The human brain only constitutes approximately 2% of an individual’s total body weight, a percentage that pales in comparison to the brain’s level of importance in human development (Koch, 2016). Although externally protected by layers of membranes as well as the skull, the brain is not very resistant to damage. Damage to the brain may compromise its functionality, which may, in turn, lead to neurodevelopmental disorders in childhood and adolescence or neurocognitive disorders for any number of reasons across the lifespan.
· Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
· Formulate differential diagnoses using DSM-5 criteria for patients with neurocognitive and neurodevelopmental disorders across the lifespan
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.
· 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.
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.).
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.
00:00:00TRANSCRIPT OF VIDEO FILE:
00:00:15OFF 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?
00:00:25HAROLD 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.
00:00:50OFF CAMERA Okay, tell me about your problem with concentration.
00:00:55HAROLD Well, um, you know it’s just… Perfect example is, is they wanted me to design um, air ducts.
00:01:05OFF CAMERA Right.
00:01:05HAROLD Air ducts, simple. But I designed them through a solid wall, a firewall, and a supporting wall and I didn’t even realize what I was doing.
00:01:15OFF CAMERA Uh-huh.
00:01:15HAROLD 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.
00:01:30OFF CAMERA Right.
00:01:30HAROLD 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.
00:01:45OFF CAMERA Uh-huh, is this a new kind of problem for you?
00:01:45HAROLD Well, I mean, I didn’t seem to have a problem when everything was relaxed, and the deadlines were normal.
00:01:50OFF CAMERA Right.
00:01:55HAROLD 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.
00:02:10OFF CAMERA Uh-huh.
00:02:10HAROLD And they think that and it’s true, I’m not.
00:02:10OFF CAMERA Now did you have these, uh, similar kind of problems back in school?
00:02:15HAROLD Well, yeah, I mean, in school everyone would go to the library to cram for big exams, so, I mean.
00:02:20OFF CAMERA Right.
00:02:20HAROLD 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 springtime. 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.
00:02:35OFF CAMERA Uh-huh, but, what other kind of difficulties do you seem to have?
00:02:40HAROLD Well, at the job we have, these uh, lectures, you know.
00:02:45OFF CAMERA Right.
00:02:45HAROLD 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.
00:02:55OFF CAMERA Right.
00:03:00HAROLD 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.
00:03:05OFF CAMERA Mm-hmm.
00:03:10HAROLD And because of that, you know, it’s not a good idea.
00:03:15OFF CAMERA So, so, is it difficult to sit and listen?
00:03:20HAROLD Yeah, I mean, okay, we were supposed to be designing this other, on top of this penthouse, this, kind of, a patio, party area.
00:03:30OFF CAMERA Right.
00:03:30HAROLD 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.
00:03:50OFF CAMERA Mm-hmm.
00:03:55HAROLD I got in a lot of trouble for that one.
00:03:55OFF CAMERA Do you have any problems organizing?
00:04:00HAROLD At home or the office?
00:04:00OFF CAMERA Uh, either.
00:04:05HAROLD 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.
00:04:20OFF CAMERA Yeah.
00:04:25HAROLD 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.
00:04:35OFF CAMERA What about problems paying bills?
00:04:40HAROLD 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.
00:04:50OFF CAMERA Hmm, what about hyperactivity?
00:04:50HAROLD 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.
00:05:20OFF CAMERA Mm-hmm, were you ever um, treated with medications or behavioral therapies for ADHD?
00:05:25HAROLD 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.
00:05:40OFF CAMERA Do you drink any caffeinated drinks?
00:05:45HAROLD 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.
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