Neurodevelopmental disorders
Neurodevelopmental Disorders – Comprehensive Psychiatric Evaluation
Patient Information: M. T, 27 years old
CC (Chief complaint): Feeling overwhelmed and stressed since having her first child
HPI: Mrs. Tilman, a 27-year-old female, presents to the clinic after her husband became worried about her recent status. She reports feeling overwhelmed and stressed out since she gave birth two months ago. She reported feeling irritable, anxious, and having difficulty sleeping. She expresses concerns about her body weight and appearance, but is overwhelmed with the responsibilities of taking care of the baby. She admitted that since the baby was born, she has been crying a lot and blaming herself. She admits to just being upset over things. She reports challenges concentrating, including writing, which she previously enjoyed.
Past Psychiatric History
General Statement: Patient reports being irritable, having mood swings, anger outbursts, and feeling overwhelmed since the birth of her daughter two months ago.
Caregivers (if applicable): Not applicable
Hospitalizations: No previous hospitalization
Medication trials: None
Psychotherapy or Previous Psychiatric Diagnosis: No previous diagnosis
Substance Current Use and History
Family Psychiatric/Substance Use History: She denied taking illicit drugs or alcohol. She reported that her brother had committed suicide through GSW. Her brother was addicted to methamphetamines.
Psychosocial History: The patient is currently married and has a two-month-old, and is a stay-at-home mother having worked at the community library for 5 years. Her mother brought her up after her parents’ divorce when she was 16 years old. She has two sisters in Troy, Alabama. She had a degree with a major in English literature. She indicated that she enjoys writing but is not focused on doing it.
Medical History: Hypertension
Current Medications: Trandate 100mg twice daily for his hypertension
Allergies: PCN
Reproductive Hx: Has one two-month-old child
ROS
General: Denies having fever, chills, or weakness. She reports having gained weight and feeling fatigued from taking care of the baby.
HEENT: Denies visual change, blurred vision, or double vision.
SKIN: Denies having any rash or itching.
CARDIOVASCULAR: denies experiencing chest pain or chest discomfort.
RESPIRATORY: Denies having shortness of breath. Denies coughing or producing any sputum.
GASTROINTESTINAL: Patient denies experiencing anorexia, nausea, or vomiting. Denies having any abdominal pain.
GENITOURINARY: Denies having a burning sensation when urinating. Denies having any change in urination urgency or abnormal odor.
NEUROLOGICAL: Denies having a headache, dizziness, or paralysis.
MUSCULOSKELETAL: Denies having muscle, back pain, or joint pain.
HEMATOLOGIC: Denies having any blood-related disorder.
LYMPHATICS: Denies having enlarged nodes.
ENDOCRINOLOGIC: Denies excessive sweating or heat intolerance.
Physical exam
Vitals
T- 98.6 P- 88 R 18 154/92 Ht 5’1 Wt 230lbs
Diagnostic Results
Assessment:
Mental Status Examination
He is a 27-year-old African American female who appears well-groomed and dressed appropriately. During the conversation, she makes eye contact, and her voice is clear and coherent. She talks at a normal rate, volume, and tone and uses no signs of pressured speech. She appears to be mildly anxious. She reports being overwhelmed and worried due to having a child to take care of. Her thought process is linear and organized, with no evidence of thought disorder. She denies having hallucinations, delusions, or suicidal ideation. Mrs. Tilman is oriented to person, place, and time. Her attention and concentration were intact. With regards to insight and judgement, she admitted to being stressed but denies having any harmful thoughts.
Differential Diagnoses
- Postpartum Depression; Postpartum depression is a mood disorder that is often experienced a few months to year after giving birth and is characterized by depressive symptoms, low mood, sleep disturbance, appetite changes, diurnal variation in mood, poor concentration, irritability, and guilt feelings concerning the inability to take care of their new baby (Anokye et al., 2021; Cho et al. 2022). From the case study, the patient, a 2-month-old, reports feeling overwhelmed, sad, and anxious ever since the baby came. She reports crying a lot, being overwhelmed, irritable, uninterested in activities such as writing and sex, and feeling guilty for her inability to take care of their child. These symptoms are highly suggestive of postpartum depression. The DSM-5-TR Criteria for postpartum depression entail the development of depressive symptoms for a few months or years, with symptoms including feelings of sadness, hopelessness, and displeasure in previously pleasurable activities.
- Adjustment disorder with anxious mood; adjustment disorder refers to a maladaptive emotional and/or behavioral response to an identifiable psychosocial stressor (O’Donnell et al., 2019). The possible stressor in the patient’s life is that she recently gave birth, which has made her overwhelmed and anxious about adjusting to a new role as a mother. The DSM-5 criteria require an exposure to one or more stressors, out-of-proportion distress from the typical reactions to a stressor, and symptoms causing significant distress and impairment in functioning. This may be regarded as a possible diagnosis since the condition is not an escalation of existing mental health issues or a reaction to normal bereavement.
- Generalized anxiety disorder (GAD) entails a variety of symptoms, such as excessive worrying, restlessness, irritability, challenges in concentration, and constantly being on edge (Stein et al., 2021). The DSM-5 criteria for GAD involve the presence of excess anxiety and worry experienced more days than not for 6 months, and the patient finds it challenging to control the concern. The lack of specific phobias or panic attacks makes it a possible primary diagnosis.
Reflections
If I were to conduct the session over again, I would explore the patientpatient’st system and coping mechanisms. It is also essential to monitor the patient’s adherence to her hypertension medication, since missing her doses is likely to worsen her anxiety level. Ethically, it is necessary to ensure the patpatient’snsent and informed consent on the recommended treatment plan. In their study, Simhi et al. (2021) noted that among mothers with PPD symptoms, they tend to have minimal energy to go outside and seek help, which reinforces the need to identify such scenarios and provide treatment to them through other means. It is essential to promote the patient’s physical wellbeing, especially as a new mother. It will be necessary to emphasize to her the importance of living a healthy lifestyle.
References
Anokye, R., Acheampong, E., Budu-Ainooson, A., Obeng, E. I., & Akwasi, A. G. (2018). Prevalence of postpartum depression and interventions utilized for its management. Annals of general psychiatry, 17, 1-8. https://doi.org/10.1186/s12991-018-0188-0
Cho, H., Lee, K., Choi, E., Cho, H. N., Park, B., Suh, M., … & Choi, K. S. (2022). Association between social support and postpartum depression. Scientific reports, 12(1), 3128. https://doi.org/10.1038/s41598-022-07248-7
O’DO’Donnell. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International journal of environmental research and public health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537
Simhi, M., Sarid, O., & Cwikel, J. (2019). Preferences for mental health treatment for postpartum depression among new mothers. Israel journal of health policy research, 8, 1-8. https://doi.org/10.1186/s13584-019-0354-0
Stein, D. J., Kazdin, A. E., Ruscio, A. M., Chiu, W. T., Sampson, N. A., Ziobrowski, H. N., … & Kessler, R. C. (2021). Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. BMC Psychiatry, 21, 1-14. https://doi.org/10.1186/s12888-021-03363-3
CLICK HERE TO ORDER A PLAGIARISM–WRITTEN PAPER
Symptom Media. (Producer). (2017). Training title 48Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-48
Training Title 8
Name: Mrs. Abrianna Tilman
Gender: female
Age: 27 years old
T- 98.6 P- 88 R 18 154/92 Ht 5’1 Wt 230lbs
Background: She recently had her first child two months ago. Currently married; stay-at-home
mother after working in a community library for 5 years. Grew up with her mother after her
parents divorced when she was 16; has two sisters in Troy, Alabama. Completed education
through bachelor’s level, majoring in English Literature. No previous suicidal gestures. Brother
committed suicide via GSW. She denied drugs/alcohol; her brother was addicted to
methamphetamines. Hx of HTN-prescribed Trandate 100mg twice daily, admits to missing doses
due to forgetting. No legal hx. Allergies: PCN
Symptom Media. (Producer). (2016). Training title 8 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-8
NRNP_6635_Week10_Assignment_Rubric
NRNP_6635_Week10_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome: Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. 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
20 to >17.0 pts
Excellent
The response thoroughly and accurately describes the ppppatient’ssubjectiveomplaint, history of present illness, past psychiatric history, medication trials, allergies,s and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, and review of all systems that would inform a differential diagnosis.
17 to >15.0 pts
Good
The response accurately describes thepatient’s subjective complaint, history of present illness, past psychiatric history, medication trials, and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
15 to >13.0 pts
Fair
The response describes the pppatient’ssubjectivecomplaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Still, it is somewhat vague or contains minor inaccuracies.
13 to >0 pts
Poor
The response provides an incomplete or inaccurate description of the pppatient’ssubjectivecomplaint, history of present illness, past psychiatric history, medication trials, and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
20 pts
This criterion is linked to a Learning Outcome. 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.
20 to >17.0 pts
Excellent
The response thoroughly and accurately documents the pppatient’sphysicalexam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
17 to >15.0 pts
Good
The response accurately documents the pppatient’sphysicalexam for pertinent systems. Diagnostic tests and their results are accurately documented.
15 to >13.0 pts
Fair
Documentation of the pppatient’sphysicalexam is somewhat vague or contains minor inaccuracies. Diagnostic tests and their results are documented but contain minor inaccuracies.
13 to >0 pts
Poor
The response provides incomplete or inaccurate documentation of the pppatient’sphysicalexam. Systems may have been unnecessarily reviewed, or objective documentation may be missing.
20 pts
This criterion is linked to a Learning Outcome. 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rule 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.
25 to >22.0 pts
Excellent
The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
22 to >19.0 pts
Good
The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.
19 to >17.0 pts
Fair
The response documents the results of the mental status exam with some vagueness or iinaccuracy… Response lists at least three different possible disorders for a differential diagnosis of the patient and justifies each, but may contain some vagueness or inaccuracy.
17 to >0 pts
Poor
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
25 pts
This criterion is linked to a Learning Outcome. Reflect on this case. 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!), social determinants of health, 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.).
10 to >8.0 pts
Excellent
Reflections are thorough, thoughtful, and demonstrate critical thinking.
8 to >7.0 pts
Good
Reflections demonstrate critical thinking.
7 to >6.0 pts
Fair
Reflections are somewhat general or do not demonstrate critical thinking.
6 to >0 pts
Poor
Reflections are incomplete, inaccurate, or missing.
10 pts
This criterion is linked to a Learning Outcome. Provide at least three evidence-based, peer-reviewed journal articles or evidence-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
15 to >13.0 pts
Excellent
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision-making.
13 to >11.0 pts
Good
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
11 to >10.0 pts
Fair
Three evidence-based resources are provided to support the assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
10 to >0 pts
Poor
Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence-based.
15 pts
This criterion is linked to a Learning Outcome, Written Expression and Formatting—” ar” “raph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused— “ei” “r long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 to >3.5 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of tAssignmentent are stated, yet they are brief and not descriptive.
3.5 to >3.0 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%†“9% o” the time. … Purpose, introduction, and conclusion of the assignment are vague or off topic.
3 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. … No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning Outcome, Written Expression and Formatting—” ng”” sh writing standards: Correct grammar, mechanics, and punctuation
5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors
4 to >3.0 pts
Good
Contains a few (one or two) grammatical, spelling, and punctuation errors
3 to >2.0 pts
Fair
Contains several (three or four) grammatical, spelling, and punctuation errors
2 to >0 pts
Poor
Contains many (≥ five) grammatical, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
Total Points: 100
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 particular 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 as brain injury, diseases such as Alzheimer’s, Parkinson’s, or Huntington’s, infection, or stroke, among others.
For the 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 the assignment.
By Day 1 of this week, select a specific video case study to use for the 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 a 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 rule 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.).