Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

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Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

Assignment: Use the patient’s case, interview transcript, the exemplar (attached in a separate paper), and the questionnaire  to fill out the comprehensive evaluation. Add main diagnosis differential and a reflection on the case

Add references from credible sources only

 

Questionnaire to consider while filing out the form

  • 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?

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  • 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.). Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

 

 

 

  1. Patient’s case

Training Title 50
Name: Harold Brown
Gender: male
Age:60 years old
T- 98.8 P- 74 R 18 134/70 Ht 5’10 Wt 170lbs
Background:
Has bachelor’s degree in engineering. He dates casually, never married, no children. Has one
younger brother. Sleeps 7 hours, appetite good. Denied legal issues; MOCA 28/30 difficulty with

attention and delayed recall; ASRS-5 21/24; denied hx of drug use; enjoys one scotch drink on
the weekends with a cigar. Allergies Dilaudid; history HTN blood pressure controlled with
Cozaar 100mg daily, angina prescribed ASA 81mg po daily, valsartan 80mg daily.
Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg
po bedtime.
Symptom Media. (Producer). (2017). Training title 50 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-50

 

2.. Video Interview transcrispt

00:00:00______________________________________________________________________________

00:00:00BEGIN TRANSCRIPT:

00:00:00[sil.]

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?  Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

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 solid wall, a fire wall, 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?  Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

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 spring time. 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 suppose 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?  Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

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.

00:06:05END TRANSCRIPT  Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

 

 

 

 

 

 

 

Subjective:

CC (chief complaint):

HPI:

Past Psychiatric History:

  • General Statement:
  • Caregivers (if applicable):
  • Hospitalizations:
  • Medication trials:
  • Psychotherapy or Previous Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

Medical History:

 

  • Current Medications:
  • Allergies:
  • Reproductive Hx:

Comprehensive Psychiatric Evaluation

Subjective:

CC (chief complaint): “I just can’t concentrate. Everyone else doesn’t have a problem with it. But I just can’t seem to be able to do the same job they’re doing.” Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

HPI This 60-year-old white male is seen for psychiatric evaluation with a chief complaint of concentration problems at work. He says his architectural engineering business has pushed project deadlines, putting him under strain. Mr. Brown notes his “silly mistakes,” such as building air ducts through solid walls or sketching overly tiny window apertures. He stresses that coworkers face various challenges, “Everyone can. It’s OK for them.”

The patient has had attention issues since school. He remembers becoming sidetracked at the library and struggling to focus. He has trouble focusing on work presentations and thinks about extraneous issues.

Mr. Brown is “messy” and forgets things, making organization difficult. He needs help paying bills on time, resulting in late fees. While he denies significant hyperactivity currently, he recalls being more hyperactive as a child, talking out of turn in class, and having difficulty staying focused.

He reports that his mother considered having him evaluated for ADHD but never followed through. The patient denies any previous psychiatric treatment or medication trials for these symptoms.

Past Psychiatric History:

  • General Statement: No prior psychiatric treatment or diagnosis
  • Hospitalizations: None
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis: None reported

Substance Current Use and History: Mr. Brown stated that he drinks one scotch over the weekends when he enjoys a cigar, but he denies any drug abuse history. He occasionally drinks caffeinated beverages but stopped using sugar because he felt hyperactive after ingesting sugar.

Family Psychiatric/Substance Use History: None reported.

Psychosocial History: Mr. Brown has a bachelor’s degree in the field of engineering. He is currently working in one of the large architectural engineering firms. He dates but has never been married and does not have children. He has one younger brother. The patient does not have legal issues currently.

Medical History:

  • Hypertension – controlled with medication Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper
  • Angina
  • Hypertriglyceridemia
  • Benign prostatic hyperplasia (BPH)

Current Medications:

  • Cozaar 100mg daily (for hypertension)
  • ASA 81mg daily (for angina)
  • Valsartan 80mg daily (for hypertension)
  • Fenofibrate 160mg daily (for hypertriglyceridemia)
  • Tamsulosin 0.4mg at bedtime (for BPH)

Allergies: Dilaudid

ROS:

  • GENERAL: Denies fever, chills, weight loss, or fatigue. Reports sleeping 7 hours per night with a good appetite.
  • HEENT: Denies visual or hearing changes
  • SKIN: No reported rashes or lesions
  • CARDIOVASCULAR: Positive for a history of hypertension and angina, denies palpitations or edema
  • RESPIRATORY: Denies shortness of breath or cough
  • GASTROINTESTINAL: Denies changes in appetite or bowel habits
  • GENITOURINARY: Positive for BPH symptoms, managed with medication
  • NEUROLOGICAL: Positive for concentration difficulties; denies headaches or dizziness
  • MUSCULOSKELETAL: Denies joint pain or mobility issues
  • HEMATOLOGIC: Denies easy bruising or bleeding
  • LYMPHATICS: Denies swollen glands or lymph nodes
  • ENDOCRINOLOGIC: Denies excessive thirst or frequent urination
  • PSYCHIATRIC: Positive for attention and organizational problems; denies depression or anxiety

Objective:

Diagnostic results:

  • MOCA: 28/30 (difficulty with attention and delayed recall)
  • ASRS-5: 21/24 Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

Assessment:

Mental Status Examination: This is a 60-year-old white male who appears his stated age. He is well-groomed and appropriately dressed for the evaluation. The patient is alert and oriented to person, place, time, and situation. His speech is of normal rate, rhythm, and volume. Their thought processes are logical and goal-directed, although he does show some tangentiality when discussing work-related problems. There is no evidence of hallucinations, delusions, or paranoid ideation. Mr. Brown’s mood is described as “frustrated,” with a congruent affect. He denies suicidal or homicidal ideation. His insight appears fair, recognizing that he has difficulties at work but is unsure of the underlying cause. Judgment seems intact. Attention and concentration are notably impaired during the interview, as evidenced by frequent shifts in conversation topics and difficulty maintaining focus on questions asked.

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Differential Diagnoses:

  1. Attention-Deficit/Hyperactivity Disorder (ADHD), Predominantly Inattentive Presentation (Primary Diagnosis)
    • Supporting evidence: Longstanding history of inattention symptoms dating back to childhood, current difficulties with concentration at work, problems with organization and task completion, high score on ASRS-5 (21/24)
    • DSM-5-TR Criteria met: Persistent pattern of inattention for at least six months, symptoms present in two or more settings (work and home), clear evidence that symptoms interfere with functioning (work performance issues), symptoms not better explained by another mental disorder
    • The patient’s history aligns closely with the DSM-5-TR criteria for ADHD, Predominantly Inattentive Presentation. His symptoms have persisted since childhood, affect multiple areas of his life, and cause significant impairment in his occupational functioning (First et al., 2022).
  2. Adjustment Disorder with Anxiety
    • Supporting evidence: Recent onset of more severe symptoms coinciding with increased work pressure and deadlines, expressed frustration and worry about job performance
    • Rule out: While Mr. Brown is experiencing increased stress due to work demands, his symptoms predate recent work stress. The longstanding pattern of symptoms is inconsistent with adjustment disorder, which typically develops within three months of a stressor and resolves within six months of the stressor’s termination (First et al., 2022). Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper
  3. Mild Neurocognitive Disorder
    • Supporting evidence: Age (60 years old), some difficulty on MOCA (28/30), reported problems with attention and organization
    • Rule out: While Mr. Brown’s age and slight difficulty with the MOCA might suggest considering a neurocognitive disorder, the lifelong pattern of symptoms is more indicative of ADHD. His cognitive difficulties appear specific to attention and executive function rather than the broader cognitive decline typically seen in neurocognitive disorders (First et al., 2022).

The primary diagnosis of ADHD, Predominantly Inattentive Presentation, is most appropriate for Mr. Brown. His symptoms have been present since childhood and persist into adulthood, affecting multiple areas of functioning, particularly his work performance. The high score on the ASRS-5 (21/24) strongly supports this diagnosis, as scores above 14 are associated with a high likelihood of ADHD in adults (Katzman et al., 2017).

The pattern of symptoms described – difficulty sustaining attention, distractibility, problems with organization, and forgetfulness in daily activities – aligns closely with the DSM-5-TR criteria for ADHD, Predominantly Inattentive Presentation. Moreover, these symptoms are causing significant impairment in his occupational functioning, a key criterion for the diagnosis (First et al., 2022).

While recent work stress may exacerbate his symptoms, the longstanding nature of his difficulties rules out an adjustment disorder as the primary diagnosis. The persistence of symptoms across different life stages and environments is more consistent with ADHD than with an adjustment disorder.

Although Mr. Brown’s age and slight difficulty with the MOCA might suggest considering a neurocognitive disorder, the specific pattern of his cognitive difficulties (primarily in attention and executive function) and their lifelong presence are more indicative of ADHD. Mild neurocognitive disorder typically presents with a noticeable decline from a previous level of cognitive functioning, which is not apparent in Mr. Brown’s case (First et al., 2022). Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

Reflection:

This instance emphasizes the need to diagnose ADHD in adults, especially those who were untreated as children. ADHD symptoms may considerably influence occupational performance, particularly in high-pressure workplaces demanding continuous attention and organization, as Mr. Brown’s scenario shows (Patel et al., 2019). His instance shows that physicians should suspect ADHD in individuals with work-related concerns, even if they seem caused by job stress.

Several ethical issues emerge. First, examine the effects of untreated ADHD in this situation. Workplace mistakes by Mr. Brown might affect building safety and project expenses. This calls into doubt patient confidentiality vs public safety. While anonymity is important, discussing workplace modifications or techniques to reduce symptoms with Mr. Brown may be helpful.

Mr. Brown’s work situation may be affected by diagnosis and treatment, another ethical issue. Treatment may enhance his job performance, but disclosing his illness to his employer may cause stigma or prejudice. Mr. Brown should be informed of the risks and advantages of disclosure and supported in making his diagnosis-sharing choices.

Mr. Brown’s education and employment may have protected him from social determinants of health, enabling him to manage his symptoms. However, his employment demands are surpassing his capacity to adjust, showing how contextual circumstances might affect ADHD symptoms. The relevance of individual and environmental variables in ADHD assessment and treatment is highlighted. Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

Mr. Brown’s ADHD symptoms and cardiovascular risk factors must be addressed for health promotion and illness prevention. ADHD adults are more likely to develop cardiovascular illness (Katzman et al., 2017). ADHD and physical health management should be part of a complete treatment regimen. This may need working with his primary care physician to address any health issues.

In future conversations, I would concentrate more on Mr. Brown’s coping mechanisms and strengths. How he succeeded professionally despite his symptoms might influence treatment strategy and increase resilience. I would also ask about his social support system since ADHD individuals need strong social relationships (Ramsay, 2021).

Conducting a more thorough assessment of potential comorbid conditions would also be beneficial. While Mr. Brown did not report significant symptoms of anxiety or depression, these conditions frequently co-occur with ADHD in adults and can complicate treatment (Katzman et al., 2017). A more detailed exploration of mood symptoms and potential substance use (given his reported alcohol consumption) would be warranted.

Mr. Brown may benefit most from multimodal therapy. Pharmacotherapy to treat his ADHD symptoms, cognitive-behavioral treatment to create coping strategies and address maladaptive thinking patterns, and skills training in organization and time management are possible. Given his professional history, executive coaching may help him use these talents at work.

This example shows that doctors should be watchful for ADHD symptoms in adults, especially when patients report work-related stress or age-related cognitive impairments. It also emphasizes the significance of a complete developmental history in diagnosis and therapy.

Finally, this instance shows that adult ADHD may provide beneficial results. Many ADHD individuals may improve their functionality and quality of life with proper diagnosis and treatment (Ramsay, 2021). ADHD treatment might improve Mr. Brown’s professional performance, well-being, and happiness.

In conclusion, Mr. Brown’s example highlights the difficulties of adult ADHD, including its effects on occupational performance, the relevance of developmental history, and the necessity for extensive, customized treatment. It also emphasizes the necessity for healthcare professionals and public education concerning adult ADHD. We may help people like Mr. Brown fulfill their potential and enhance their quality of life by diagnosing and treating ADHD. Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper

References

First, M. B., Yousif, L. H., Clarke, D. E., Wang, P. S., Gogtay, N., & Appelbaum, P. S. (2022). DSM‐5‐TR: overview of what’s new and what’s changed. World Psychiatry, 21(2), 218–219. https://doi.org/10.1002/wps.20989

Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry, 17(1). https://doi.org/10.1186/s12888-017-1463-3

Patel, P. C., Rietveld, C. A., & Verheul, I. (2019). Attention Deficit Hyperactivity Disorder (ADHD) and earnings in Later-Life Self-Employment. Entrepreneurship Theory and Practice, 45(1), 43–63. https://doi.org/10.1177/1042258719888641

Ramsay, J. R. (2021). Adult attention-deficit/hyperactivity disorder. In American Psychological Association eBooks (pp. 389–421). https://doi.org/10.1037/0000219-012 Neurocognitive and Neurodevelopmental Disorders Discussion Essay Paper