For this Assignment, as you examine the client case study, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.
Learning Objectives: Students will:
The Actual Assignment
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 clientâ€™s diagnosis and treatment.
At each Decision Point, stop to complete the following:
A woman with personality disorder
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: â€œIâ€™m at the end of my rope, I donâ€™t know what else to do.â€ She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have â€œabandonedâ€ 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 â€œwhen 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!â€
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. â€œIt was my friendâ€™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 â€¦ people just canâ€™t go back on their word like that when other people are counting on them.â€
Rhonda reports that she was â€œalways in troubleâ€ as a kid. She states that people were always picking on her, to which she adds: â€œthe other kids my age were just stupid. They didnâ€™t know how to have fun.â€ She says â€œI have always been impulsive, but itâ€™s fun. Sometimes people can be such prudes â€¦ you only go around life once, so you have to make the best of it.â€
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 â€œplantedâ€ 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 â€œset her upâ€ with the police.
MENTAL STATUS EXAM
Rhonda is alert and oriented Ã— 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as â€œterrible!â€ 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 DSMâ€“5 criteria to support your diagnosis.
Number 3 : Antisocial Personality Disorder is my Decision One
Decision Point Two
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:
Number 1 : Refer to psychologist for psychological testing is my Decision Two
RESULTS OF DECISION POINT TWO
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.
Number 1 : Refer to group-based cognitive behavior therapy is my Decision Three
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, Rhondaâ€™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 â€œimprovementâ€ 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.
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