Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Introduction

The case under analysis concerns an adult by the name Harold who works in a large architectural engineering firm and complains of a decrease in his level of concentration. Although paying attention and concentrating has always been a problem to him even in his school years, he managed to get to adulthood, but recently the situation has worsened and it started after the supervisor tightened the deadlines that Harold and his colleagues are expected to deliver their assigned tasks. Since then, Harold has been having challenges concentrating due to the immense pressure placed by the deadlines and seems to have lost his level of concentration even on the small tasks that he is assigned; for instance, the case of gutters, where he designed and was required to place them, but upon reaching the work site, he notices that the tiles are Italian and are not aligned, although there were some people assigned to work on the tiles, he started to study them.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

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The subjective and objective information suggest that Harold suffers from Attention- Deficit Hyperactivity Disorder (ADHD), although differential diagnosis assessment will be carried out to ensure that the diagnosis is correct and pave way for the treatment process.

CC: “ 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.”The patient  complains of having a problem with concentration

HPI: H.H is a male and presents for psychiatric evaluation for concentration difficulty. He is not presently under any psychotropic medications prescriptions. He is referred by his supervisor for medication evaluation and treatment.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

The issue of concentration has been ongoing for a long time, actually, since childhood, but the client has never been diagnosed. As a child, Harold’s mother made threats that she would take him forcefully to the hospital, but never did. However, owing to his high level of hyperactivity, she opted to ensure that he never took caffeine or sugar, the argument being that if he did, then he would climb wall, which even without the consumption of the said products he was already doing. Although as an adult Harold drinks caffeine and soda once in a while, he has managed to progress and live his life without major occurrences like the ones that he is experiencing presently, where he seems to have lost his sense of concentration with his work and it is getting him into constant problems with his supervisor and colleagues. Innately, without the introduction of the tight deadlines, Harold was leading a normal level and was in a position to concentrate on his work and complete them the same way his colleagues are doing, even with the introduction of the tight deadlines as nothing has changed for them.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Past Psychiatric History:

• General Statement:The patient has never been under any psychotropic               medications prescriptions
• Hospitalizations: No instances of hospitalizations related to concentration difficulty
• Medication trials: No History of psychotropic medications tried by the patient
• Psychotherapy or Previous Psychiatric Diagnosis : no previous diagnosis for the patient noted from previous treatments and other providers.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Substance Current Use and History: Although as an adult Harold drinks caffeine and soda once in a while, he has managed to progress and live his life without major occurrences like the ones that he is experiencing presently, where he seems to have lost his sense of concentration with his work and it is getting him into constant problems with his supervisor and colleagues.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Family Psychiatric/Substance Use History:  No family history of psychiatric illness, substance use illnesses, and family suicides

Psychosocial History: There is no personal or social history that is provided about Harold

Medical History: Since no diagnosis has ever been done to determine the type of disease that causes the symptoms that Harold displays, he has never and is not currently on any medication

• Current Medications: not presently under any psychotropic medications
• Allergies: No known allergies
• Reproductive Hx: No reproductive history provided

ROS:

• GENERAL: No fever, chills, weakness, fatigue or weight loss
• HEENT: Eyes: visual imparement. Ears, Nose, Throat: hearing impairment, no congestion, runny nose or sore throat.
• SKIN: No itching or rash
• CARDIOVASCULAR: No form of chest discomfort. No presence of palpitations or edema.
• RESPIRATORY: No breath shortness, cough, or sputum
• GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
• GENITOURINARY: No burning on urination, odor, odd color
• NEUROLOGICAL: No headache, dizziness, paralysis, ataxia, numbness, or extremities tingling. No change control of bowel or bladder.
• MUSCULOSKELETAL: No muscle, back,or joint pain.Absence of stiffness
• HEMATOLOGIC: No bleeding ,anemia or bruising
• LYMPHATICS: No enlarged nodes. No splenectomy history
• ENDOCRINOLOGIC: No sweating, cold, or heat intolerance reports. No reports of polyuria or polydipsia.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Physical exam: physical examination involved inspections for hearing and vision impairments, neurodevelopmental immaturity in relation to fine motor functions retardation. neurological assessment indicates visual and helaring imparement.

Diagnostic results: Rating scales, intellectual screenings, Questionnaires and sustained attention and distractibility measures .This diagonistics are required to confirm the presence, persistence, generality, and functional complications of core symptoms, as well as  establish the coexistence of emotional, behavioral, and medical disorders.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

ADHD is a mental health illness that presents a combination of persistent issues such as impulsive behavior, hyperactivity and challenges in paying attention. ADHD symptoms can emerge from childhood and continue to adulthood and the symptoms make it difficult for the individual to function normal and carry out their daily duties. The result of this is poor relationship with others, for instance a partner or colleagues; poor academic performance among school children, lack of focus and concentration on the normal activities that an individual carries out, this includes concentrating at the workplace whereby the individual opts to focus on other issues that do not align with the duties assigned to him, trouble dealing with pressure or stress, challenges completing assigned task, being messy and lacking organization and low self-esteem (Mayo Clinic, 2019).Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Assessment

Mental Status Examination: The client is alert and oriented to person, place, and event. The client’s speech if coherent and adheres with the questions that he is asked. The client appears to understand that he has a problem and one that needs to be addressed, based on the reflection about his life from his childhood to date that he gives. The client’s self-reported mood is not euthymic.

Differential Diagnoses:

Bipolar disorder

Bipolar disorder is one of the mental disorders that can easily be misdiagnosed as ADHD owing to a number of symptoms that the two disorders share that include mood swings, difficulty focusing and maintaining attention and hyperactivity. However, the differentiating symptoms of the two mental disorders include delusions, insomnia and euphoric mood, which are specific for bipolar disorder (Torres, et al., 2018).Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Major Depressive Disorder

Major depressive disorder is another mental disorder that can easily be passed for ADHD based on the similarity in symptoms such as poor or lack of concentration, memory and attention; and difficulty completing the tasks that one is assigned, which is associated with the challenge of maintaining concentration. The differentiating features of the two mental disorders include appetite and sleep disturbance; and anhedonia and enduring dysphoric mood, which are specific for major depressive disorder (Katzman, et al., 2017).

Personality Disorders: Antisocial and Borderline Personality Disorders

There are a number of personality disorders that can be passed as ADHD, and which thereby demand thorough diagnosis and they include borderline personality disorder and antisocial disorder. The symptoms that are similar to those of ADHD include interpersonal difficulties, impulsivity and affective liability, for instance, the case of gutters and tilted Italian tiles, whereby although his task was to place the gutters, Harold started studying the tiles after noticing that they were titled, yet this was a duty assigned to other individuals. The distinguishing symptoms include repeated self-injuries and suicidal behavior in the case for borderline personality disorder; arrest history in the case of antisocial personality disorder and the failure to determine the impact of one’s behavior to self and others. The diagnosis and test screening utilized for the personality disorders discussed include interview for the diagnosis and severity for the antisocial personality disorder; and MacLean Screening Instrument for the for the borderline personality disorder (Sánchez-García, et al., 2020).Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Generalized Anxiety Disorder

The other mental disorder that the client must be cleared for is the generalized anxiety disorder, which as well shares some similarities with ADHD such as lack and difficulties concentrating and fidgetiness. However, there are differentiating symptoms that include insomnia and syncope and exaggerated worrying and apprehension, which are very common for generalized anxiety disorder. The disorder is as well diagnosed using the generalized anxiety disorder (GAD-7) screening and the adult severity measure for the generalized anxiety disorder diagnosis (Loskutova, Callen & Lutgen, 2019).

Substance use disorders or Dependence

The substance use disorders or dependence aligns with the use of substances that are considered illegal and addictive, which include cocaine, alcohol, opiates, hallucinogens, and other psychotic stimulants. The danger with excessive use of these substances is that they disrupt the normal functioning of the individual, mood and behavior. Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.The symptoms of substance use disorder that are similar to those of ADHD include mood swings, this is because the individual has become dependent on the substance that he abuses and challenges paying attention, loss of memory and lack of concentration. The differentiating symptoms between substance use disorder and ADHD include psychologic and physiologic symptoms such as dependence, withdrawal and tolerance; and substance use pathological patterns that have social consequences. The test screening and diagnosis for substance use disorder include interview for diagnosis and severity and NIDA Modified ASSIST Drug Use Screening tool screening (Crunelle, et al., 2018). Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Mild Autism Spectrum Disorder (Asperger Syndrome)

According to Mayo Clinic (2018) autism spectrum disorder is a mental disorder that can be passed for ADHD, which is associated with brain development and thus, it impacts on the individual’s ability to socialize as well as their perception. The result of this is ineffective communication, poor social interaction and challenges making decisions. The symptoms that can easily make this mental disorder be misdiagnozed for ADHD include lack of attention and concentration, interrupting others and talkativeness.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders. However, the symptoms that differentiate Asperger syndrome with ADHD include the patient being often illogical, hyper focus on certain activities that are excluded from the normal daily life of the individual, the inability to study the social cues and the lack of interest with other people, inability to socialize. The diagnostic and test screening tests used for the disorder is Diagnostic Statistical Manual of Mental Disorder (DSM-5)- diagnosis.

Reflections: The assessment of the possible mental disorder that the client suffers in line with the differential diagnosis shows that it is adult ADHD, which is a mental disorder that is characterized by a combination of inattention, impulsiveness and hyperactivity. It is estimated that 8 million adults or rather 4% of the adult population of the United States suffers from adult ADHD (ADAA, 2020). The unfortunate fact is that less than 20% of the adults with ADHD have been diagnosed and this is very clear with the case of Harold, who were it not for the tightening of deadlines at his workplace, he would not have been diagnosed with the disorder, as he had learnt to live and cope with the disease and proceed with his day-to-day activities without interference. Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.This is even with the realization that he had concentration issues from childhood, which his mother as well recognized, but did not take the initiative to have him diagnosed. ADHD is believed to be genetic or biological and that it starts early in brain development, although in the case of Harold there is no enough information to determine whether the disorder was genetic or biological. The five symptoms that help in the diagnosis of adult ADHD include emotional instability, inattention, impulsivity, hyperactivity and disorganization (ADAA, 2020). Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.From the analysis of the case of Harold, it is clear that he displays all of these symptoms, inattention is demonstrated by his inability to concentrate on his assigned tasks after the supervisor tightened the deadlines, which increase the pressure that was required to focus on the work. Impulsivity and disorganization are demonstrated by the gutters and Italian tiles case, where instead of working on his assigned tasks, he started studying a task that was already assigned to other individuals; Harold did not consider the feelings and emotions of the people that were already assigned the Italian tiles task. Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.This gutters tasks caused Harold too much trouble with his supervisor and the client who had given his company the job, and it is also demonstrated the hyperactivity symptom, where the individual feels that he needs to multitask, but unfortunately this only results incomplete tasks as the attention is soon diverted to something else prior to the completion of the task at hand. The client reports that he is messy and disorganized, which is one of the symptoms of individuals with ADHD. Emotional instability is displayed by the lack of motivation of the client to his assigned tasks; while his colleagues were motivated by the tightened deadlines, Harold panic and lost his level of concentration, the result of which was lack of completion of his tasks.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

The diagnosis of the client will take into account ethical considerations to ensure that the client comprehends the diagnosis process and most especially the mental disorder that he suffers. The diagnosis process demands that the client gives consent for the procedure to be carried out and on the same note is offered the guarantee that confidentiality of his medical information will be observed. Legal consideration that aligns with the diagnosis of ADHD will as well be taken into consideration, with the realization that the mental disorder displays symptoms that are very similar to other mental disorders, meaning that they can be easily passed for another mental disorder. The possible outcome of this is medical error as the client will be treated for the wrong disorder, and leading to a legal suit for the healthcare provider and the health care organization. For this reason, a differential diagnosis of the mental disorders that display similar symptoms as as ADHD will be analyzed and a proper diagnosis provided. Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.

Conclusion

This paper sought to examine the case of a client by the name Harold, who has been having challenges focusing on his assigned tasks at the workplace after tight deadlines were introduced, leading his supervisor to make appointment for him with the healthcare provider. From the subjective and objective data, it is clear that the client suffers from ADHD. Although to be sure that it was no other mental disorder, differential diagnosis was conducted.Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders.