NRNP 6635 Week 10 Psychopathology and Diagnostic Reasoning Essay

NRNP 6635 Week 10 Psychopathology and Diagnostic Reasoning Essay

NRNP 6635 Week 10 Psychopathology and Diagnostic Reasoning Essay

NRNP 6635  Week 10 Psychopathology and Diagnostic Reasoning Sample Essay

Subjective:

CC (chief complaint): “ forgetfulness and inattention.”

HPI: Sara, an eleven-year-old female patient, visited the clinic with her mother, and the mother indicated that she has been having academic and behavioral issues since her kindergarten days. She fidgets a lot and finds it hard to be still when being taught in school. In addition, she has also been disruptive in school. The mother reports that her daughter can only be attentive for five minutes when reading and rarely remembers what she has read. Even when her instructors read to her, she finds it difficult to remember what has been read. The patient has also developed a tendency to lose her belongings, such as her geography textbook and jewelry. The mother indicated that Sara usually daydreams and is, at times, irritable. She also loses lists made by teachers daily to help her complete her assignment. The patient reports that she has complications with her temperament, which gets triggered when her teachers want her to do something which she has failed to hear. The patient has also been making a lot of mistakes while doing her assignments.

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Past Psychiatric History:

• General Statement: The patient is visiting the clinic after complaints of inattention and forgetfulness
• Caregivers (if applicable): the patient lives with her parents, who are also her caregivers
• Hospitalizations: No history of hospitalizations
• Medication trials: No records of medication trials
• Psychotherapy or Previous Psychiatric Diagnosis: No history of previous psychiatric diagnosis

Substance Current Use and History: no history of or current use of substances

Family Psychiatric/Substance Use History: no significant family psychiatric or substance use history

Psychosocial History: The patient is an eleven-year-old female who lives with her parents. She was born and raised in Washington, D.C. Her developmental milestones are up to date. She is attending regular elementary school in public school. The patient enjoys playing games and also likes playing with her pet dog. She has consistent sleep averaging nine hours every night.

Medical History:

 

• Current Medications: no history of current medications
• Allergies: no known allergies

• Reproductive Hx: the patient is a minor of eleven years with no significant reproductive history.

ROS:

• GENERAL: The patient is cooperative and calm. However, she is easily distracted. No weight changes, headache, or fever.
• HEENT: no ear discharge, no ear pain, no hearing loss, no eye discharge, no loss in vision, no difficulty swallowing
• SKIN: no lesions, no rashes, no eczema
• CARDIOVASCULAR: no loss of consciousness, no fainting, no chest pain.
• RESPIRATORY: No history of asthma, no wheezing, no coughing
• GASTROINTESTINAL: Good appetite but experiences complications having meals due to inattention, no constipation, no vomiting, no nausea
• GENITOURINARY: no history of UTI, no history of bed wetting
• NEUROLOGICAL: No problems with speech, no weakness, no numbness, no headache, no dizziness. The patient is forgetful
• MUSCULOSKELETAL: No stiffness, no injuries
• HEMATOLOGIC: No bleeding, no bruising
• LYMPHATICS: No splenectomy history, no enlarged nodes
• ENDOCRINOLOGIC: no polydipsia, no polyuria

Objective:

T- 97.4 P- 58 R 14 98/62 Ht 4’5 Wt 65lbs

Physical exam: if applicable

Diagnostic results: NICHQ Vanderbilt Assessment Scale

Assessment:

Mental Status Examination: The patient is an eleven-year-old female who was brought to the facility by her mother. She is appropriately dressed, alert and oriented. The patient managed to sit still during the interview, though she fidgets. The mother confessed that she doesn’t remember her being still for as long as she did during the interview. She found it hard to concentrate during the interview and lost attention within two minutes. Her thought process is coherent, and she has intact judgment. She daydreams a lot.

Differential Diagnoses:

1. Attention-Deficit/Hyperactivity Disorder: This is a condition characterized by inattention and hyperactivity, which impairs an individual’s functionality. According to the DSM-V diagnostic criteria, a person has to show various symptoms for this diagnosis to be confirmed. They include making careless mistakes in schoolwork and other activities, complications sustaining attention when performing tasks or playing, failing to listen, failing to follow instructions and failing to complete chores and school work, a habit of losing things necessary for tasks, being easily distracted and forgetfulness (Chandra et al.,2021). Other symptoms include fidgeting, not being able to sit still, talking excessively, trouble waiting for turns, and intruding or interrupting others. The patient showed more than six of these symptoms making this ADHD the most likely diagnosis.
2. Autism Spectrum Disorder: This is a developmental disability that makes individuals interact, communicate, learn, and behave in ways different from most other individuals. According to DSM-V diagnostic criteria, this condition presents various symptoms. The symptoms include persistent deficits in social interactions and social communication, repetitive, restricted patterns of activities, interests, and behavior, hyperactivity, and perseverative interests (Wiggins et al.,2019). The patient has shown various symptoms, such as reduced emotions and interests. She lives games but has no interest in friendships. However, the patient has been exhibiting these symptoms since kindergarten days; hence this condition is less likely.

• A Specific learning disorder: This is a condition that is characterized by displaying academic performance lower than the expected levels (Eissa, 2018). She finds it difficult to complete assignments and is disruptive. A more elaborate interview could have revealed more symptoms related to this disorder.

Reflections:

This case study presents an opportunity to learn new ideas and acquire new knowledge regarding psychiatric assessment. It is important to perform a comprehensive psychiatric assessment for better diagnosis. In addition, it is also important to get information from caregivers in cases of children and adolescents since they may give insufficient information.

One of the ethical considerations in this case study is that Sarah is a minor, and in the case of pharmacological and psychiatric management, then the parent will have to give consent on behalf of the patient. It is also important to get more information from the patient’s teachers to make a more informed decision. It is also important to ensure that any treatment or management action carried towards helping the patient should not harm her. However, the first line of medication treatment for ADHD is stimulants (Rosenthal & Burchum, 2021). Stimulants may cause changes in appetite, and the patient already has problems with her meals due to inattention hence raising ethical concerns. The patient’s caregivers should be offered education, especially on how to take care of patients with ADHD. They need to be advised on why it is important that the patient sticks to the prescribed medication regimen.

References

Chandra, S., Biederman, J., & Faraone, S. V. (2021). Assessing the validity of the age at onset criterion for diagnosing ADHD in DSM-5. Journal of Attention Disorders, 25(2), 143-153. https://doi.org/10.1177/1087054716629717

Eissa, M. A. (2018). Issues Related to Identification of Children with Specific Learning Disorders (SLDs): Insights into DSM-5. International Journal of Psycho-Educational Sciences, 7(1), 106–111. https://eric.ed.gov/?id=EJ1253028

Rosenthal, L. D., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Providers-E-Book. Elsevier Health Sciences.

Wiggins, L. D., Rice, C. E., Barger, B., Soke, G. N., Lee, L. C., Moody, E., … & Levy, S. E. (2019). DSM-5 criteria for autism spectrum disorder maximizes diagnostic sensitivity and specificity in preschool children. Social Psychiatry and Psychiatric Epidemiology, 54, 693–701. https://doi.org/10.1007/s00127-019-01674-1

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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, 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 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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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.
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-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.).
REQUIRED READINGS

https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x17_Neurocognitive_Disorders

https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x01_Neurodevelopmental_Disorders

VIDEO CHOICES

https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/training-title-48

https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/training-title-50

After you choose the video, use attached Case History Reports to get patients history

Please, use DSMV when putting differential diagnosis and put DSMV in reference.

Please make sure your grammar is correct.