The case study involves a client with a personality disorder. Accordingly, the focus of this paper will be on making a differential diagnosis for the client, selecting the treatment plan for psychotherapy, and selecting a treatment plan for psychopharmacology for the client. Finally, ethical factors likely to impact the client’s treatment plan will be analyzed. Decision #1: Differential Diagnosis paper
Decision #1: Differential Diagnosis
The selected decision point one is that the client’s diagnosis is an antisocial personality disorder. This is because Rhonda manifests symptoms consistent with symptoms of antisocial personality disorder. According to DSM-5, American Psychiatric Association (2013) diagnostic criteria of antisocial personality disorder includes: disregard for or violating rights of other people from the age of 15 years as illustrated by features such as violation of laws and social norms by taking part in behaviors leading to arrest of warranting criminal arrest; lying and manipulating other people; impulsivity; irritability and aggression exhibited by frequent fights; irresponsibility; and lack of guilt or remorse. The individual should be aged 18 years and above (Alves et al, 2014). The subjective and objective data indicates that Rhonda has severally disregarded the law, social norms and rights of other people and has aggression as indicated by frequent fights, disagreements, and the numerous arrests. She has also stolen from other people, and tries to always justify herself. She also lacks remorse, for instance after taking her friend’s money she tries to justify the reason. She also confessed that she is impulsive and has been having the fights ever since she was young.
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Decision #2: Treatment Plan for Psychotherapy
The selected decision point two is to start Haldol 5 mg orally daily for the client. The rationale for selecting Haldol for the patient is because this medication is an antipsychotic that has been shown to be effective in the treatment of severe behavior problems such as the ones exhibited in individuals with antisocial personality disorder (Decuypere et al, 2017).
With this decision, it was hoped that behavioral problems such as impulsivity, aggression and violating the law and social norms would significantly improve. This is because the medication has been shown to be effective in improving behavioral problems (Decuypere et al, 2017).
The outcome of the decision was that the medication was making the client sleepy and therefore she discontinued. The medication was improving some symptoms such as irritability in the morning but the symptoms would resurface in the afternoon. Additionally, the client complained of weight gain after starting the medication. The reason for the client experiencing effects such as sleepiness and weight gain is because Haldol has a sedation effect and also weight gain is among the most common side effects of the medication. In addition, symptoms such as irritability would resurface in the afternoon because Haldol 5 mg is a short-acting medication and hence by afternoon the medication would wear off and hence resurfacing of the symptoms (Decuypere et al, 2017). Decision #1: Differential Diagnosis paper
Decision #3: Treatment Plan for Psychopharmacology
The selected decision point three is to refer the client to a group-based cognitive behavior therapy. The rationale for selecting this decision is that a cognitive behavioral therapy is suitable for addressing various and normally longstanding problems of individuals with personality disorders such as antisocial personality disorder (Matusiewicz & Hopwood, 2015). This is because personality disorders are normally maintained by several maladaptive thoughts and beliefs about self and other people, environmental factors reinforcing the problematic behavior, as well as undermining the appropriate behavior, in addition to skill deficits precluding adaptive responding (Matusiewicz & Hopwood, 2015). Accordingly, during CBT, various techniques will be integrated in order to modify such factors through cognitive restructuring, modification of the behavior, socialization with other people, psycho-education, in addition to skills training. Moreover, a group CBT is recommended for people with personality disorders because CBT emphasizes the significance of a supportive, cooperative, as well as definite therapeutic relationship; this encourages individuals with personality disorders to willingly make changes and learn to form good relationships with other people, something that is always impaired in personality disorders. Nazar et al (2017) further add that group CBT will encourage the client to challenger her core beliefs and have an insight on how her thoughts and feelings influence her behavior. This will make the client see the importance of replacing the negative thoughts and feelings with positive ones, in order to influence her behavior.
With this decision, it was hoped that augmentation of pharmacological treatment with CBT would further reduce behavioral symptoms for the client. It was expected that group CBT would help Rhonda to replace the maladaptive thoughts, feelings, and behaviors with healthy ones.
The main ethical aspects that may impact the treatment plan of the client include informed consent and autonomy. According to Murgic et al (2015), a patient has the autonomy to decide about his/her treatment. In this case, it is evident that Rhonda stopped taking the prescribed medication and threw them away. A patient has the right to accept or reject treatment. Secondly, there is an aspect of informed consent. The therapist should provide all the required information about the treatment in order for the client to decide about treatment from an informed perspective (Murgic et al, 2015). If the client does not consent to treatment, the therapist should respect this. Decision #1: Differential Diagnosis paper
The client’s diagnosis is antisocial personality disorder because most of her behavioral symptoms meet the diagnostic criteria for antisocial personality disorder. The selected decision point two is for the client to begin Haldol because this medication has been shown to be effective in improving behavioral problems. A group-based cognitive behavior therapy has been selected because evidence shows it is effective in improving behavioral problems and changing an individual’s way of thinking. Finally, autonomy and informed consent are ethical factors likely to impact the client’s treatment plan.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Alves M, Gomes F, Lessa M, Neto M et al. (2014). The Antisocial Personality Disorder and its characteristics, changes and advances: a challenge. International Journal of Collaborative Research on Internal Medicine & Public Health. 5(1).
Decuypere F, Sermon J, Geerts P, Denee TR, De Vos C, Malfait B, et al. (2017). Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study. PLoS ONE. 12(6):e0179049
Matusiewicz A & Hopwood C. (2015).The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. Psychiatr Clin North Am. 33(3): 657–685.
Murgic L, Bebert P, Sovic S & Gordana P. (2015). Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country. BMC Medical Ethics.16(65).
Nazar N & Ramganesh E. (2017). Cognitive Behavior Treatment of Personality Disorders. International Journal of Humanities and Social Science Invention. 6(11), 20-29.
Schrijver E, Graaf K, Vries O & Maier A. (2015). Efficacy and safety of haloperidol for in-hospital delirium prevention and treatment: A systematic review of current evidence. European Journal of Internal Medicine. 3(3), 1-10. Decision #1: Differential Diagnosis paper
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