Week 10 Assignment: Neurocognitive and Neurodevelopmental Disorders

Week 10 Assignment: Neurocognitive and Neurodevelopmental Disorders

Week 10 Assignment: Neurocognitive and Neurodevelopmental Disorders

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.

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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
• Read rating descriptions to see the grading standards!

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.
• Read rating descriptions to see the grading standards!

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.
• Read rating descriptions to see the grading standards!

Reflect on this case. Include: 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.).

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation.  Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS.  The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5-TR diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. 

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

Assessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnostic impression selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating 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.).

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

 Week 10 Assignment Neurocognitive and Neurodevelopmental Disorders

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Week 10 Assignment Neurocognitive and Neurodevelopmental Disorders

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.

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