Posted: May 11th, 2022

NRNP 6665: PMHNP Care Across the Lifespan I

Week 7: Neurocognitive Disorders
My mother used to be a teacher—an elementary school teacher. We were all so proud of her when she completed her PhD when she was 50. Now she is 75 and has begun to have times when she does not know what day it is. We found her wandering around the neighborhood because she could not find her way home. Once, she forgot where she parked her car at the grocery store. She thought someone had stolen it. The manager was so kind to drive her around the parking lot until she recognized her car. We are afraid she might get hurt or lost.

—Gary, age 50, son of Dorothy, age 75

Neurocognitive disorders are unique among the other psychiatric disorders you have studied in that they “are syndromes for which the underlying pathology, and frequently the etiology as well, can potentially be determined” (DSM-5, 2013). That is, diseases or injuries are to blame for the neurocognitive manifestations. These conditions are acquired and (in contrast to neurodevelopmental disorders) represent a decline from a previous higher level of functioning. Neurocognitive disorders present a diagnostic challenge for the PMHNP in that many of the signs and symptoms overlap. Neurocognitive issues are special among the other mental problems you have concentrated around there “are conditions for which the hidden pathology, and oftentimes the etiology too, can conceivably be resolved” (DSM-5, 2013). That is, illnesses or wounds are to be faulted for the neurocognitive signs. These conditions are procured and (as opposed to neurodevelopmental messes) address a decrease from a past more elevated level of working. Neurocognitive problems present a demonstrative test for the PMHNP in that a large number of the signs and indications cover.

This week, you will investigate proof based psychotherapy and psychopharmacologic treatment for neurocognitive issues.
This week, you will explore evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders.

Learning Resources
Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Medication Review
Review the FDA-approved use of the following medicines related to treating neurocognitive disorders.

Alzheimer’s disease Delirium Parkinson’s disease dementia/psychosis
caprylidene
donepezil
galantamine
memantine
rivastigmine There are no FDA-approved medications for the treatment of delirium. nuplazid
rivastigmine
pimavanserin

Assignment: Diagnosing, and Treating Patients With Neurocognitive Disorders

Photo Credit: Getty Images/iStockphoto

Neurocognitive disorders (NCDs) such as delirium, dementia, and amnestic disorders are more prevalent in older adults. As the population ages and as life expectancy in the United States continues to increase, the incidence of these disorders will continue to increase. Cognitive functioning in such areas as memory, language, orientation, judgment, and problem solving are affected in clients with NCDs. Caring for someone with a neurocognitive disorder is not only challenging for the clinician; it is stressful for the family as well. The PMHNP needs to consider not only the patient but also the “family as patient.” Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also becomes extremely important.

There is no Assignment due this week. You should review this week’s Learning Resources and consider the insights they provide about assessing, diagnosing, and treating neurocognitive disorders. Use this quiet week to work on your practicum assignment if you are taking both courses concurrently.

Week 8: Neurodevelopmental Disorders
I can’t believe I am sitting here talking to this lady. Mom thinks I am nuts just because I will not do what she asks. She doesn’t care about me. She only cares about my little brother and that man that keeps coming around. I don’t care about her. That is why I throw things and won’t do what she asks. I don’t care about anyone. Those kids at school who used to be my friends don’t know anything. I am so much smarter than they are.
—Jacob, age 11

There are many mental disorders that occur early in the life course. The DSM-5 describes neurodevelopmental disorders such as intellectual disability and delay, autism spectrum disorder, language and speech disorders, ADHD and specific learning disorder (e.g., dyslexia, difficulty mastering mathematical reasoning). Diagnosis of these various conditions can rarely be made in a single office visit and often requires a comprehensive approach involving multiple stakeholders, including the child, his or her parents, teachers, other significant figures in the child’s life, and medical and mental health professionals, such as psychologists who can conduct comprehensive neuropsychological testing.
The PMHNP must coordinate and integrate several sources of information to arrive at an accurate diagnosis of these disorders. Early and accurate diagnosis is essential to developing an effective treatment plan, which will have the potential to minimize the impact of these disorders on the child’s developmental trajectory. When one considers appropriate diagnosis from this perspective, the importance of diagnostic accuracy becomes quite apparent.

This week, you begin exploring disorders that occur early in the life course and use this knowledge to create a study guide for a neurodevelopmental disorder.

Learning Objectives
Students will:

Analyze signs and symptoms of neurodevelopmental disorders
Analyze the pathophysiology of neurodevelopmental disorders
Analyze diagnosis and treatment methods for neurodevelopmental disorders
Summarize legal, ethical, and patient education factors related to neurodevelopmental disorders
Learning Resources
Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Medication Review
Irritability in autism Attention-deficit/hyperactivity disorder
aripiprazole
risperidone
amphetamine IR, XR, and ER
dextroamphetamine
atomoxetine

clonidine hydrocholoride ER
Dexmethylphenidate IR and XR
guanfacine hydrocholride ER
lisdexamfetamine
methylphenidate
methylphenidate hydrocholoride IR and ER, transdermal

Assignment: Study Guide Forum
Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or nonpharmacological, while other disorders are chronic and need to be managed throughout the lifespan.

For this Assignment, you will develop a study guide for an assigned disorder and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.

Photo Credit: Getty Images/iStockphoto

To Prepare
Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5.
Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.
The Assignment
Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an Help write my thesis – APA paper. Your guide should be informed by the DSM-5 but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

Signs and symptoms according to the DSM-5
Differential diagnoses
Incidence
Development and course
Prognosis
Considerations related to culture, gender, age
Pharmacological treatments, including any side effects
Nonpharmacological treatments
Diagnostics and labs
Comorbidities
Legal and ethical considerations
Pertinent patient education considerations
By Day 7 of Week 8
Submit your Assignment to the forum as an attachment. Although no responses are required, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.

NRNP 6665: PMHNP Care Across the Lifespan I

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