Neurodevelopmental Disorders Begin In Developmental Period
Neurodevelopmental Disorders Begin In The Developmental Period Of Chil
Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from very specific to a general or global impairment, and often co-occur (APA, 2022). 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 as 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. 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. 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-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. 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.).
Paper For Above instruction
In this comprehensive psychiatric evaluation, the focus is on analyzing a patient presenting with signs suggestive of a neurocognitive disorder, which requires detailed assessment of subjective complaints, objective observations, mental status examination, differential diagnosis, and reflection on clinical approach. For this example, we consider a case involving an elderly patient, Mr. A, who reports recent memory loss, disorientation, and difficulty performing daily activities, which aligns with clinical features consistent with mild to moderate neurocognitive decline.
Subjective Data
The patient, a 72-year-old male, reports progressive memory difficulties over the past six months, including forgetting appointments, misplacing items, and difficulties recalling recent events. He mentions increasing confusion, especially in unfamiliar environments, and episodes of disorientation. The patient reports his wife has expressed concern about his declining cognitive abilities and increased dependence. He denies significant mood disturbances such as depression or anxiety, but admits feeling frustrated and anxious about his memory loss. His medical history includes hypertension and hyperlipidemia, managed with medication, with no history of traumatic brain injury or neurological illnesses. He abstains from alcohol and smoking. Family history reveals that his mother suffered from dementia in her late 70s.
Objective Observations
During the mental status assessment, Mr. A appeared alert but slowly responsive, with some difficulty following complex commands. His speech was coherent but occasionally tangential. Orientation to time and place was impaired; he struggled to recall the current date and location. Immediate and short-term memory tests were impaired, as evidenced by inability to recall three unrelated words after five minutes. His judgment appeared somewhat compromised, but attention span was adequate. No motor deficits or signs of neurological abnormalities, such as tremors or weakness, were observed during physical examination.
Assessment
The mental status examination indicates impaired orientation, memory deficits, and intact language function. Based on the subjective complaints and objective findings, differential diagnoses include:
- Alzheimer’s Disease (Major Neurocognitive Disorder due to Alzheimer’s) — Supported by insidious onset, memory impairment, and gradual decline. According to DSM-5-TR, criteria include significant cognitive decline in memory and learning, interference with independence, and not attributable to other conditions.
- Vascular Neurocognitive Disorder — Possible given the patient's history of hypertension; however, the episodic nature and progressive decline point more towards Alzheimer’s disease.
- Major Depressive Disorder with Cognitive Impairment (Pseudodementia) — To be considered; however, absence of mood symptoms and anosognosia diminish this likelihood.
The DSM-5-TR criteria for Alzheimer’s disease include evidence of cognitive decline from previous levels in one or more cognitive domains, interference with daily functioning, and not due to other neurological or systemic illnesses. Vascular neurocognitive disorder requires evidence of cerebrovascular disease, typically with a stepwise decline, which is less characteristic here. Depression-related cognitive impairment generally involves a significant mood component and fluctuating cognition, which are absent in this case.
The critical-thinking process involved correlating the history, clinical presentation, and examination findings. The gradual onset and progression of memory decline strongly suggest Alzheimer’s. The family history further supports this diagnosis. Negative findings, such as absence of prominent mood symptoms or neurological signs, help rule out other possibilities.
Reflection and Ethical Considerations
If I could conduct this assessment again, I would incorporate more detailed neuropsychological testing to better quantify cognitive deficits and monitor progression. Additionally, involving family members earlier might provide broader context for functional decline. Ethically, it is essential to consider patient autonomy and informed consent, especially given the progression of cognitive decline. Legal considerations include planning for future decision-making capacity and potential guardianship arrangements. Culturally, understanding the patient's background can help tailor interventions, including culturally sensitive communication and support systems.
Health promotion should focus on managing vascular risk factors through lifestyle modification, medication adherence, and regular monitoring to potentially slow disease progression. Preventive strategies include cognitive stimulation, social engagement, and physical activity, emphasizing a multidisciplinary approach. Recognizing that socioeconomic and cultural factors influence access to care, tailored interventions are crucial for effective management and improving quality of life.
References
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
- Koch, C. (2016). Does brain size matter? Scientific American.
- Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry (11th ed.). Wolters Kluwer.
- Reitz, C., Mayeux, R., & Brickman, A. M. (2020). Alzheimer disease: Epidemiology, diagnostic criteria, risk factors and biomarkers. Biological Psychiatry, 88(5), 434-444.
- Harvey, P. D. (2019). How neuropsychology informs diagnosis and treatment of neurocognitive disorders. American Journal of Psychiatry, 176(10), 819-827.
- Hawkins, K. A., & Smith, R. L. (2018). Neuropsychological assessment of aging populations. Neuropsychology Review, 28, 183-202.
- Geldmacher, D. S. (2019). Vascular cognitive impairment: Clinical features and diagnosis. Current Treatment Options in Neurology, 21, 12.
- World Health Organization. (2019). Dementia: A public health priority. WHO Press.
- Rosenberg, P. B., et al. (2020). Culturally sensitive approaches to dementia diagnosis. J Gerontol B Psychol Sci Soc Sci, 75(1), 19-27.
- Johnson, L., et al. (2021). Ethical considerations in diagnosing cognitive disorders. AMA Journal of Ethics, 23(2), E134-139.