NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example Introduction

Neurocognitive and neurodevelopmental disorders are complex conditions that require careful assessment and differentiation to ensure proper diagnosis and management. Neurodevelopmental disorders often present in childhood and can persist into adulthood, encompassing conditions like attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). In contrast, neurocognitive disorders represent a decline from previous functioning due to conditions like Alzheimer’s disease, brain injury, or stroke. This paper will provide a comprehensive psychiatric evaluation of Harold Brown, a 60-year-old male presenting with potential neurocognitive symptoms. The assessment will explore his clinical presentation, differential diagnosis, and develop a treatment plan based on evidence and DSM-5-TR criteria.

Subjective Data

Chief Complaint:

Harold Brown reports mild difficulty with attention and short-term memory, particularly when recalling recent events. He has expressed concerns about these issues affecting his daily activities, although he continues to work part-time as an engineer. He denies significant interference with basic functioning but mentions occasional lapses in attention and memory at work and in social settings. He was encouraged by his brother to seek evaluation after noticing a pattern of forgetfulness and distraction.

History of Present Illness (HPI):

Mr. Brown states that his symptoms began approximately 18 months ago and have gradually worsened. He reports difficulty maintaining focus during long tasks and trouble recalling names or recent conversations. He denies any abrupt changes in memory, mood disturbances, or significant changes in his personality. He describes himself as independent, though he acknowledges his brother’s concerns regarding his recent forgetfulness. His symptoms do not seem to vary based on time of day or specific activities. He denies any head trauma, seizures, or major medical illnesses contributing to his cognitive difficulties.

Medical History:

• Hypertension: Controlled with Cozaar (Losartan) 100mg daily
• Hypertriglyceridemia: Managed with fenofibrate 160mg daily
• Benign Prostatic Hyperplasia (BPH): Managed with tamsulosin 0.4mg at bedtime
• Angina: Taking aspirin 81mg daily

Medications:

• Cozaar (Losartan) 100mg daily
• Fenofibrate 160mg daily
• Tamsulosin 0.4mg at bedtime
• Aspirin 81mg daily

Allergies:

Allergic to Dilaudid.

Family History:

His father had hypertension and passed away at the age of 75 due to complications from a stroke. His mother died of Alzheimer’s disease at the age of 80. He has one younger brother, who is in good health.

Social History:

Mr. Brown lives alone, has never married, and has no children. He casually dates and reports a healthy social life. He enjoys having a scotch and cigar on weekends. He denies any history of drug use. He continues to work part-time and maintains good relationships with his colleagues and family members.

Developmental History:

No developmental delays or learning difficulties reported in childhood or adolescence.

Objective Data

General Appearance and Behavior:

Mr. Brown presents as a well-groomed, alert, and oriented male who appears his stated age. He is cooperative and maintains good eye contact throughout the interview. No abnormal movements or signs of agitation were observed. His speech was fluent and coherent, with normal rate and rhythm.

Vital Signs:

• Temperature: 98.8°F
• Pulse: 74 bpm
• Respiration: 18 breaths/min
• Blood Pressure: 134/70 mmHg
• Height: 5’10”
• Weight: 170 lbs

Neurological/Cognitive Observations:

• Montreal Cognitive Assessment (MoCA): Score of 28/30, indicating mild cognitive impairment. Notable difficulty was observed in the attention and delayed recall sections of the test.
• Attention Deficit: He had trouble sustaining attention during long tasks, such as performing serial 7s.
• Memory: Delayed recall was impaired, as he struggled to remember words presented earlier during the MoCA. Immediate memory, however, remained intact.

Mental Status Examination (MSE)

Appearance:

Well-groomed, appropriately dressed for the weather and occas