Please read the instructions:
Peer 1
Eve
Summarize the clinical case, including the significant subjective and objective data.
Ms. Richardson’s complex situation suggests cognitive and mental disability. Ms. Richardson subjectively struggles with time, place, and current occurrences. Her inability to recollect the month or characterize her current situation, combined with her history of illness and weakness, suggests mental illness. Her denial of her predicament, attributing her symptoms to physical disease, and rejecting neighbors’ concerns may indicate anosognosia, a typical hallmark of neurocognitive disorders (Emmady et al., 2020).
Ms Richardson’s uncleanliness, bad smell, and filthy living conditions, as noted by police and healthcare experts, demonstrate her environmental and personal hygiene negligence. Cognitive problems are highlighted by her poor facial expression and psychiatric interview response. Her responses to medication questions and mistaking an actual firearm for a toy from her deceased brother suggest perceptual disturbances and possible psychotic symptoms, aligning with DSM-5 criteria for delirium or major neurocognitive Disorder (Echeverría et al., 2022).
Generate a primary and two differential diagnoses. Use the DSM5 to support the assessment. Include the DSM5 and ICD 10 codes.
The main diagnosis
Alzheimer’s Disease-related Major Neurocognitive Disorder (DSM-5: 331.0, ICD-10: F00)
Major Neurocognitive Disorder entails severe cognitive deterioration in one or more cognitive domains, such as memory, and impairs daily independence. Her presentation meets DSM-5 criteria. Ms. Richardson has significant cognitive impairment, including memory deficits (inability to recall recent events and forgetting medication names), disorientation (not knowing the day of the month or hospital location), and functional decline. These signs suggest Alzheimer’s Disease, a common neurocognitive condition in elderly persons.
Differential Diagnoses
Delirium (DSM-5: 293.0, ICD-10: F05): Her uncontrolled diabetes may have exacerbated her underlying medical problem. Metabolic abnormalities or infections can cause acute confusion, disorientation, and altered awareness in delirium. Given her admittance to diabetes treatment, Ms. Richardson’s weakness, confusion, and perceptual problems may indicate delirium due to her poorly managed diabetes.
Psychotic Disorder due to Another Medical Condition (DSM-5: 293.81, ICD-10: F06.2): Ms. Richardson’s history of psychiatric treatment for insomnia, perceptual disturbances (such as believing her dog was tranquilized and sent for repair), and confusion about past psychiatric medications (mentioning “Haldol” incorrectly) may indicate psychotic symptoms. Due to her age and medical history, an underlying medical cause, such as uncontrolled diabetes, should be investigated to distinguish a primary psychotic condition from a later presentation.
Discuss a pharmacological treatment you would prescribe. Use the clinical guidelines to support the rationale for this treatment.
Ms. Richardson’s symptoms suggest psychosis, disorientation, and perceptual problems; therefore, low-dose haloperidol may be examined. Haloperidol can treat psychosis (Rahman & Marwaha, 2020). Antipsychotics could help Ms Richardson’s disordered thinking, disorientation, and perceptual abnormalities, such as believing her dog was tranquilized and sent for repair. Clinical guidelines advise older adults to use antipsychotics cautiously due to increased sensitivity and side effects; thus, haloperidol should be started at a low dose and monitored for side effects, especially extrapyramidal symptoms and drowsiness (Rahman & Marwaha, 2020). This treatment would reduce Ms Richardson’s psychotic symptoms and enhance her mental health, allowing for a more accurate cognitive and functional assessment. However, her medical complexity and age require careful examination and continuing monitoring to guarantee pharmaceutical safety and efficacy.
Discuss the non-pharmacological treatment you would prescribe. Use the clinical guidelines to support the rationale for this treatment.
Cognitively challenged adults like Ms. Richardson need non-pharmacological treatments. Her Major Neurocognitive Disorder from Alzheimer’s requires non-pharmacological therapies. Clinical criteria show that psychosocial and environmental interventions increase dementia patients’ quality of life and diminish behavioral symptoms (Emmady et al., 2020). Thus, a complete care plan for Ms Richardson should include environmental adjustments for safety and comfort, daily routines for familiarity and agitation reduction, and carer education and support for social engagement and well-being. Sensory stimulation, memory, and music therapy may benefit cognitive and emotional dementia sufferers (Begali, 2020). These non-pharmacological treatments aim to improve Ms Richardson’s mental and social relationships and distressing symptoms. Evidence-based psychosocial therapy tailored to Ms. Richardson’s cognitive impairment and behavioral symptoms can enhance her well-being and functional independence.
Describe a health promotion intervention that would be appropriate for this patient.
Ms. Richardson’s lecture shows that Alzheimer’s Disease produces Major Neurocognitive Disorder, making career support and education essential health promotion tools. Alzheimer’s disease, its course and symptoms, and behavior management can be taught to caregivers. Guardians must learn how to maintain their houses safely and effectively. Begali (2020) recommends cleanliness, food, and managing behavioral indicators like agitation and roaming. Respite care can minimize Ms. Richardson’s carer burden and fatigue; for her health and cognition, Ms. Richardson must address her physical health difficulties, especially her poorly managed diabetes. Effective diabetes management requires medication adherence, dietary adjustments, and regular blood glucose testing (Echeverría et al., 2022). To improve Ms. Richardson’s quality of life and postpone illness progression, doctors must establish a personalized treatment plan that includes cognitive and physical health therapies. Support networks and community resources can improve health promotion activities. Local Alzheimer’s support groups or elder care organizations may help Ms Richardson and her carers. Carer education, diabetes management, and community assistance can improve Ms. Richardson’s health and independence.
Peers 2
Jessica
Summary of the clinical case
Module 6 case is about an older woman (74-year-old) named Ms. Richardson. Ms. Richardson was brought to the hospital by police, accusing her of having mental challenges. She appeared unkempt and foul-smelling. During the interview, she failed to look at the interviewer, seemed confused, and did not respond to most of the interviewer’s questions. However, she knows her name and address well but does not know the month’s date. Her neighbors called the police, reporting Ms. Richardson was unwell. She was reported as wandering around and not caring for herself. The medical officers had been sent twice to look for her but could not find her. Finally, the police broke into her house and found her with a dog. They used a tranquilizing gun to contain the dog and get Ms. Richardson, who was hiding in a corner naked. Her apartment was dirty, with her dog’s feces everywhere. The house had a gun, which the police took into custody for her safety.
The following morning, before she was transferred to a medical facility, the interviewer tried to ask her some questions. She remembered that her neighbor called the police since she was not feeling well, which was true, and the police shot her dog. She remembered that her dog had been taken to a shop and expected it when she was at home. She also respects her neighbor’s privacy and refuses to state his name, saying he had his own troubles.
She repudiated visiting any psychiatric hospital or hearing voices but accepted that she was assigned a psychiatric near her home. The psychiatrist recommended some medication that was too strong, and she did not take them for long. She could not remember the drug’s name, but when the interviewer asked if it was Thorazine, she nodded. The interviewer was persuaded that the drug influenced her condition, but other observers tried to find something else that could have affected her condition. When asked about the gun, she denied it with irritation, arguing it was a toy gun. Ms. Richardson was still feeling weak and complained her back was aching.
In this case, the objective data include overall poor health, confusion, dementia, signs of neglect, memory loss, and attention. On the other hand, the subjective data could consist of mental illness, poor living status, mood, age, cognitive deficits, and denial of her real gun, stating it was a toy. The collection of both subjective and objective data would help psychiatrists develop a well-personalized treatment plan for Ms. Richardson.
Diagnosis
Ms. Richardson’s disturbance could be due to another medical condition or exposure to toxins. Therefore, according to DSM-5 292.0 and ICD-10 F05.0 codes, the primary diagnosis could be delirium due to another medical condition (ICD-10, n.d.) (Pedersen, 2021). Her acute confusion, disorientation, and altered consciousness could result from uncontrolled diabetes or other medical factors. The two differential diagnoses could be major neurocognitive disorder due to Alzheimer’s disease and Schizophrenia, residual type. According to DSM-5 code 331.0 and ICD-10 code F00, the age of a patient and cognitive deficit issues lead to dementia and memory loss (ICD-10, n.d.) (Pedersen, 2021). Ms. Richardson appeared to have a memory loss condition resulting from a major neurocognitive disorder due to Alzheimer’s disease. Besides, DSM-5 code 295.60 and ICD-10 code F20.5 describe a patient with vague medical references and a history of psychiatric treatment to have Schizophrenia, residual type.
Pharmacological treatment
The possibility of delirium in the patient will be due to other underlying medical conditions such as blood sugar. Therefore, medical officers should start by treating underlying medical conditions, like stabilizing the blood glucose levels for diabetic patients. This would help lower the effect of delirium on a patient’s mental condition. Besides, low doses of antipsychotic drugs like haloperidol or risperidone can be prescribed to treat Ms. Richardson’s agitation and psychotic symptoms (Prendergast et al., 2022).
Non-pharmacological treatment
Psychiatrists should recommend the establishment of a calm, structured environment with frequent re-orientation. Ms. Richardson should also maintain consistent sleep and wake cycles and move frequently to manage delirium (Williams et al., 2019). This will help calm down how psychotic behaviors.
Health promotion intervention
Ms. Richardson should be admitted to a long-term care facility. The case reveals that she appeared to be neglected. She is old and has no one to take care of her in her mental health status. Therefore, she should be admitted to a long-term care facility where she can get both physical and mental health treatment while being taken care of.
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