Assignment 2: Week 8 Practicum: Decision Tree

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

The Assignment:

Learning Objectives

Students will:

Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

Which Decision did you select?

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

Note: Support your rationale with a minimum of three academic resources less than five years In APA Format Including Introduction and Conclusion

ORDER CUSTOM, PLAGIARISM-FREE PAPER

NEUROCOGNITIVE DISORDER

The human ability to think and reason is a major function of the brain and this helps to give meaning to the quality of life that any individual could attain. Thus the ability of the neurons of the brain to function effectively makes it possible for thinking and reasoning capability to be achieved hence its term cognitive functioning becomes an essential part of proper human healthy living. However, any malfunctioning of the neurons in the brain will eventually affect the cognitive capability of individuals and this can result in what is known as neurocognitive disorder (NCD). The fact that as a person grow older problem of cognitive issue become more pronounce it is therefore not surprising that the elderly population are the most affected as seen with the case of dementia hence the increase in the number of aged population with neurocognitive disorder and according to researcher the number is expected to increase in double fold such as in the year 2050 the number of age population with dementia would likely reach 115 million. (Walker et al, 2015). The DSM-5 can be used to illustrate those factors that are associated with neurocognitive disorder from a mild form of the illness to the major form of the disease. Thus early detection of dementia conditions will make it possible to develop plans and strategies to manage the disease. This paper will address the case study, make diagnosis, prescribe medication, monitor the patient’s progress, and ethical implication and concern of the case.

Patient Background

The client Mr. Charles Wingate is a Caucasian male of aged 76 who presents himself to the clinic accompanied by his son Mark and lives with him and explains forgetfulness and inability to perform basic cognitive processes, this he explains further started about 2-years ago as issue of memory and cognitive issue became more pronounced. And this is followed by a problem of coordination and muscle extension and relaxation as he experiences tremor when his hands are at rest and nightmare was also mentioned by the son. This, according to Mark, is making him too worried.

Decision One

The patient was diagnosed with Major Neurocognitive Disorder with Lewy Bodies (MNDLB), obviously this decision was arrived at after extensive assessment of the client presenting symptoms, subjective, and objective data.The American Psychiatric Association (2013), Major Neurocognitive Disorder with Lewy Bodies is mental health problem that is associated with progressive impairment of the cognitive function of the brain in which the prgessive alteration and changes in the affected individual memory and ability to learning process with characteristic such as rapid eye movement (REM), hallucination, depression, and delusion. (APA, 2013). The symptom of the REM is an indication that the patient is having problems with sleeping hence a sleeping disorder is manifesting itself at the initial stage of a cognitive degeneration. Thus the patient’s ability to remember things continues to decrease and this becomes worden as the patient gets older as this can be supported on the account given by the client in which he was lost while trying to go home from a shopping trip. While in other instances he forgot the due date of his bill or where he kept his key to the house. And in a more safety concern he forgot the food in the oven only to be alerted by the smoke detector, just as sometimes he would be confused of whether he had taken his medication for the day or not and eventually used overdose thereby bringing about side effects such as nightmares, insomnia, etc. Also the patient manifests onset of Parkinson’s as he exhibits the fine resting tremor and he scores 17 in his mini-mental status exam (MMSE) with low memory, orientation and place. It should be noted that there are similarities in terms of symptoms between dementia with Lewy bodies and Alzheimer disease hence a great challenge in early diagnosis. (Walker et al, 2015). With this client’s diagnosis (MNDLB) in mind, the next step is to give treatment for the illness and collaboration with other medical professionals towards this treatment.

Decision Two

The client for a start will be treated with 1.5 mg Rivastigmine by mouth twice a day. This medication belongs to the class of acetylcholinesterase inhibitors as they are known for their cognitive enhancing properties. (Stahl, 2014). In the same light, donepezil justas rivastigmine are preferable when it comes to managing the symptoms of dementia with Lewy Bodies. Olanzapine 5 mg can be used during the time to sleep or 8 mg of Remelton per day. As an atypical antipsychotic medication can be used to stabilize the mood of individuals with schizophrenia, mania, or bipolar disorder. (Stahl, 2014). The use of Ramelton during the time of sleep is meant to help with insomnia as it belongs to the class of melatonin receptor agonists to manage insomnia. However, by starting with rivastigmine the aim is to treat the neurocognitive disorder with the expectation of decrease in the disorder in weeks after the patient starts using the medication. The return visit of Mr. Wingate after 4-weeks was encouraging as he was able to explain that there was little to no side effect of the medication and he is experiencing improvement in his ability to remember simple things such as where he left his keys. Obviously there is no treatment for dementia at the moment however, managing the various symptoms associated with this illness is a step in the right direction. (Buckley & Salpeter, 2015). However, the client still complains of nightmares.

Decision Three

The next step would be to prescribe Clonazepam 0.5 mg by mouth per day because it helps with the rest eye movement (REM) which is a sleep behavior disorder common in dementia with Lewy Bodies. (Hugo & Ganguli, 2014) as this will help with the nightmare problem the client is facing every night while sleeping. The inclusion of therapy to manage the patient behavior would also be a good addition to the treatment of the patient’s mental illness, thus counselling is highly recommended. In comparison to decision two, the use of Clonazepam is able to help with the nightmare issues that the patient is having.

Conclusion

The diagnosis of mental illness such as the type Mr. Wingate has Mental Neurocognitive Disorder with Lewy Bodies (MNDLB) can be very challenging because of the various similarities with other forms of dementia and Parkinson illness. It is also important to point out that families and guardians of patient with (MNDLB) will have to be committed to caring and monitoring the patient as this will help to achieve positive patient outcome. Early diagnosis will help to manage the illness and prevent progressive impairment of cognitive function of the memory because the idea of managing most mental illness is to slow down the progression of this mental illness.

Assignment 2: Week 8 Practicum: Decision Tree

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Buckley, J., & Salpeter, S. (2015). A Risk-Benefit Assessment of Dementia Medications: Systematic Review of the Evidence. Drugs & Aging, 32(6), 453-467. doi:10.1007/s40266- 015-0266-9

Hugo, J., & Ganguli, M. (2014). Dementia and cognitive impairment: Epidemiology, diagnosis, and treatment. Clinics in Geriatric Medicine, 30(3), 421–442. http://doi.org/10.1016/j.cger.2014.04.001

Laureate Education (Producer). (2017a). A gentleman with a neurocognitive disorder

Multimedia file]. Baltimore, MD: Author.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Walker, Z., Possin, K. L., Boeve, B. F., & Aarsland, D. (2015). Lewy body dementias. The

Lancet, 386(10004), 1683-1697.