A CASE PRESENTATION FOR NEUROCOGNITIVE DISORDERS

Elijah Leonardo BolusaJohn Donyell DalisayPeter Joshua Gomez

INTRODUCTION

• In reference to Abnormal Psychology (latest), NEUROCOGNITIVE DISORDERis one of the main categories for disorders itself.

• HISTORY OF DISORDER: –Organic disorders (Early DSM'S).–Cognitive disorders (DSM-IV TR).–Neurocognitive disorder (DSM-V).

• EPIDEMIOLOGY:–INCIDENCE:•Occurs more generally in Old age.•Occurs generally with a mental illness.–SEX:•In general, females are likely older.•Females to have more medical comorbidity.

–PREVALENCE:•Varies by age and etiological sub types.•Estimates are generally available for old age.•Prevalance increases among 60 year olds.•1-2% at age 65 years,while•30% by age 85.

–AGE:•Generally in old age.•Generally to 60-85 years old.

• ETIOLOGY–BIOLOGICAL•Alzheimer's disease,Huntington,Parkinson's disease and others.•Vitamin B and B12 defficiency.

–GENETICS•Abnormal chormosome genes: 21, 19, 14, 12 and 1.•You have it in your genes.–PSYCHOSOCIAL FACTORS•Lifestyle,diet and stess influence.

NEUROCOGNITIVE DISORDERSCLASSIFICATIONS OF DSM-5

1.) DELIRIUM

Specify conditions in the following fields:A.) Substance Intoxication/Withdrawal or Medication Induced. B.) Duration of the presence of symptoms.C.) Psychomotor activity.

2.) OTHER SPECIFIED DELIRIUM Does not meet the full criteria for delirium and other NCDs; reason for not meeting the criteria is mentioned in diagnosis.

3.) UNSPECIFIED DELIRIUM Reason for not meeting the criteria is

not mentioned in the diagnosis.

4.) MAJOR AND MILD NEUROCOGNITVE DISORDER

A. MAJOR NEUROCOGNITVE DISORDER -Significant cognitive deficits interfere with i

ndependence.Specify:

- With or without behavioral disturbance

- Severity (mild, moderate, severe).

B. MILD NEUROCOGNITVE DISOREDER - Modest cognitive deficits do not interfere

with independence. Specify: - With or without behavioral

distrubance.

5.) MAJOR OR MILD FRONTOTEMPORAL NEUROCOGNITVE DISORDER

- Insidious onset and gradual progression of the disturbance.

- Behavioral Variant or Language Variant.- Probable or Possible Frontotemporal Neurocognitive

Disorder.

6.)MAJOR OR MILD VASCULAR NEUROCOGNITIVE DISORDER

- Clinical features are consistent with a vascular etiology.

- Sufficient evidence in medical history leading to

NCD.

7.) SUBSTANCE/MEDICATION INDUCED MAJOR OR MILD NEUROCOGNITIVE DISORDER

–NCD persists beyond usual duration of intoxication.

–substance and duration of use is capable of producing NCD.–NCD is consistent with timing of substance use.

MAJOR OR MILD NEUROCOGNITVE DISORDER DUE TO:

8.) ALZHEIMER'S DISEASE - evidence of a causative Alzheimer’s disease gene - no evidence of mixed etiology .

- Major or mild NCD criteria are met.- Insidious onset and gradual progression.

9.)TRAUMATIC BRAIN INJURY - evidence of traumatic brain injury- NCD is present immediately after traumatic

event

10.) HIV INFECTION- Documented infection of HIV - Not better explained by non-HIV conditions.

11.) PRION DISEASE- Motor features (myoclonus, ataxia or biomarker evidences).

12.) PARKINSON'S DISEASE - Parkinson’s disease precedes onset of NCD.

13.) LEWY BODIES- NCD development subsequent to spontaneous features of Parkinsonism.

14.) HUNTINGTON'S DISEASE - Clinically established genetic risk of the disease.

15.) OTHER MEDICAL CONDITION - historical laboratory evidence that NCD

is consequence of other medical condition

16.) MULTIPLE ETIOLOGIES- Evidence that NCD is consequence of more

than one etiological process - Excluding stubstances.

17.) UNSPECIFIED NEURO COGNITIVE DISORDER

- Characteristics of NCD cause clinically significant

distress but do not meet the full criteria

of any cognitive disorder.

CLINICAL CASE FORMULATION

•PROFILE OF THE CLIENT

NAME: Mr. C.AGE: 55 yrs. old.PLACE OF BIRTH: Tarlac City, Tarlac.CURRENT ADDRESS: Romualdez St., Manila.REFERRED TO CLINICIAN BY: Mrs. C (wife).DATE REFERED TO CLINICIAN: July 14, 2015.

• MENTAL STATUS EXAMINATIONAPPERANCE: Semi-ungroomed, with facial hair, Bald.BEHAVIOR: Disorganize, Restless, and Confused.EMOTION: Irritated, Melancholic, aggressive at times.THOUGHT PRPOCESS: Forget what is going on, unfocus

ed.

THOUGHT CONTENT: Memory recall difficulty, Grammatical Error

COGNITION AND INTELLECTUAL RESOURCES: Difficulty in concentration

• CLINICAL CASE HISTORY - Mr. C is an outstanding librarian; Perfectionist. - Increased difficulty in thought expression. - Developed difficulty in concentration and neglected grooming. - Given an early retirement because of impairment - Feels that he lost at his own home. - Got lost at his own neighborhood.

• ASSESMENT–WAIS-RFull Scale IQ 80; BorderlinePoor Results of performance testSeverely disabled memory recall Visual Analysis Significant grammatical error

• ASSESMENT–PROJECTIVE TESTS.Possible OrganicityForgets about the instructionsCan give him a state of emotional disturbancePossible poor psychological controlPossible brain damage

•DIAGNOSISUNSPECIFIED NEUROCOGNITIVE DISORDE

RSignificant cognitive declineCognitive deficits in everyday activitiesDeficits doesn’t fit the context of deliriumDeficits aren’t caused by other mental disorders

• DIAGNOSIS–Unspecified because it does not fall on any category of other NCD’s

–Further testing must be done to identify the cause (e.g. Lewy body, HIV, etc.)

•TREATMENT PLAN

Identify the cause of the disorder (e.g. Biological or Psychosocial Factor)Prescription of specific medicine to tacklethe cause of the disorder Adjunctive Therapy(Regulation of neurotransmitters)Cognitive Behavioral Therapy ( Management of Impaired Functions)

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

David H. Barlow and V. Mark Durand (2015), Abnormal Psychology, An Integrative Approach, Seventh Edition.University Of South Florida-St.Petersburg.