Neurocognitive disorders in psychiatry: a case example of diagnostic and treatment dilemmas.
We present a case example that illustrates the diagnostic and treatment difficulties engendered by adult psychiatric patients with primary behavioral problems and neurocognitive disorders. In the case cited, the neuropsychological evaluation plays a significant role in reconceptualizing a patient who had accrued multiple psychiatric diagnoses including schizophrenia, borderline personality, and impulse control disorder. Formal examination revealed deficits in language, executive, and attentional functions that were far greater than had been expected and led to a major change in treatment strategy, including successful trial of imipramine and nadolol and more structured milieu therapy. The cognitive deficit and intrapsychic conflict models are used to demonstrate the critical aspects of our diagnostic reclassification of the patient to Neurodevelopmental Disorder of Unknown Etiology and Auditory Attention Deficit Disorder.
Weinstein
C S
CS
Department of Psychiatry, Cambridge Hospital, Harvard Medical School, MA 02139.
Seidman
L J
LJ
Feldman
J J
JJ
Ratey
J J
JJ
D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D003937:Diagnosis, Differential; D006760:Hospitalization; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology; D008607:Intellectual Disability / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008019:Life Style; D008297:Male; D019965:Neurocognitive Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D009483:Neuropsychological Tests; D009769:Object Attachment; D010349:Patient Compliance / Q000523:psychology; D011613:Psychotherapy; D012559:Schizophrenia / Q000175:diagnosis* / Q000628:therapy; D012564:Schizophrenic Language; D012565:Schizophrenic Psychology; D012931:Social Environment