Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example
Subjective: Name: Harold Griffin, Gender: Male, Age : 58 years old, Race: Causcasian
CC (chief complaint): I work at this architectural Engineering firm, and it is so great, except they have accelerated the deadlines now, and it just puts much pressure, and I can’t concentrate.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
HPI: HG is a 58-year-old Caucasian male who works in an architectural Engineering firm presenting for psychiatric evaluation for concentration difficulty. He reports he is not currently having prescribed psychotropic medications and was referred to the psychiatric clinic after he informed his supervisor he was having challenges concentrating when designing house plans. The patient complains that although the firm he works for is great, the management has of late unreasonably accelerated the deadlines, which exerts much pressure on H.G. The unwarranted pressure makes the patient unable to concentrate, nor can he do the same job as he used to. He cites an example of a silly mistake where after designing a beautiful building, every wall he drew the window openings way too small. He feels that if such mistakes persist, it would cost the firm millions. Another day during a team bonding lecture where the chief engineer was lecturing them on the mission of the day, H.G. could not concentrate. He found himself thinking ‘your dog needs a bath’, what he would take for lunch, and generally everything else except what the chief engineer was saying. The patient laments that it seems he is the only one who cannot keep up with the ridiculous deadlines and sometimes feels it is other people’s business to fix his mistakes. The patient also admits he is a messy person, who seems to lose socks, shoes, anything, and cannot pay bills on time. Bills are settled after threatening calls from the debtors, and he has to pay them with penalties. He finds he is still disorganized even after scheduling events and activities in a calendar, which he does not seem to follow or adhere to. He also fidgets and reckons when his mother had threatened to take him for ADHD assessment, but it just remained that a threat but he was never dragged in front of a doctor. The patient reports a history of hypertension controlled with Losartan 100mg daily, amongst other medications to manage angina, hypertriglyceridemia, and benign prostatic hyperplasia(BPH).(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Past Psychiatric History:
· General Statement: – The patient reports he has never gone for psychiatric assessment in his six decades but admits his mother once threatened him to take him for evaluation, but she never acted on the threat.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
· Caregivers (if applicable): N/A
· Hospitalizations: Negative for hospitalizations, nil detox, no residential treatments, no history of suicidal or homicidal behaviors, no history of self-harm behaviors
· Medication trials: The patient has No previous psychotropic medications, therefore nil reactions
· Psychotherapy or Previous Psychiatric Diagnosis: No past psychotherapy interventions or previous psychiatric diagnosis.
Substance Current Use and History: Admits using caffeine ever since he was a child; reports caffeine helps him stay focussed. Admits taking one scotch drink with a cigar. Denies history of drugs or substance abuse.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Family Psychiatric/Substance Use History: Denies any family member has a psychiatric history or issues with substance use. And no history of suicides within the family.
Psychosocial History: Raised by parents, has one sister younger. He is currently single, dates casually, has never married, and has no children. He is a graduate with a bachelor’s degree in engineering. Sleeps 4-6 hours every day and denies legal history. He is employed in a large architectural engineering firm and appeared to enjoy his work until the company started setting ridiculous submission deadlines for projects. He has no trauma or violent history.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Medical History:
At 58 years, the patient has a host of medical issues, hypertension, angina, hypertriglyceridemia, and BPH, all of which are managed with medications making him practice polypharmacy.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
· Current Medications:
1. Losartan 100mg daily to manage HTN,
2. ASA 81mg P.O. daily for angina
3. Metroplrolol 25mg twice daily for angina
4. Fenofibrate 160 mg daily for Hypertriglyceridemia
5. Tamsulosin 0.4 PO bedtime for Benign prostatic hyperplasia
· Allergies: Morphine
- Reproductive Hx: Has anal sex, is a homosexual
- and dates casually
ROS:
· GENERAL: Patient denies feeling hot/warm. Negative for any weight loss or gain
However, he admits excessive hyperactivity, impulsivity, and lack of concentration. However, inattentiveness is not accompanied by a lack of comprehension. He reports no sleep difficulties.
· HEENT: Negative for dry eyes, pain, or itching. Has no photophobia. Negative for hearing loss, tinnitus, and has no nasal congestion, blockage, or sneezing. Reports no sore throat.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
· SKIN: No swelling, cyanosis, or pallor.No lesions, bruises, or rash.
· CARDIOVASCULAR: RRR, S1 and S2 are normal. Negative for murmurs
· RESPIRATORY: No breathing difficulties, no coughing, no phlegm
· GASTROINTESTINAL: No vomiting, lack of appetite, or diarrhea
· GENITOURINARY: No burning sensation, no polyuria(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
· NEUROLOGICAL: Denies any headache, instability while walking, no numbness, or changes in bladder control or bowel control
· MUSCULOSKELETAL: Reports no muscle pain or stiffness
· HEMATOLOGIC: Negative for abnormal bleeding or fatigue
· LYMPHATICS: No enlarged nodes
· ENDOCRINOLOGIC: Denies polyuria or polydipsia. No unusual sweating or heat/cold intolerance
Objective:
Physical exam: if applicable
Vitals:T-98.8 P-86 R18 134/88 Ht 5’11 Wt 180 lbs
Man is well-groomed and well-nourished with a healthy weight. HEENT Head is normocephalic with normal contours and no bruises. Both pupils equal, round, and reactive to light and accommodation. Intact extraocular muscles. Intact tympanic membrane with no discharge. No halitosis. No throat exudates. Neurologic Cranial nerves are intact with normal symmetric reflexes. Alert and oriented in time, space, person, and place. No motor, sensory or focal deficit noted(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Diagnostic results:
MOCA 27/30 difficulty with attention and delayed recall
ASRS-5 20/24
DSM-5 criteria for ADHD Man met all six criteria for ADHD
Full blood count ruled out any systemic infections
Assessment:
Mental Status Examination:
The appearance of the 58-year-old man appears the stated age, is appropriately groomed. His behavior demonstrates a man in no acute distress but has minor challenges redirecting for the interview. The motor activity indicates minimal psychomotor agitation, has a regular gait and posturing with no tics, tremors, or EPS. H.G.’s speech is fluent, pressured rate with regular volume and rhythm and a happy tone. He has a fantastic mood with an elated affect which though congruent, is sometimes inappropriate. The patient’s thought process manifests with flights of ideas while thought content is negative for suicidal or homicidal ideations. No grandiose delusions were elicited. Perception is normal, with no hallucinations, and appears negative to an active response to internal stimulation. At the cognition level, the man is alert and oriented to person, place, and time. The patient’s attention/concentration is poor, and he could not spell the word ENGINEER backward. He has an intact memory as he was able to recall 3/3 objects immediately and after one minute. Recent memory intact what had you for lunch, and long-term memory intact to what college he attended.Abstract reasoning intact while both insight and judgment were poor(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Differential Diagnoses:
- Adult ADHD with combined presentation(314.01(F90.2)- confirmed
This is the first and most likely diagnosis because the patient meets the DSM-5 diagnostic criteria for ADHD (Ustun et al., 2017). This diagnosis was confirmed because although there is no single test to diagnose ADHD, the psychiatrist relies on several things, among them the patient’s interview and that of his supervisor, personally watching the individual and questionnaires(Brevik et al, 2020). There are also rating scales that measure symptoms of ADHD and other psychological tests(Saczynski et al., 2015)(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example). The patient had 7 out of the minimum six required to confirm an adult ADHD diagnosis as the combined hyperactivity and inattentiveness type. These symptoms were failure to pay attention to detail resulting in serious mistakes, listening, having trouble organizing tasks, and even when he draws a calendar does not stick to the scheduled events. He keeps losing his socks, shoes, ties, and reports getting distracted very easily. He also tends to avoid things that demand much concentration. He also talks excessively and fidgets a lot on the seat. After having ruled out physiological causes, all these symptoms confirmed ADHD that had gone undiagnosed and therefore untreated until late adulthood years(El Banna et al., 2019).(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
- Autism Spectrum Disorder 299.00(F84.0) Refuted
Studies indicate that some autistic adults may present with symptoms that resemble those of ADHD. However, Mouti et al. (2019) note that using social communication, one can easily distinguish between the two as ASD patients have difficulties interpreting what others are thinking, have challenges regulating their emotions, and trouble keeping up with a conversation. Other symptoms prevalent in ASD and not in ADHD tend to engage in repetitive or routine behaviors and not liking unexpected all of were not exhibited by H.G. The absence of these symptoms was used to rule out ASD.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
- Oppostional Defiant Disorder 313.81(F91.3)- Refuted
Similarly, ODD was refuted because individuals with ODD resist tasks that demand self-application. Sönmez & Kayaalp,( 2018). Observe that some of the differences between the two include but are not limited to the fact that in ODD, their aggressiveness is purposefully designed to bother and irritate others. A display of negativistic, hostile supports its diagnosis, and deviant behavior exceeding 180 days or more.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example) At least four diagnosing symptoms are loss of temper frequently, arguing with those in authority, deliberately annoying people, or blaming others for one’s behavior. The individual is also usually spiteful or vindictive. The ODD behavior disturbance has to clinically cause impairment at the academic, social, or in H.G.’s case, occupational functioning, which is not the case here. When compared to the symptoms of ADHD like inadequate concentration, lack of organization, amongst others, it is clear that ODD is unlikely. The American Psychiatric Association further notes that ODD criteria do not meet the criteria for anti-social Personality Disorder in adults.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Reflections:
Upon reflection, I would concur with the diagnosis of the preceptor and not that H.G is a victim of ADHD that was diagnosed in childhood and therefore has not been diagnosed properly until his late fifties. Pharmacotherapy would be recommended as this approach helps alleviate the core ADHD symptoms, mainly impulsivity, inattention, and hyperactivity. The psychiatric health provider has a legal and ethical obligation to make a referral for a hyperactive active individual who has been assessed, diagnosed, and treated. Despite the late diagnosis, it is paramount that the patient is treated optimally after seeking the patient’s consent. Failure to secure consent for assessment or treatment initiation constitutes the offense of battery. A multimodal approach to therapy needs to be incorporated in the treatment plan comprising behavioral therapy, medications, and alternative therapies like diet modifications. The man would also be advised to join a support group of individuals living with ADHD as part of the health promotion measures.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Most importantly, this experience underpins the fact that ADHD is a condition whose impact has lifelong implications. The existence of other conditions that closely mimic the symptoms of ADHD makes diagnosis even more challenging(Grogan et al.,2018). Lastly, behavioral therapy’s significance has to be highlighted as it plays a key role in ADHD management and improves success in remission.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
References
Brevik, E. J., Lundervold, A. J., Haavik, J., & Posserud, M. B. (2020). Validity and accuracy of the Adult Attention‐Deficit/Hyperactivity Disorder (ADHD) Self‐Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) symptom checklists in discriminating between adults with and without ADHD. Brain and behavior, 10(6), e01605.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
El Saied El Banna, A., & Eissa Saad, M. A. (2019). Attention-Deficit/Hyperactivity Disorder: Insights from DSM-5. International Journal of Psycho-Educational Sciences, 8, 25-29.
Grogan, K., Gormley, C. I., Rooney, B., Whelan, R., Kiiski, H., Naughton, M., & Bramham, J. (2018). Differential diagnosis and comorbidity of ADHD and anxiety in adults. British Journal of Clinical Psychology, 57(1), 99-115.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Mouti, A., Dryer, R., & Kohn, M. (2019). Differentiating autism spectrum disorder from ADHD using the social communication questionnaire. Journal of attention disorders, 23(8), 828-837.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Saczynski, J. S., Inouye, S. K., Guess, J., Jones, R. N., Fong, T. G., Nemeth, E., … & Marcantonio, E. R. (2015). The Montreal cognitive assessment: Creating a crosswalk with the mini‐mental state examination. Journal of the American Geriatrics Society, 63(11), 2370-2374.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Sönmez, A. Ö., & Kayaalp, M. L. (2018). Comparing Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder Singly and Together in Terms of Behavioral Problems, Family Conflict, and Cognitive Functions. The Medical Bulletin of Sisli Etfal Hospital, 52(4), 254.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
Ustun, B., Adler, L. A., Rudin, C., Faraone, S. V., Spencer, T. J., Berglund, P., … & Kessler, R. C. (2017). The World Health Organization adult attention-deficit/hyperactivity disorder self-report screening scale for DSM-5. Jama psychiatry, 74(5), 520-526.(Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Comprehensive Nursing Essay Example)
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