Assignment: Case Study Neurocognitive Disorders

Differential Diagnosis
The differential diagnosis that aligns with Mr. Charles’s symptoms is major neurocognitive disorder with Lewy bodies. This diagnosis was reached due to a number of reasons. According to DSMV, patients are diagnosed with this condition if there is a reduction of multiple cognitive performances in the patient. It includes the patient requiring assistance in complex attention as well as function. The patient also requires assistance in undertaking activities of the daily living such as paying bills and taking medications. The cognitive impairment that the patient has cannot be attributed to other causes such as delirium. Therefore, a positive diagnosis of a major neurocognitive disorder with Lewy bodies can be made. The patient cannot however be diagnosed with neurocognitive disorder caused by Alzheimer’s disease because of the lack of its family history. Alzheimer’s disease is significantly associated with genetic predisposition. A genetic testing would also be required to confirm this diagnosis. The patient also has episodes of memory improvement, which is not the case with Alzheimer’s disease. The patient cannot also be diagnosed with frontotemporal neurocognitive disorder because of the insufficiency in mild apathy that the patient has. There is also the lack of symptoms that include loss of empathy, inhibition, decline in personal grooming, compulsive behaviors, and repetitive behaviors such clapping (Schatzberg & Nemeroff, 2017).

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I was hoping to achieve a number of outcomes by coming up with the above differential diagnosis for this patient. I was hoping to come up with a clear differentiation of the diagnosis with the other closely related neurocognitive disorders. I was also hoping to use the definitive differential diagnosis to come up with the appropriate treatment plans for the patient. Lastly, I was hoping to identify the differences in symptoms of neurocognitive disorders due to Alzheimer’s disease, fronto-temporal neurocognitive disorder and neurocognitive disorder with Lewy bodies.
There were minimal differences in the outcomes of the decision that was made. It became evident that neurocognitive disorder with Lewy bodies does not have a genetic predisposition as seen in Alzheimer’s disease. It also became evident that substantial behavioral problems such as loss of empathy, repetitive and compulsive behaviors differentiate neocognitive disorder with Lewy bodies from frontotemporal neurocognitive disorder.
Psychotherapeutic Treatment Plan
The psychotherapeutic treatment plan that was selected for the patient in this case study is Ramelteon 8 mg to be taken at bedtime. This decision was reached due to the ability of the drug to manage sleep problem that the patient has. The use of this medication in adults is associated with minimal adverse effects. The toxicity and side effects of the drugs are also minimal. This implies that the drug can be used in the patient with minimal risk of misuse. The patient in the case study is old (Tousi, 2017). Caution should be taken when determining the most effective drug for use. As a result, the other drug alternatives such as Olanzapine and Rivastigmine have more side effects when compared to Ramelteon. Studies have shown that the use of Rivastigmine is associated with side effects such as dizziness, stomach upsets, and gaining of weight, which might worsen the patient’s health outcomes. For example, an occurrence of dizziness due to the use of this drug will increase the risk of injuries to the patient (Rajkumar & Aarsland, 2020). Similar side effects are seen with Olanzapine where the risks of dizziness and alterations in personality are enhanced in patients using it.
Anticipated Outcomes
The decision to use Ramelteon was adopted with the aim of managing sleep disturbance symptoms that the patient had. It was expected that the quality of sleep would improve significantly.
Outcomes against Anticipated Results
The client came back to the clinic after using Ramelteon for a month. Charles’s son reported that Charles takes medications as prescribed. However, there has been prolongation of duration of his sleep alongside experiencing falls in the night while going to the bathroom. Charles complained of headers and fatigue with minimal changes in his horrible dreams. These complaints were expected due to the side effects of the drug. There is also the increased possibility that the client experienced them due to low dosage of the drug.
Psychopharmacologic Treatment Plan
The selected decision is the initiation of Clonazepam 0.25 mg orally during bedtime. The decision to prescribe this drug was based on the earlier complaints that the client raised. They included dizziness, sedation, and fatigue, which can be managed better with the addition of clonazepam. The need for this drug is also attributed to the lack of efficacy of Ramelteon. Instead of improving the outcomes, it predisposed the patient to harm as seen from incidents of falls. The side effects of clonazepam are minimal when compared to the other options of using Melatonin and Ambiem. Melatonin will bring similar outcomes as Ramelteon since it has similar mechanism of action. The efficacy of Ambien on sleep disorders is also yet to be documented (Hershey & Coleman-Jackson, 2019). Therefore, clonazepam is the best drug of choice for the patient’s sleep problems when used in low dosages. The patient returned to the clinic a month later with reports of improved sleep quality, minimized incidences of falls, and horrible dreams. These outcomes were expected since the therapeutic level of the drug is yet to be achieved. Therefore, the current dosage should be maintained.
Ethical Considerations
A number of ethical considerations should be considered in providing care to the patient in this case study. One of them is safety of the selected treatment. The adopted decision of care should be associated with minimal harm to the patient. It should optimize the management of symptoms and improve the quality of life of the patient. There is also the need to ensure that integrity of the patient information be maintained. The data should be kept private and confidential. It should only be used for making treatment decisions. Access of the data by unauthorized persons should be limited (Stephany, 2020). Therefore, consent should be sought from the patient prior to sharing his information with other parties.
References
Hershey, L. A., & Coleman-Jackson, R. (2019). Pharmacological management of dementia with Lewy bodies. Drugs & aging, 36(4), 309-319.
Rajkumar, A. P., & Aarsland, D. (2020). Dementia with Lewy bodies. New Oxford Textbook of Psychiatry, 424.
Schatzberg, A. F., & Nemeroff, C. B. (Eds.). (2017). The American psychiatric association publishing textbook of psychopharmacology. American Psychiatric Pub.
Stephany, K. (2020). The Ethic of Care: A Moral Compass for Canadian Nursing Practice (Revised Edition). Bentham Science Publishers.
Tousi, B. (2017). Diagnosis and management of cognitive and behavioral changes in dementia with Lewy bodies. Current Treatment Options in Neurology, 19(11), 42.

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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 clientâ€™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.