Please answer the following questions 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 clients diagnosis and treatment. case study 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: Im at the end of my rope, I dont 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 friends 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 cant 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 didnt know how to have fun. She says I have always been impulsive, but its 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. 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 DSM5 criteria to support your diagnosis. 1- Decision #1: Differential Diagnosis * Which Decision did you select?( I SELECTED Antisocial Personality Disorder) *-Why did you select this Decision, Use specific symptoms presented in the case to DSM5 criteria to support your diagnosis.? Support your response with evidence and references to the Learning Resources. explain why you did not choose the other two options (Borderline Personality Disorder, nor Histrionic Personality Disorder) * 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? 2-Decision Point Two I selected (Refer to psychologist for psychological testing) Why did you select this Decision? Support your response with evidence and references to the Learning Resources. Explian why you did not chose (to begin Haldol 5 mg), explain why you did not choose ( to refer to psychodynamic psychotherapy) Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different? *- RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks The psychologists 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 psychologists report with her. Rhonda seems upset, but also states well, thats why I am here, to get better what do I need to do? BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Answer Chosen: Refer to psychologist for psychological testing RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks The psychologists 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 psychologists report with her. Rhonda seems upset, but also states well, thats why I am here, to get better what do I need to do? Decision #3: Treatment Plan for Psychopharmacology I selected (Refer to group-based cognitive behavior therapy) Why did you select this Decision? Support your response with evidence and references to the Learning Resources. Explain why u did not select( dialectical therapy), explain why you did not select (transference focus therapy) What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.explain why you did not choose the other two options Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Some Guidance and Rationale for Answer to Chosen Rhonda has APD; however, as you can see, she has signs/symptoms of other personality disorders. In many cases, individuals with personality disorders can demonstrate features of several personality disorders. 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, Rhondas symptoms are most consistent with antisocial personality disorder, but as you can see, she has signs/symptoms of other personality disorders. There are currently no FDA-approved medications to treat APD, thus Risperdal would not be useful. 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. 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. * include how ethical considerations might impact your treatment plan and communication with clients and their family.
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