Evaluate clients for treatment of mental health disorders

Evaluate clients for treatment of mental health disorders

Evaluate clients for treatment of mental health disorders 150 150 Nyagu

Nurs 6670 decision tree – antisocial personality disorder essay
Nurs 6670 decision tree – antisocial personality disorder essay

Decision Tree

Introduction

Personality disorders refer to the extreme personality traits that interfere with an individual’s daily life and functioning. Personality disorders are characterized by unhealthy and persistent long-term patterns of thoughts, feelings and behavior. The behaviors can lead to serious problems in work and relationships (Sadock et al., 2014). This case study presents a client with a personality disorder Nurs 6670 decision tree – antisocial personality disorder essay. Accordingly, three decisions will be made about the diagnosis of the client’s personality disorder as the treatment choices for the client. The paper will conclude by discussing ethical issues likely to impact the treatment of this client.

Decision Point One

The diagnosis for this client is antisocial personality disorder. According to the DSM-5 diagnostic criteria, antisocial personality disorder is characterized by…

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Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

Case #1
A woman with personality disorder
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 Nurs 6670 decision tree – antisocial personality disorder essay. 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.” Nurs 6670 decision tree – antisocial personality disorder essay.

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. 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 Nurs 6670 decision tree – antisocial personality disorder essay.

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. Nurs 6670 decision tree – antisocial personality disorder essay.

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.
Borderline Personality Disorder
Histrionic Personality Disorder
Antisocial Personality Disorder
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/index.html

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? I CHOSE ANTI-SOCIAL PERSONALITY DISORDER

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 Nurs 6670 decision tree – antisocial personality disorder essay.
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
I CHOSE REFER TO PSYCHOLOGIST FOR PSYCHOLIGICAL TESTING

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
REFER TO GROUP-BASED COGNITIVE BEHAVIOR THERAPY

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 Nurs 6670 decision tree – antisocial personality disorder essay.

Decision Tree

Introduction

Personality disorders refer to the extreme personality traits that interfere with an individual’s daily life and functioning. Personality disorders are characterized by unhealthy and persistent long-term patterns of thoughts, feelings and behavior Nurs 6670 decision tree – antisocial personality disorder essay. The behaviors can lead to serious problems in work and relationships (Sadock et al., 2014). This case study presents a client with a personality disorder. Accordingly, three decisions will be made about the diagnosis of the client’s personality disorder as the treatment choices for the client. The paper will conclude by discussing ethical issues likely to impact the treatment of this client.

Decision Point One

The diagnosis for this client is antisocial personality disorder. According to the DSM-5 diagnostic criteria, antisocial personality disorder is characterized by patterns of manipulation, exploitation and violating the rights of other people without any remorse or guilt. The behavior may lead to problems in work and relationships. In addition, people with this type of personality disorder tend to violate the law and may be involved in criminal activities. The key characteristics of antisocial personality disorder include disregard for wrong and right; poor/abusive relationships; persistent deceit to exploit other people; callousness and cynicism; arrogance; impulsivity; persistent problems with the law; lack of empathy or remorse; engaging in risky and impulsive behaviors; irritability; violence; and consistent irresponsibility (American Psychiatric Association, 2013).

The client in this case study manifested symptoms such as relationship problems; lack of friends and blaming others for her problems; taking unnecessary impulsive risks such as when she bought a car that was later repossessed; lack of remorse; reported that she was always in trouble even in childhood, inability to maintain employment; stealing and failure to admit her mistakes; problem with the law as indicated by incarceration, as well as violence as indicated by beating up a girl Nurs 6670 decision tree – antisocial personality disorder essay. These symptoms fit the diagnostic criteria for antisocial personality disorder justifying the selected decision (American Psychiatric Association, 2013).

With this decision, it is expected that the right diagnosis will facilitate the appropriate treatment for this client.

Decision Point Two

The second decision is to refer the client for psychological testing. The rationale for this decision is to ensure that the client will undergo psychological tests that will help in confirming or ruling out the diagnosis of antisocial personality disorder. According to Dixon-Gordon K et al., (2015) psychologists use a variety of assessment tools and specially designed interviews to assess individuals with personality disorders. The psychologist basis the diagnosis on the findings from the assessment tools and also the client’s descriptions of the symptoms and the observation of the behavior and attitude of the client.

The expected outcome of this decision is that the diagnosis for the client will be confirmed using psychological testing. This is because in psychological tests various tools are used to assess different types of personality disorders using objective and subjective data Nurs 6670 decision tree – antisocial personality disorder essay.

Just like it was expected, when the client returned after four weeks, the comprehensive psychological battery test performed for this client indicated that the client manifested traits of various personality disorders but the highest score was of antisocial personality traits, indicating that the diagnosis for this client was antisocial personality disorder. A psychological assessment explores thoughts, feelings, behavior, relationships, as well as family history (Dixon-Gordon K et al., 2015).

There was no difference between the expected results and the actual outcome because the psychological testing confirmed the diagnosis of antisocial personality disorder for this client. Psychological tests are useful in assessing various mental traits and abilities that include personality and neurological functioning (Dixon-Gordon K et al., 2015). Therefore, just like it was expected the psychological testing assessed the client’s mental traits and personality and therefore confirmed the diagnosis of antisocial personality disorder.

Decision Point Three

The third decision that was selected is for the client to undergo group-based cognitive behavior therapy (G-CBT). The rationale for selecting this decision is that CBT is well-suited in addressing antisocial personality disorder because according to CBT, personality disorders such as antisocial personality disorder are maintained by maladaptive beliefs regarding self and other people, environmental/contextual factors reinforcing the problematic behavior, as well as the skill deficits that impede positive and adaptive responding (Nazar & Ramganes, 2017). CBT integrates various techniques to modify these factors through cognitive restructuring, modifying the behavior, psychoeducation, in addition to skills training (Stahl, 2014). Additionally, CBT in people with personality disorders highlights the significance of a supportive and collaborative therapeutic relationship because this improves the willingness of the client to make the necessary changes. Moreover, the client will participate in group-CBT and this will give the client a chance to discuss her feelings and behaviors with people facing similar issues.

The expected outcome with this decision is that the group CBT will effectively restructure the cognitive functioning of the client and her intermediate beliefs, and hence change her behavior (Nazar & Ramganes, 2017). Therefore, after undergoing group CBT it is expected that the symptoms of antisocial personality disorder will significantly improve.

Ethical Considerations

Ethical treatment for this client will require vigilant risk-benefit analysis in collaborating with the numerous issues of the client likely to affect the treatment and outcome for the client. It will be essential for the PMHNP to establish a collaborative relationship and honor it, seek informed consent from the client and use evidence to make treatment decisions for this client. It will also be important for the PHMNP to carefully manage the boundary issues with this client. This is because clients with personality disorders tend to have boundary issues such as excessively calling their therapists, as well as making unreasonable demands in terms of availability and accessibility. Therefore, the PMHNP will need to carefully assess the genuine needs of the client and maintain boundaries in aspects key to competent and ethical treatment (Ekselius, 2018). Moreover, it will be important to respect the autonomy and decision-making ability of the client Nurs 6670 decision tree – antisocial personality disorder essay.

Conclusion

The first decision is that the diagnosis for this client is antisocial personality disorder. This is because the symptoms the client manifests are consistent with the DSM-5 criteria for antisocial personality disorder. The second decision was to refer the client for psychological testing in order to confirm the diagnosis for the client. The last decision was to have the client undergo a group cognitive behavior therapy. Ethical considerations for the client include maintaining boundaries, seeking informed consent from the client and respecting the autonomy and decision-making ability for the client Nurs 6670 decision tree – antisocial personality disorder essay.

References

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

Ekselius L. (2018). Personality disorder: a disease in disguise. Ups J Med Sci, 123(4), 194–204.

Dixon-Gordon K, Whalen D, Layden B & Chapman A. (2015). A Systematic Review of Personality Disorders and Health Outcomes. Can Psychol, 56(2), 168–190.

Nazar N & Ramganes E. (2017). Cognitive Behavior Treatment of Personality Disorders. International Journal of Humanities and Social Science Invention ISSN, 6(11), 2319 –7714.

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

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press Nurs 6670 decision tree – antisocial personality disorder essay