Personality disorder Decision Tree
Decision Tree
Introduction
Personality disorders are characterized by inflexible and unhealthy thinking patterns, as well as unhealthy functioning and behaviors. People with personality disorders experience problems when it comes to the perception and relating to people and situations. This leads to significant problems and challenges in social activities, relationships, academics, and even work (Ekselius, 2018) Personality disorder Decision Tree. People with personality disorders might not be aware of their personality disorders because their way of thinking and behavior seems normal to them. They may even put the blame other individuals for their issues and problem. Personality disorders normally start during adolescence or early adulthood. There are various types of personality disorders. The 32-year-old client, in this case, the study presented with symptoms of being manipulative, exploitative, lack of remorse, blaming other people for her mistakes, irresponsibility, stealing, and often breaking the law Personality disorder Decision Tree. These behaviors started manifesting during the client’s childhood. The purpose of this paper is to identify the differential diagnosis for the client, evaluate the available treatments and finally present decisions about the diagnosis and treatment for the client.
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Decision #1: Differential Diagnosis
The diagnosis for this client is an antisocial personality disorder. This decision was selected because the client manifests symptoms consistent with the symptoms outlined in DSM-5 diagnostic criteria for antisocial personality disorder. According to the DSM-5 diagnostic criteria, the characteristic symptoms of the antisocial personality disorder include disregarding and violating the law and rights of other people; manipulating and deceiving others; problems with maintaining interpersonal relationships; blaming other people for self-mistakes; irresponsible behaviors; and lack of remorse (Grenyer et al., 2018) Personality disorder Decision Tree. The client in the case study manifests symptoms such as disregarding the law; manipulative and exploitative behaviors; disregard for the law as indicated by imprisonment; blaming third-parties for her mistakes; delinquent behaviors such as stealing; lack of remorse; relationship behaviors; aggression; illegal possession of a gun; and recklessness as indicated by her inability to manage finances. Moreover, the behaviors started manifesting since childhood and hence confirming the diagnosis of antisocial personality disorder.
Selecting antisocial personality disorder as the diagnosis for this client hoped that the correct diagnosis for the client was made. Therefore, this facilitates the right treatment for this client. The correct diagnosis ensures that there is no misdiagnosis and thus an individual receives treatment for the ailment (Singh et al., 2017).
Since the client exhibits symptoms of antisocial personality disorder as per the DSM-5 diagnostic criteria, there is no difference between the achieved outcome and the expected outcome Personality disorder Decision Tree.
Decision #2: Treatment Plan for Psychotherapy
The second decision is to refer the client to a psychologist for psychological testing. The reason for referring the client for psychological testing is to have her undergo a comprehensive assessment. The psychological assessment should include the administration of psychological tests to the client to objectively, comprehensively and consistently assess her behavior (Bornstein, 2015). Therefore, the client will be administered with some clinical, behavioral and psychological assessment tools that will identify any cognitive problems, behavioral problems, or personality problems (Jadhakhan et al., 2019).
The expected outcome by referring the client for psychological testing is that the diagnosis (antisocial personality disorder) would be verified. Secondly, it is anticipated that the administration of psychological tests would identify other mental health conditions or comorbidities that could be contributing to the symptoms the client is manifesting (Jadhakhan et al., 2019) Personality disorder Decision Tree.
According to the findings from the comprehensive psychological battery test, the client exhibits symptoms of various personality disorders. However, the highest score was on the traits associated with antisocial personality disorder and this, therefore, is suggestive that the diagnosis for this client is an antisocial personality disorder. Therefore, there is no difference between the achieved outcome and the expected outcome. This is because as was expected, the psychological testing revealed that the client’s diagnosis was an antisocial personality disorder. Moreover, the psychological testing indicated a probability of other comorbidities for the client as demonstrated by the results showing that the client has symptoms of personality disorder Personality disorder Decision Tree. Evidence demonstrates that the majority of individuals with one personality disorder also manifest symptoms and signs of other personality disorders (Grenyer et al., 2018). This explains why the client manifests symptoms for multiple personality disorders, even though the score was highest for antisocial personality disorder.
Decision #3: Treatment Plan for Psychopharmacology
The third decision that was selected is to refer Rhoda to group-based cognitive behavior therapy. This decision was chosen because the group-based cognitive behavior therapy (G-CBT) has been demonstrated to be effective in improving symptoms and treating many personality disorders such as antisocial personality disorder. According to CBT, antisocial personality disorder results from the maladaptive beliefs as well as environmental factors that facilitate and promote the problematic behaviors associated with the disorder (Mancke et al, 2018). Additionally, the lack of the appropriate skills to adjust and respond suitably to situations is associated with the development of antisocial personality disorder. Therefore, the CBT utilizes different therapeutic techniques to change the negative thinking patterns and beliefs and thus eventually modify the behavior. Also, CBT equips people with the necessary skills to adapt, handle and respond suitably to situations (Mancke et al, 2018). More importantly, the CBT is a group-CBT and thus this will allow the client to interact with other members of the group (Mancke et al, 2018). This will improve the client’s social skills and thus improve her ability to maintain interpersonal relationships.
The selection of G-CBT for this client hoped that the behavioral deficits and symptoms the client is manifesting would greatly improve. The G-CBT will alter and modify the negative thinking pattern and maladaptive beliefs for this client. Additionally, a G-CBT will equip her with the essential social skills. G-CBT will lead to the client adopting a maladaptive thinking pattern and thus result in behavior change, and at the same time, the client will adopt the socially accepted behaviors (Mancke et al, 2018) Personality disorder Decision Tree.
Ethical Considerations
The first ethical consideration that the therapist should consider is informed consent. The PMHNP should obtain informed consent from the client before starting any assessment or treatment. The autonomy of the client should also be respected and therefore is she refuses any treatment, the PMHNP should accept the client’s decision. Thirdly, any information that the client reveals during the therapy including issues associated with breaking the law should be kept confidential and private (Warrender, 2017). Lastly, evidence shows that people with personality disorders may sometimes fail to respect the boundary issues and the therapeutic relationship. Therefore, the PMHNP should ensure that the client is educated about the expected boundaries during the treatment. Boundary issues common among people with personality disorders include irrational demands associated with the availability and accessibility of the therapist, irrationality, disrespect, and excessive phone calls to the therapist (Warrender, 2017). Therefore, it is the responsibility of the PMHNP to identify the honest needs of this client and maintain firm boundaries to ensure the provision of ethical and competent treatment. Personality disorder Decision Tree.
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Conclusion
The diagnosis for this client was identified as an antisocial personality disorder. This decision was selected since the client reported and manifested symptoms associated with antisocial personality disorder according to the DSM-5 diagnostic criteria. The second decision that was chosen was to refer the client to a psychologist form comprehensive psychological testing to confirm or rule out the diagnosis of antisocial personality disorder and any other associated comorbidity. The final decision was to refer Rhoda to a G-CBT due to the intervention’s efficacy in the treatment of personality disorders. In conclusion, the ethical considerations during the treatment for this client involve autonomy, informed consent, as well as boundary issues Personality disorder Decision Tree.
References
Bornstein R. (2015). Personality Assessment in the Diagnostic Manuals: On Mindfulness, Multiple Methods, and Test Score Discontinuities. J Pers Assess, 97(5), 446–455.
Ekselius L. (2018). Personality disorder: a disease in disguise. Upsala journal of medical sciences, 123(4), 194–204. https://doi.org/10.1080/03009734.2018.1526235.
Grenyer, B., Lewis, K. L., Fanaian, M., & Kotze, B. (2018). Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial. PloS one, 13(11), e0206472. https://doi.org/10.1371/journal.pone.0206472.
Jadhakhan, F., Lindner, O. C., Blakemore, A., & Guthrie, E. (2019). Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis. BMJ Open, 9(9), e028295. https://doi.org/10.1136/bmjopen-2018-028295.
Mancke F, Schmitt R, Winter D, Inga N, Sabine H & Scmahl C. (2018). Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder. J Psychiatry Neurosci, 43(3), 171–181.
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.
Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J. (2017). The global burden of diagnostic errors in primary care. BMJ quality & safety, 26(6), 484–494. https://doi.org/10.1136/bmjqs-2016-005401.
Warrender D. (2017). Borderline personality disorder and the ethics of risk management: The action/consequence model. Nursing Ethics, 25(7), 918-927. Personality disorder Decision Tree
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.
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
** Assigned in Week 3 and submitted in Week 4 Personality disorder Decision Tree
Examine Case 1: 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
o Which Decision did you select?
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o 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
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Personality disorder Decision Tree
o 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
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o 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 Personality disorder Decision Tree.
By Day 7
A woman with personality disorder Case #1 A woman with personality disorder SUBJECTIVE Rhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help. Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you. She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!” Rhonda explains that her current financial situation is also precarious. She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft. “It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.” Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.” OBJECTIVE Rhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant Personality disorder Decision Tree. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons. She was also arrested for cashing checks under an alias, for which she spent 120 days in jail. Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police. MENTAL STATUS EXAM Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation. Decision Point One BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO RHONDA? In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis. Decision Point One Borderline Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin dialectical behavior therapy Begin treatment with Abilify 5 mg orally daily Decision Point One Histrionic Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin Seroquel 25 mg orally at bedtime Refer to group therapy for personality-disordered individuals Decision Point One Antisocial Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin Haldol 5 mg orally daily Refer for psychodynamic psychotherapy Borderline Personality Disorder Histrionic Personality Disorder Antisocial Personality Disorder Personality disorder Decision Tree