Decision Tree – DIFFERENTIAL DIAGNOSIS, Psychotherapy & PSYCHOPHARMACOLOGY

Decision Tree – DIFFERENTIAL DIAGNOSIS, Psychotherapy & PSYCHOPHARMACOLOGY

Assignment 1-Decision Tree-WK3-D-WK4
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
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:

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• 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. Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.
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.
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? Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.
• 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.

NOTE
1. DIFFERENTIAL DIAGNOSIS- SELECT ANTISOCIAL PERSONLAITY DISORDER AND JUSTIFY FROM THE CASE #1 SCENARIO ATTACHED.
2. FOR • Decision #2: Treatment Plan for Psychotherapy – WRITE ON PSYCHOTHERAPY HERE AND NOT MEDICATION
ONE OF THEM IS \” group-based cognitive behavior therapy \” AND JUSTIFY THAT.
3. PSYCHOPHARMACOLOGY- WHAT MEDICATION IS APPROPRIATE FOR THE PATIENT AND ANSWER THE QUESTION AS APPLIED.

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. Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology 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. 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. Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.

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.

 Borderline Personality Disorder

 Histrionic Personality Disorder

 Antisocial Personality Disorder

Decision Point One

Antisocial Personality Disorder

Decision Point Two

Refer to psychologist for psychological testing

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• The psychologist’s report indicates that a comprehensive psychological battery was performed for the purposes of diagnostic clarification. The end result suggested that Rhonda has traits of multiple personality disorders, but scores highest in antisocial personality traits, suggesting antisocial personality disorder. Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.
• When Rhonda returns to the office, you review the psychologist’s report with her. Rhonda seems upset, but also states “well, that’s why I am here, to get better … what do I need to do?”

Decision Point Three

Refer to group-based cognitive behavior therapy

Guidance to Student

Referral to a psychologist was appropriate for the purposes of diagnostic clarification. Psychological tests can help tease out the actual personality disorder that Rhonda has. In this case, Rhonda’s symptoms are most consistent with antisocial personality disorder, but as you can see, she has signs/symptoms of other personality disorders.

Of the available choices, group-based cognitive behavior therapy may be useful in treating individuals with this personality disorder, but all “improvement” in signs/symptoms should be met with great skepticism. Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.

Dialectical behavior therapy is ineffective in people with APD.

Beginning Latuda is not appropriate, as there are currently no FDA-approved medications to treat APD. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Decision Point One

Borderline Personality Disorder

Decision Point Two

Refer to psychologist for psychological testing

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• The psychologist’s report indicates that a comprehensive psychological battery was performed for the purposes of diagnostic clarification. The end result suggested that Rhonda has traits of multiple personality disorder, but scores highest in antisocial personality traits, suggesting antisocial personality disorder (APD). Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.
• When Rhonda returns to the office, you review the psychologist’s report with her. Rhonda seems upset, but also states “well, that’s why I am here, to get better … what do I need to do?”

Decision Point Three

Begin Abilify 15 mg orally daily

Guidance to Student

DBT has not been demonstrated as an effective means of treating APD. There are currently no FDA-approved medications to treat APD either, and Abilify has been associated with an increase in impulse control issues (such as gambling). Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Of the available choices, group-based cognitive behavior therapy may be useful in treating individuals with this personality disorder, but all “improvement” in signs/symptoms should be met with great skepticism Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.

Decision Point One

Borderline Personality Disorder

Decision Point Two

Refer to psychologist for psychological testing

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• The psychologist’s report indicates that a comprehensive psychological battery was performed for the purposes of diagnostic clarification. The end result suggested that Rhonda has traits of multiple personality disorder, but scores highest in antisocial personality traits, suggesting antisocial personality disorder (APD).
• When Rhonda returns to the office, you review the psychologist’s report with her. Rhonda seems upset, but also states “well, that’s why I am here, to get better … what do I need to do Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology?”

Decision Point Three

Begin group-based cognitive behavioral therapy

Guidance to Student

DBT has not been demonstrated as an effective means of treating APD. There are currently no FDA-approved medications to treat APD either, and Abilify has been associated with an increase in impulse control issues (such as gambling) Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Of the available choices, group-based cognitive behavior therapy may be useful in treating individuals with this personality disorder, but all “improvement” in signs/symptoms should be met with great skepticism.

Week 3: Personality Disorders

I cannot believe these people. Don’t they know who I am? I deserve better treatment than this. That hostess should have seated me immediately, but I had to wait for 10 minutes and then she put me at this table right by the kitchen. I see an empty table right in the middle where I should be. I am just going to get up and move there. I don’t care what the hostess says, rules don’t apply to me.

Ashley, age 25

Personality disorders represent perhaps the most challenging disorders that the psychiatric mental health nurse practitioner will have to address in their professional careers. Personality disorders can co-occur in every mental health disorder and, in some cases, can mask as disorder . Although difficult to treat, the PMHNP must be able to identify personality disorders and endeavor to work with the client to not only recognize the disorder, but to treat a disorder that clients often do not believe they have.

This week, you will explore the many personality disorders and use the DSM-5 criteria for diagnosing individuals with specific personality disorders. You will use the Decision Tree format to diagnose and treat a client with a personality disorder. You also will complete the Fitzgerald University Exit Comprehensive Exam to determine your readiness for the certification exam. Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.

Photo Credit: kaisersosa67 / iStock / Getty Images Plus / Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 12 “Leadership” (pages 76-77)

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 4, “Theories of Personality and Psychopathology” (pp. 151–191)
• Chapter 22, “Personality Disorders” (pp. 742–762)
• Chapter 13, “Psychosomatic Medicine” (pp. 451–464)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications. Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.

• Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”
• Chapter 69, “Antisocial Personality Disorder”
• Chapter 70, “Borderline Personality Disorder”
• Chapter 71, “Histrionic Personality Disorder”
• Chapter 72, “Narcissistic Personality Disorder”
• Chapter 73, “Cluster C Personality Disorders

Note: You will access this book from Walden Library databases.

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

• “Personality Disorders”

Note: You will access this book from Walden Library databases.

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry: Interpersonal & Biological Processes, 76(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Note: You will access this article from Walden Library databases.

Rees, C. S., & Pritchard, R. (2015). Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52(1), 45–55. doi:10.1037/a0035158

Note: You will access this article from Walden Library databases.

Required Media

Laureate Education. (2017a). A woman with personality disorder [Interactive media file]. Baltimore, MD: Author.

Kernberg, O. (n.d.). Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg, MD. [Video file]. Mill Valley, CA: Psychotherapy.net

Note: This video is approximately 94 minutes of length. You will access this article from Walden Library databases Decision Tree – Differential Diagnosis, Psychotherapy & Psychopharmacology.