NRNP 6635 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

NRNP 6635 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

NRNP 6635 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Introduction: This is a comprehensive psychiatric evaluation of a 9 year old female child who presents to the clinic with her mother along with copies of questionnaires on attention deficit and hyperactivity disorder completed by her teacher and parent due to problems paying attention in school.

Purpose statement: The purpose of this assignment is to complete a comprehensive psychiatric evaluation of a 9 year old child with attention issues in school, to assess and diagnose her with any neurocognitive/neurodevelopmental disorders that may be present.

Subjective:

CC (chief complaint): Sarah has trouble paying attention in school as well as with remembering and losing things every day.

Sarah, a 9-year-old African-American girl, is currently separated from her mother and has struggled to pay attention and remember things since Kindergarten. Teachers gave Sarah a list of her assignments, but she kept misplacing it because she couldn’t remember where she put it. As a result, teachers have been leaving assignment lists in her mother’s cell phone. Sarah has also had difficulty sitting still in her chair at school, which frequently gets her in trouble. Sarah finds it difficult to sit still, even when she is reading a book or a newspaper she enjoys; the longest she can sit in her chair is about five minutes. Sarah has trouble recalling what she or the teacher has read. Sarah misplaces or loses things on a daily basis: she misplaced her Geography book (which her mother believes she left on her school bus), a bracelet she adored that was given to her by her grandmother (mother thinks she may have taken it off to wash her hands and left it in the bathroom at a restautant). Sarah is upset when she misplaces her belongings. When teachers say they asked Sarah to do something and she didn’t, Sarah becomes enraged. Sarah daydreams about going home and playing with her dog Conley, as well as missing her mother, because Sarah and her mother are currently separated. (The provider should have inquired about the provider’s living situation.) Sarah is frustrated because, despite her best efforts, she consistently makes mistakes in her classwork and homework. Sarah enjoys art and museums, but she jumps from one painting to the next three or four times. Sarah has difficulty waiting her turn, especially in large groups. Sarah enjoys video games and can spend hours playing them. Her parents were afraid to take her to the zoo when she was younger because she would stick her hand inside the bars, where animals could bite her. Sarah jumped into the pool before she even knew how to swim at times. That hasn’t happened since she was a child.

Also Check Out: NRNP 6635 Assessing and Diagnosing Patients With Personality and Paraphilic Disorders Assignment

Past Psychiatric History:

• General Statement: Sarah is a 9 years old female child who is currently separated from her mother and has a history of trouble with paying attention in school as well as remembering and losing things since kindergarten.
• Caregivers (if applicable): Separated from mom. Provider should have asked about the living condition/arrangement
• Hospitalizations: None
• Medication trials: none
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History:

Provider should have asked.

Family Psychiatric/Substance Use History:

Provider should have asked

Psychosocial History:

Sarah is a 9 years old child who is currently separated from her mother (provider should have asked about number of siblings, lives at home with, marital status of parents, friends, what grade Sarah is in, if she is part of any special program in school). Sarah likes art, museums, and playing video games. She sleeps 9 hours at night. Despite having hard time sitting for meals, her nutrition is adequate per PCP. Sarah met her developmental milestones on time and her vaccinations are up to date.

Medical History:

 

• Current Medications: None
• Allergies: provider should have asked
• Reproductive Hx: Female with all developmental milestones met on time. Provider should have asked about periods/menstrual cycle.

ROS:

• GENERAL: Alert and oriented, appears stated aged, well groomed.
• HEENT: Provider should examine
• SKIN: Provider should examine
• CARDIOVASCULAR: Provider should examine
• RESPIRATORY: Provider should examine
• GASTROINTESTINAL: Provider should examine
• GENITOURINARY: Provider should examine
• NEUROLOGICAL: Provider should examine
• MUSCULOSKELETAL: Provider should examine
• HEMATOLOGIC: Provider should examine
• LYMPHATICS: Provider should examine
• ENDOCRINOLOGIC: Provider should examine

Objective:

Physical exam:

T – 97.4

P – 62

R – 14

B/P – 95/60

Ht – 4’5”

Wt – 63 lbs

Diagnostic results: Questionnaire of attention deficit hyperactivity disorder filled out by teachers and mother.

Besides the questionnaire on ADHD, provider should request screen for learning disabilities such as inability to read or do mathematics.

Assessment:

Mental Status Examination:

Appearance:  Sarah appears well groomed and stated aged

Eye contact: hesitant

Speech: clear and coherent with normal rate, rhythm, and volume

Behavior: anxious, distracted

Psychomotor: restless.

Mood: anxious, guarded

Affect: restricted

Thought Process:  linear, goal directed

Thought Content: Provider should have asked for suicidal, homicidal, or self-harm ideation. Provider should have explored further for delusion thinking.

Perception:  No reaction to external or internal stimuli.

Attention/ Concentration: distractable

Cognition:  Alert and oriented.

Memory:  Impaired short-term memory as evidenced by inability to recall questions asked during the interview. Long-term memory grossly intact as evidenced by their recall of narrative.

Insight: fair

Judgment: fair

Fund of Knowledge:  consistent with age and education, as demonstrated by use of grammar, vocabulary, and sentence structure

Intelligence: consistent with age and education, as demonstrated by use of grammar, vocabulary, and sentence structure.

Differential Diagnoses:

 

Attention Deficit Hyperactivity Disorder: As evidenced by inattention: Sarah is reported to make a lot of mistakes in her classwork and homework, she can’t stay focused or attentive in class, she gets frustrated because teachers think she doesn’t do what asked/didn’t listen, looses important things such as Geography book and gifted bracelet,distractible during interview, forgets assignments daily and requires a list from teachers. As evidenced by impulsivity: fidgets, can’t sit still in chair in school, eating is an issue because she can’t sit still, can’t wait turn as reported in questionnaire from teachers, runs from painting to painting three of four times, acts without thinking sucha as jumped in pool before learning to swim.

Learning Disability: As evidenced by missing assignments, despite trying hard Sarah can’t do her assignments right and makes a lot mistakes in classwork as well as homework. Can’t focus on reading or doesn’t remember what she or the teacher read. However, she can stay focused on videogames.

Anxiety Disorder: As evidenced by distractibility, reported frustration (irritability), missing mom in school, difficulty paying attention, fidgety/restless.

Mania: As evidenced by excessive distractibility, extreme fidgeting, and frustration (irritability) which is more common than euphoria in children.

 

Reflections:

This case is quite simple and I was able to quickly come to a conclusion that sarah probably has ADHD. According to Radmanović and Burgić (2020), ADHD is a very common neurodevelopmental disorder seen in children. However, learning disability can cause much similar symptoms such as inattention, as a provider I would get neuropsych testing done to rule out if Sarah has any learning disability before finalizing the ADHD diagnosis. In a study by Reale et al. (2017), learning disability was highly associated in children with ADHD. Since Sarah is separated from her mother, this may cause extreme anxiety in a 9 years old child and can manifest symptoms such as inattention, frustration, and easily distracted. Sarah mentions daydreaming about missing mom. Much of sarah’s ADHD symptoms may be sprouting from anxiety related to separation from her mother. As stated by Sayal, Prasad, Daley, Ford, and Coghill (2018), Child psychiatrist and psychologists have been arguing that attachement and trauma should be considered when diagnosing children with ADHD. Mania is another condition that may be the cause of Sarah’s intattention, inability to wait for turn, excessive distractibility, extreme fidgeting and frustrations (irritability) which is more common than euphoria in children. Bhandari (2018), reports that Bipolar disorder is more frequently being diagnosed in children with ADHD.

References

Bhandari, S. (2018). Bipolar Disorder or ADHD? Diagnosing teens with both the conditions. Mental Health Matters, 5(1), 15-16.

Radmanović, M. B., & Burgić, S. S. (2020). Comorbidity in Children and Adolescents with ADHD. In ADHD. IntechOpen.

Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., … & Bonati, M. (2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European child & adolescent psychiatry, 26(12), 1443-1457.

Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175-186.

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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

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

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Name: NRNP_6635_Week 10 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Assignment Rubric

 

		Excellent	Good	Fair	Poor
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		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: • 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.		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: • 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 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.		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.	20 (20%) – 22 (22%) The response 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 an accurate justification for each of the disorders selected.	18 (18%) – 19 (19%) The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess 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: 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.		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.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation		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