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.
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.
· Explain the diagnostic criteria for your assigned neurocognitive disorder (Lewy Body
· Compare differential diagnostic features of neurocognitive disorders (Lewy Body Dementia)
· Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder. (Lewy Body Dementia)
· Evaluate benefits and risks of neurocognitive therapies
· 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 (REFERENCES MUST BE LESS THAN 5 YEARS OLD)
PLEASE YOU MUST INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES
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.
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. (2017). Lewy body dementias. Focus, 15(1), 85–100. doi: 10.1176/appi.focus.15105
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
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