Psychopathology and Diagnostic Reasoning
Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders. Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis
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 facto
Neurocognitive and Neurodevelopmental Disorders Training Title 48
Case study: Name: Sarah Higgins Gender: female Age: 9 years old T- 97.4 P- 62 R 14 95/60 Ht 4’5 Wt 63lbs Background: no history of treatment, developmental milestones met on time, vaccinations up to date. Sleeps 9hrs/night, meals are difficult as she has hard time sitting for meals, she does get proper nutrition per PCP. Symptom Media. (Producer). (2017). Training title 48 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-48 Training Title 50 Name: Harold Griffin Gender: male Age:58 years old T- 98.8 P- 86 R 18 134/88 Ht 5’11 Wt 180lbs Background: Has bachelor’s degree in engineering. He is homosexual and dates casually, never married, no children. Has one younger sister. Sleeps 4-6 hours, appetite good. Denied legal issues; MOCA 27/30 difficulty with attention and delayed recall; ASRS-5 20/24; denied hx of drug use; enjoys one scotch drink on the weekends with a cigar. Allergies Morphine; history HTN blood pressure controlled with losartan 100mg daily, angina prescribed ASA 81mg po daily, metoprolol 25mg twice daily. Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg po bedtime. Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreet
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.
In the Subjective section, provide:
- Chief complaint
- History of present illness (HPI)
- Past psychiatric history
- Medication trials and current medications
- Psychotherapy or previous psychiatric diagnosis
- Pertinent substance use, family psychiatric/substance use, social, and medical history
- Allergies
- ROS
- Read rating descriptions to see the grading standards!
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.
- Read rating descriptions to see the grading standards!
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.
- Read rating descriptions to see the grading standards!
Reflect on this case. Include: 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.).
(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)
Sample Paper
Case Scenario
SUBJECTIVE DATA
- Chief Complaint – The patient states that he has an acute lack of enough sleep during the night hours and increasingly high levels of lack of concentration in performing daily activities.
- History of Present Illness – G.G. is a 52-year-old African American male who presents for psychiatric evaluation for insomnia. The patient is not under medication for the current condition. The patient said that he has been having sleeping problems since childhood and has grown into adulthood. He says that the problem has increased for the last two weeks, sleeping for few hours as few as 4-6 hours a day. His primary care provider referred him for psychiatric evaluation and treatment.
- Past Psychiatry History – The patient has no history of psychiatry or has ever visited a psychiatrist.
- Medication Trials and Current Medication – The patient has no record of medication trials for the sleeping problem. The current medications include losartan 100mg/day, metoprolol 25mg, tamsulosin 0.4mg, ASA 81mg, and hypertriglyceridemia prescription of fenofibrate 160mg/day.
- Psychotherapy or previous psychiatric diagnosis – The patient does not have a previous psychiatric diagnosis.
- Pertinent substance use and Family – Some family members have a history of substance use. The father uses alcohol occasionally. Her sister smokes a cigar. The patient enjoys once scotch drink with a cigar, only on weekends.
- Allergies – The patient is allergic to morphine, an opioid.
- Social History – G.G. was born in Colorado and raised by his parents in the city. The patient is the firstborn in a family of two siblings. He is not married but is a casual homosexual. He lives with his younger sister. He is professionally a working engineer and has no past legal issues. He has no history of any form of violence. He has a history of a traumatic childhood; he was sodomized at eight years.
Review of Systems (R.O.S.)
HEENT – The patient reports no dry, painful, or itching eyes. He has no vision problems. Denies hearing loss, sneezing, tinnitus, runny nose, or sore throat.
Respiratory System: Denies coughing and breathing problems.
Cardiovascular – Reports angina, denies palpitations.
Gastrointestinal – Patient denies vomiting, diarrhea, or lack of appetite.
Genitourinary – Denies pain or burning sensation during urination, no polyuria.
Musculoskeletal – Denies muscle pain, stiffness, or bone issues.
Neurologic – reports the reduced level of attentiveness and concentration, denies headache or numbness.
Psychiatric – reports that he has a history of abnormal sleep problems, forgetfulness, and lack of attentiveness. Denies depressive or anxiety symptoms.
Hematologic/ Lymphatic – Denies abnormal hemorrhage, abnormal nodes, or general body fatigue.
Endocrine – Denies polydipsia, polyuria, and excessive sweating.
Immunologic/ Allergy – Denies seasonal allergies related to chest tightness, breathing problems, asthma, or eczema.
OBJECTIVE DATA
- Constitutional – He is well-nourished and confident. Temperature 98.8, respiratory rate 18, pulse rate 86, blood pressure 134/88, height 5’11, and weight 180 lbs. The patient is obese.
- HEENT – Head atraumatic and normocephalic with generally normal contours. The pupils are round, equal, and reactive to light, with no exudates, and no halitosis.
- Neurologic – Intact cranial nerves with relatively normal symmetric reflexes. The patient is momentarily alert on time, space, person, and place. No focal, motor, or sensory deficits were noted.
- Psychiatric – Unable to concentrate for long and maintain straight eye contact.
- Diagnostic results – The PATIENT underwent blood tests to establish probable hyperthyroidism. The results indicated that the thyroid levels were within the normal range (3.4 milli-international units per liter of blood). The blood sugar tests results indicated that it was within the normal range (5.6 mmol/L). Serum creatinine test results were 1.02 mg/dL, within the normal range.
ASSESSMENT
Diagnosis – The 52-year old male patient had a cooperative encounter with the examiner. His level of attentiveness was moderate, with clarity in speech and volume. The tone was moody, and thus there is any evidence of anxiety contributing to his strained relationships. His cognitive ability is normal, with minimal levels of forgetfulness. He is concerned about his lack of sleep and hyperactiveness. Using the DSM-5 criteria for ADHD, the patient met criteria one and two: inattentiveness and hyperactivity or impulsivity (Craig, 2020). The patient is also experiencing difficulties in relationships being unmarried with casual homosexuality. The patient has sleep problems that can be associated with numerous health complications. The blood and urinalysis tests show thyroid, blood sugar, and creatinine levels within the normal range, and thus they may not affect the patient’s health condition.
The differential diagnoses include ADHD, Bipolar, and low blood sugar diabetes.
- Attention deficit hyperactivity disorder (ADHD) –This is the most probable diagnosis since the patient’s symptoms match with the DSM-5 criteria for the mental condition. The patient has the symptoms of inattentiveness and loss of concentration which are included in the criteria for identifying ADHD. The patient is experiencing sleep problems, sleeping only 4-6 hours in a day below the standard eight hours, which is associated with ADHD (Díaz-Román et al., 2018). The patient’s social life is affected, as evidenced by not being married and having homosexual casual relationships. These are key symptoms of ADHD and thus the priority diagnosis.
- Bipolar – Bipolar is a mental condition characterized by mood changes, restlessness, sleeplessness, and impatience (Porter, 2021). The patient is experiencing strained relationships and sleep disturbances. These are associated with a bipolar condition. The patient’s restlessness and moody conditions are continuous, while in the bipolar condition, they are seasonal, thus weakening the possibility of bipolar diagnosis (Porter, 2021).
- Low-blood sugar diabetes (Hypoglycemia) is a condition caused by decreased sugar levels in the blood, and according to Pacheco (2020), the condition has symptoms such as sleep problems, irritability, and fatigue. The patient is experiencing sleep problems and strained relationships related to hypoglycemia. The patient’s blood sugar level is within the normal range, and thus the patient is not hypoglycemic.
Reflection
From the psychiatric examination of the patient, I have learned that many patients live with the ADHD condition but are not aware or understood within society. The condition associated with sleeplessness, strained relationships, compulsivity, hyperactivity, and restlessness develops in childhood, unlike bipolar, which mostly starts at adolescence and continues to adulthood. This shows that early detection of the mental issue in childhood can help in early intervention through psychiatric programs to improve the lives of the affected persons.
References
Craig, J. (2020). DSM-5® Diagnostic Criteria | For Adult ADHD. Www.Qandadhd.Com. ADHD
Díaz-Román, A., Mitchell, R., & Cortese, S. (2018). Sleep in adults with ADHD: systematic review and meta-analysis of subjective and objective studies. Neuroscience & Biobehavioral Reviews, 89, 61-71.
Pacheco, D. (2020, December 4). Sleep and Blood Glucose Levels. Sleep Foundation. https://www.sleepfoundation.org/physical-health/sleep-and-blood-glucose-levels
Porter, E. (2021, August 9). Conditions That Mimic ADHD. Healthline. https://www.healthline.com/health/adhd/adhd-misdiagnosis#bipolar-disorder
