Denies headache, photophobia, tinnitus, rhinorrhea, otorrhea, or sore throat.
• SKIN: Negative for itching, eczema, or rashes.
• CARDIOVASCULAR: Negative for chest pain or discomfort. Also denies edema or palpitations.
• RESPIRATORY: Denies shortness of breath, wheezing, coughing, or producing sputum.
• GASTROINTESTINAL: Negative for nausea, diarrhea, vomiting, or chaned bowel habits.
• GENITOURINARY: Denies frequency of micturition, dysuria, or differently colored urine.
• NEUROLOGICAL: Negative for paraesthesia, pins and needles in extremities, dizziness, syncope, or paresis. Positive for amnesia especially for things learnt at school.
• MUSCULOSKELETAL: Denies muscular pain or joint pains.
• HEMATOLOGIC: Mother denies a history of blood disorders or cloting disorders in the family.
• LYMPHATICS: Negative for lymphadenopathy and never had splenectomy.
• ENDOCRINOLOGIC: Mother denies previous hormonal therapy. Also patient denies heat/ cold intolerance or excessive thirst.

Objective:

Physical exam (Vital signs): T- 98.1; P- 65; R 15; BP 95/55; Ht 4’5; Wt 67 lbs

Diagnostic results: Laboratory tests and radiological examination show no infectious process or traumatic brain injury (TBI).

Assessment:

Mental Status Examination: The child is an 8 year-old Caucasian female who looks appropriate for her chronological age in terms of development. Her speech is clear, coherent, and goal-directed. Her appearance shows that she s well-dressed according to the time of the year and the prevailing weather. There are no tcs or mannerisms from the child that are noted. Her mood as she reports herself is “good” while her affect as observed is euthymic. This shows some level of congruence between the two. She denies having hallucinations, delusions, or paranoid thoughts. There is no indication of suicidal or homicidal ideation. Insight and judgment on her part are appropriate for her age. She is diagnosed with 314.01 (F90.2) Attention-Deficit/ Hyperactivity Disorder or ADHD (APA, 2013; Sadock et al., 2015).  

Differential Diagnoses

• 314.01 (F90.2) ADHD combined presentation: This 8 year-old girl most likely suffers from the neurodevelopmenbtal disorder that is ADHD from the presentation that she shows. These symptoms characteristic of her illness conform to the diagnostic criteria for ADHD in the DSM-5. She is showing inattention, hyperactivity, and impusivity all that are affecting her at school and in her learning. Additionally, she is still below the age of 12 years. All these are citeria for diagnosing ADHD in the DSM-5 (APA, 2013; Sadock et al., 2015).
• 313.81. (F91.3) Oppositional Defiant Disorder: This is the first differential diagnosis after the above primary diagnosis. The DSM-5 states that the diagnostic criteria for this disorder includes the display of irritability and defiant mood by the child for a period not less than six months (APA, 2013). These symptoms must cause the child some distress and interfere with their functioning in a number of areas that include studies, and social life/ relationship with peers and parents (Wender & Tomb, 2017). This girl fulfils a good number of these criteria.
• 312.34 (F63.81) Intermittent Explosive Disorder: according to the DSM-5, this condition would be diagnosable if there was repeated loss of the ability for the child to control her outbursts. She would be displaying behavior that is too aggressive and dsptoportionate to hatever caused her to be angry in the first place. She may also be destructive to property without provocation and all these have to happen at the age of six years and above (APA, 2013; Wender & Tomb, 2017). This patient is 8 years and shows some of these symptoms. This is why this disorder is considered as a viable differential diagnosis.   

Reflections: The process of assessing this child is one that I undertook with precision and I followed all the required protocols and procedures for the intitial psychiatric interview for children (Carlat, 2017). Because this was a minor and could not give informed consent, this was obtained through the parents who were ver cooperative. Informed consent is part of the bioethical principle of autonomy (Haswell, 2019). The parents were advised to seek family therapy for themselves so tht they can learn how to take care of a child with ADHD and lso how to cope with the diagnosis. The child would also be taken through therapy with individualized cognitive behavioral therapy or CBT (Wheeler, 2020). This will neeed to run for a period of eight weeks since this will be a long-term thing. If I were to follow-up the patient I would continuously encourage the parents to show her love and understanding and not to raise her as a special child as this would increase the effect of the stereotype and stigma.

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References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Carlat, D.J. (2017). The psychiatric interview, 4^th ed. Wolters Kluwer.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Wender, P.H. & Tomb, D.A. (2017). ADHD: A guide to understanding symptoms, causes, diagnosis, treatment, and changes over time in children, adolescents, and adults, 5^th ed. Oxford University Press.

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, 3^rd ed. Springer Publishing Company, LLC.