NRNP 6635 Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders
Sample Answer for NRNP 6635 Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders Included After Question
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 mayhave 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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A Sample Answer For the Assignment: NRNP 6635 Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders
Title: NRNP 6635 Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders
Subjective:
CC (chief complaint): “psychiatric evaluation of attention deficit hyperactivity disorder.”
HPI: The 9-year-old female patient was accompanied to the psychiatric department by her mother following the positive findings of the completed attention deficit hyperactivity disorder (ADHD) questionnaire. The patient’s teacher also got an opportunity to complete the ADHD questionnaire based on her behavior and habits at school. According to the patient’s mother, her daughter has displayed difficulties in paying attention and is always forgetful. The patient’s teacher also reports similar symptoms at school, as the patient frequently forgets her assignments. At school, the patient fidgets a lot, displaying difficulties in sitting still on a chair. Additional symptoms reported include daydreaming, temperamental, and engaging in injurious activities. The patient started experiencing the above symptoms when she joined the kindergarten. Her mother claims that no treatment approach has been used so far in the management of the patient’s symptoms.
Past Psychiatric History:
- General Statement: The patient presents with attention deficit and memory problems which affect her academic performance and other daily activities.
- Caregivers (if applicable): The 9-year-old girl is under the care of one of her mothers.
- Hospitalizations: No history of hospitalization was reported.
- Medication trials: No medication has been used to manage the patient’s current symptoms.
- Psychotherapy or Previous Psychiatric Diagnosis: The patient has never been diagnosed with a mental disorder or taken part in therapy.
Substance Current Use and History: The patient lives and studies in a drug-free environment, with no exposure to cigarette or marijuana smoke.
Family Psychiatric/Substance Use History: No history of mental disorder or use of substances has been reported among any family member.
Psychosocial History: The patient is the only kid, who was being raised by her two moms. However, they recently got separated to resolve their marital issues, leaving the patient to stay with one, the current historian. The patient is in the 3rd grade, with poor performance due to her mental condition. She gets adequate sleep every night, for about 9 hours. Her PCP reports that the patient displays difficulties in consuming an entire meal as a result of being unable to sit down but she manages to get proper nutrition. She has a dog and also likes visiting art galleries and playing video games.
Medical History: No history of any chronic medical condition was reported.
- Current Medications: The patient is not on any medication.
- Allergies: No known food, environmental, or drug allergies.
- Reproductive Hx: Mother reports normal birth, with no birth defects. No family history of reproductive disorders.
ROS:
- GENERAL: Generally healthy with no recent changes in body weight. Denies fever, chills, fatigue, headache, lethargy, or dizziness.
- HEENT: Head: denies headache. Even distribution of hair. No signs of injury or trauma. Eyes: No redness, excessive tearing, itchiness, polyploidy, or pain. Ears: No tinnitus, hearing loss, inflammation, itchiness, or exudates. Nose & Throat: No congestion, sinus problems, bleeding nose, running nose, inflammation, or itchiness. No sore throat, swallowing difficulties, or bleeding gums.
- SKIN: Warm but somehow dry. No lesions, bruises, lumps, redness, inflammation, or eczema.
- CARDIOVASCULAR: No palpitations, murmurs, chest tightness, cyanosis, syncope, arrhythmias, or hypertension.
- RESPIRATORY: No running nose, congestion, breathing difficulties, sneezing, wheezing, cough, sputum production, asthma, or chest discomfort.
- GASTROINTESTINAL: No tenderness, hernia, abdominal distension, diarrhea, constipation, nausea, or vomiting.
- GENITOURINARY: No urgency, frequency, or burning sensation when urination or incontinence. Has not yet experienced her first menses.
- NEUROLOGICAL: No ataxia, headache, heat or cold intolerance, reduced appetite, paresthesia, or dizziness.
- MUSCULOSKELETAL: No muscle or joint tenderness, stiffness, or inflammation. Confirm full range of movement in both lower and upper extremities.
- HEMATOLOGIC: Denies easily bruising, bleeding gums, nose bleeding, anemia, or any other hematological disorder.
- LYMPHATICS: No lymphadenopathy or splenectomy.
- ENDOCRINOLOGIC: No hypothyroidism, hyperthyroidism, polyphagia, polyuria, or polydipsia.
Objective:
Physical exam: Vitals: Temp- 97.4 Pulse- 62 RR 14 95/60 Ht 4’5 Wt. 63lbs
Diagnostic results: To assess the patient for any underlying diseases complete blood count was ordered. Additional tests ordered for routine assessment include blood sugar tests, ELISA tests, basic metabolic panel, lipid profile, Hb test, and urine test for drugs. Imaging studies such as CT scans and X-rays of the head are also ordered to check for any anatomical deformities or signs of trauma, that may lead to the present symptoms. For further assessment of the patient’s signs of ADHD, the following screening tools were utilized, Conners Comprehensive Behavior Rating Scale (CBRS), National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale, and ADHD parent-teacher questionnaire (Halperin & Marks, 2019).
Assessment:
Mental Status Examination: The patient appears healthy and well-groomed in age-appropriate clothing. Her orientation is compromised as she keeps forgetting where she is, and why she is there. She however fidgets a lot. She is also impulsive and unable to sit still for quite a short period. She is very forgetful and seems distracted most of the time. Her mood is slightly elevated. She is very irritable. She speaks with a normal tone rate but is sometimes loud. Her thought process is intact. Denies hallucinations or delirium. Her thought content is appropriate for her age. Denies suicidal or homicidal or psychotic symptoms.
Differential Diagnoses:
- Attention Deficit Hyperactivity Disorder (ADHD): The diagnosis of ADHD as outlined in the DSM-V among children and adolescents requires a history of hyperactivity, behavioral problems, poor academic performance, distractibility, and inattention (Wolraich et al., 2019). The patient is also required to present with no less than 6 symptoms of hyperactivity or inattention or both leading to functional impairment just like for the patient in the provided case study. Consequently, the patient must start presenting with these symptoms before the age of 12 years, and the patient in the provided case study reported a set of symptoms immediately after joining kindergarten (Bélanger et al., 2018). From the mental status examination results, and provided patient history, in addition to the completed ADHD parent-teacher questionnaire, the patient qualifies for ADHD as the primary diagnosis.
- Separation Anxiety Disorder (SAD): According to the DSM-V this disorder is assigned to patients who normally display anxiety or excessive fear when separated from an individual that they were strongly attached to like a family member (Becker et al., 2018). The patient was being raised by two mothers, who ended up separating leaving the patient to stay with one. Patients diagnosed with this disorder will also present with symptoms such as persistent worry about the unexpected event, nightmares about the separation, afraid of being left alone, and unusual distress (Sadaqa Basyouni, 2018). The patient in the provided case study is negative for most of these symptoms which disqualifies this diagnosis.
- Unspecified Neurodevelopmental Disorder: According to the DSM-V, UNDD is usually diagnosed in patients who present with symptoms of a certain neurodevelopmental disorder but do not meet the criteria for any of them (Rivollier et al., 2019). It is one of the most common differential diagnoses for ADHD. The patient in the provided case study displayed ADHD symptoms, based on the complete ADHD questionnaire by both her mother and teacher. However, her mother was not sure whether the patient has this disorder, given that she was also separated from her other mother, which might contribute to her symptom and suggestion of another mental problem. This disorder will however be considered only if the patient fails to meet the diagnosis of ADHD.
Reflections: Based on the information provided, the PMHNP was very professional with the use of respectful language and maturing a healthy therapeutic relationship with the patient. The information gathered is quite adequate to support the diagnosis of ADHD. Since the patient’s mother was ready to seek medical attention based on the previously completed ADHD questionnaire, the PMHNP would have thus focused on discussing the available treatment options for the patient (Halperin & Marks, 2019). The patient’s mother has a legal obligation in making decisions concerning her child’s health. As such, the clinician must educate the patient’s mother on the advantages and disadvantages of each treatment option, and convince her of the most effective approach based on clinical judgment (Wolraich et al., 2019). Respecting the patient’s autonomy is crucial to promote positive treatment outcomes.
References
Becker, S. P., Schindler, D. N., Holdaway, A. S., Tamm, L., Epstein, J. N., & Luebbe, A. M. (2018). The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD. Journal of Psychopathology and Behavioral Assessment, 41(1), 93–106. https://doi.org/10.1007/s10862-018-9702-6
Bélanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1—Etiology, diagnosis, and comorbidity. Paediatrics & Child Health, 23(7), 447–453. https://doi.org/10.1093/pch/pxy109
Halperin, J. M., & Marks, D. J. (2019). Practitioner Review: Assessment and treatment of preschool children with attention-deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 60(9), 930–943. https://doi.org/10.1111/jcpp.13014
Rivollier, F., Krebs, M.-O., & Kebir, O. (2019). Perinatal Exposure to Environmental Endocrine Disruptors in the Emergence of Neurodevelopmental Psychiatric Diseases: A Systematic Review. International Journal of Environmental Research and Public Health, 16(8), 1318. https://doi.org/10.3390/ijerph16081318
Sadaqa Basyouni, S. (2018). Separation Anxiety and its Relation to Parental Attachment Styles among Children. American Journal of Educational Research, 6(7), 967–976. https://doi.org/10.12691/education-6-7-12
Wolraich, M. L., Chan, E., Froehlich, T., Lynch, R. L., Bax, A., Redwine, S. T., Ihyembe, D., & Hagan, J. F. (2019). ADHD Diagnosis and Treatment Guidelines: A Historical Perspective. Pediatrics, 144(4), e20191682. https://doi.org/10.1542/peds.2019-1682
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NRNP 6635 Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders Rubric Detail
Name: NRNP_6635_Week10_Assignment_Rubric
| Excellent | Good | Fair | Poor | |||
| Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
In the Subjective section, provide: |
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. |
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| 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 |
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| Total Points: 100 | ||||||