Discussion: Treatment of Neurocognitive Disorders

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Week 8: 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

The neurocognitive disorders are unique among the other psychiatric disorders you have studied in that the diseases that are to blame for the neurocognitive manifestations that have been extensively studied. Additionally, these conditions are also acquired and represent a decline from a previous level of functioning. The neurocognitive disorders present a diagnostic challenge to the PMHNP in that many of the signs and symptoms overlap.

This week, you will explore evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders. You will complete your final Decision Tree as you rationalize and justify your diagnosis and treatment of a patient with a mental health disorder.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

  • Chapter 21, “Neurocognitive Disorders” (pp. 694–741)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

  • Chapter 63, “Delirium”
  • Chapter 64, “Neurocognitive Disorder Due to Alzheimer’s Disease”
  • Chapter 65, “Frontotemporal Neurocognitive Disorder”
  • Chapter 66, “Vascular Neurocognitive Disorder”
  • Chapter 67, “Neurocognitive Disorder Due to Parkinson’s Disease”

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

  • “Neurocognitive Disorders”

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

 

Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/

 

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Alzheimer disease Delirium Dementia Parkinson’s disease dementia
caprylidene
donepezil
galantamine
memantine
rivastigmine		 haloperidol (adjunct)
lorazepam (adjunct)		 donepezil
galantamine
memantine
rivastigmine		 rivastigmine
pimavanserin

Note: For more information on Pimavanserin, see:

Acadia Pharmaceuticals. (2017). Transform the treatment of Parkinson’s disease psychosis with NUPLAZID. Retrieved from https://www.nuplazidhcp.com/?gclid=CIHS5auvwtMCFQkaaQodrU0FGQ

U.S. Food and Drug Administration. (n. d.). Highlights of prescribing information: Nuplazid. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/207318lbl.pdf

Hopkins, S. A., & Chan, D. (2016). Key emerging issues in frontotemporal dementia. Journal of Neurology, 263(2), 407–413. doi:10.1007/s00415-015-7880-7

Walker, Z., Possin, K. L., Boeve, B. F., & Aarsland, D. (2015). Lewy body dementias. The Lancet, 386(10004), 1683-1697.

Required Media

Laureate Education (Producer). (2017a). A gentleman with a neurocognitive disorder [Multimedia file]. Baltimore, MD: Author.

 

Bolin, P. (2015, December 31). Neurocognitive disorders – CRASH! Medical review series [Video file]. Retrieved from https://www.youtube.com/watch?v=bQXOPITY9XM

 

Note: The approximate length of this media piece is 57 minutes.

Optional Resources

Kota, L. N., Bharath, S., Purushottam, M., Moily, N. S., Sivakumar, P. T., Varghese, M., . . . Jain, S. (2015). Reduced telomere length in neurodegenerative disorders may suggest shared biology. The Journal of Neuropsychiatry and Clinical Neurosciences, 27(2), e92–e96. doi:10.1176/appi.neuropsych.13100240

Lepkowsky, C. M. (2016). Neurocognitive disorder with Lewy bodies: Evidence-based diagnosis and treatment. Practice Innovations, 1(4), 234–242. doi:10.1037/pri0000031

Oltra-Cucarella, J., Pérez-Elvira, R., Espert, R., & Sohn McCormick, A. (2016). Are cognitive interventions effective in Alzheimer’s disease? A controlled meta-analysis of the effects of bias. Neuropsychology, 30(5), 631–652. doi:10.1037/neu0000283

Discussion: Treatment of Neurocognitive Disorders

Neurocognitive disorders (NCD) 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 such 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, but also stressful for the family. The PMHNP needs to consider not only the client but also the “family as client.” Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also becomes extremely important.

In this Discussion, you will integrate several sources of knowledge specific to NCDs as you discuss evidenced-based therapies used to treat these disorders.

Learning Objectives

Students will:
  • Analyze diagnostic criteria for neurocognitive disorders
  • Analyze evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders
  • Evaluate benefits and risks of neurocognitive therapies
  • Compare differential diagnostic features of neurocognitive disorders

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • By Day 5 of Week 7, your Instructor will have assigned you a neurocognitive disorder, which will be the focus for your initial post for this Discussion.
  • Review the Learning Resources.

By Day 3

Post:

  • Explain the diagnostic criteria for your assigned neurocognitive disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder.
  • Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
  • Support your rationale with references to the Learning Resources or other academic resource.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 8 Discussion

Assignment: 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. While you may use the course text to support your rationale, it will not count toward the resource requirement.

By Day 7 of Week 10

Submit your Assignment.

Making Connections

This week, you explored evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders. You completed your final Decision Tree as you rationalized and justified your diagnosis and treatment of a patient with a mental health disorder.

Next week, you will explore a wide variety of disorders along the schizophrenia spectrum as you become “captain of the ship” once again. You also will analyze issues involved with state practice agreements.

To go to the next week:

Week 9