For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders. Decision Tree Essay Paper

To Prepare
* Review the interactive media piece assigned by your Instructor. Interactive media pieces copied and pasted below:

BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”
Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.
Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

BACKGROUND
This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.”  Decision Tree Essay Paper

SUBJECTIVE
The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!”
The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”
He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.”
During the client interview, the client states “oh! It’s happening, let me show you!” this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. “It will last about a minute or two, then it will let up” he reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. The client states “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain.

MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal/homicidal ideation, and is future oriented.
Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy).

* Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
* Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
* You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.  Decision Tree Essay Paper
By Day 7 of Week 8
Write a 1- to 2-page summary paper that addresses the following:
* Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
* Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
* What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
* Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

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 Decision Tree

Mr. Akkad, a 76-year-old Iranian man who has been exhibiting abnormal behavior for the last two years, is the subject of the case study. There have been some shifts in his personality, including a loss of interest for things he used to like.

Decision 1: Aricept (donepezil) 5 mg orally at bedtime

It was determined that Aricept would be the best choice because of its reputation for streamlining behavioral, cognitive, and functional capabilities (Kumar & Sharma, 2020). Because the client’s behaviors, functional abilities, and cognitive functioning are all compromised, Aricept would be effective in alleviating the patient’s condition. This choice was made in the hopes of improving the patient’s cognitive deficits, which was shown by the mini-mental State test and included deficiencies in orientation as well as recollection and concentration issues. The outcomes of this choice were different from what was expected. Mr. Akkad’s son states that there has been no improvement in his father’s cognitive functioning after four weeks.

Decision 2: Cognitive-behavioral therapy

This choice was made because cognitive behavioral therapy (CBT) has the ability to improve the patient’s behavior, including increasing self-control and partaking in cognitive control (Grossberg et al., 2019). CBT would also give the patient with the motivation he needs to return to things he previously enjoyed. I had thought that by making this choice, I would be able to increase the functional level of the patient, allowing him to enhance his behavioral and cognitive abilities. Patients’ cognitive skills, as well as mood and self-control are improved with cognitive behavioral therapy.  Decision Tree Essay Paper

Decision 3: Family-based therapy

This choice was made as medication non-compliance is most prevalent in the elderly population, and including MR. Akkad’s family in his treatment offers him a support mechanism that may help him stick to his medicine. I hoped that by including Mr. Akkad’s family in his care, I might be able to increase the client’s adherence to his therapy. Individuals with Alzheimer’s disease commonly forget things, and including members of the family attempts to strengthen the patient’s care and provide a supportive network (Bondi et al., 2017). There is a gap between what I intended to achieve and what really occurred. Conversely, the presence of family members during patient treatment contributes to the patient’s cognitive well-being.

References

Bondi, M. W., Edmonds, E. C., & Salmon, D. P. (2017). Alzheimer’s disease: Past, present, and future. Journal of the International Neuropsychological Society, 23(9-10), 818-831. https://doi.org/10.1017/s135561771700100x

Grossberg, G. T., Tong, G., Burke, A. D., & Tariot, P. N. (2019). Present algorithms and future treatments for Alzheimer’s disease. Journal of Alzheimer’s Disease, 67(4), 1157-1171.

Kumar, A., & Sharma, S. (2020). Donepezil. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK513257/

Decision Tree Essay Paper