Part 1

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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
  • Which Decision did you select?
  • 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 #1 and the results of the Decision. Why were they different?
• Decision #2: Treatment Plan for Psychotherapy
  • 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
  • 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.

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

My Decision: 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

My decision: 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.
• 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

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Refer to group-based cognitive behavior therapy

Begin Latuda 40 mg orally daily

Refer for dialectical behavior therapy

My decision: 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.

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.

Part 2

Narcissistic Personality Disorder

• Explain the diagnostic criteria for your assigned personality disorder.
• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.
• Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.
• Support your rationale with references to the Learning Resources or other academic resources.

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