Case #1
A woman with personality disorder

A woman with personality disorder

 

Decision Point One


 Borderline Personality Disorder
Decision Point Two
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:


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


Begin dialectical behavior therapy (DBT)
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.


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.


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). 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.


Begin dialectical behavior therapy

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Upon her return, you learn that Rhonda feels no change. She seems “agitated” and states “look, you told me this therapy stuff was going to help me. It’s done nothing. I’m better than those people. They are all whiney. They need to get a life!”
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Refer to psychologist for psychological testing
Guidance to Student

Referral to a psychologist should be considered 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.

Based on a diagnosis of APD, dialectical behavior therapy would be of limited value. In fact, Rhonda’s presence in such a group could be detrimental to the other group members.

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.


Begin DBT
Guidance to Student

Referral to a psychologist should be considered 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.

Based on a diagnosis of APD, dialectical behavior therapy would be of limited value. In fact, Rhonda’s presence in such a group could be detrimental to the other group members.

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.


Begin Abilify 5 mg orally daily
Guidance to Student

Referral to a psychologist should be considered 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.

Based on a diagnosis of APD, dialectical behavior therapy would be of limited value. In fact, Rhonda’s presence in such a group could be detrimental to the other group members.

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.


Begin treatment with Abilify 5 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Rhonda returns 4 weeks later and tells you that “medicine is garbage. I’m really upset about it!” She reports that she has been taking the medication and it has done “absolutely nothing” for her, and now she reports being upset because “you told me that this medication would help, and it didn’t … now what are you going 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 a licensed psychoanalyst
Guidance to Student

Referral to a psychologist should be considered 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.

Based on a diagnosis of APD, psychoanalysis has not been found to be beneficial in treatment.

There are currently no FDA-approved medications to treat APD, and Abilify has been associated with an increase in impulse control issues (such as gambling). Therefore, Abilify should be stopped, not increased. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.


Increase Abilify to 10 mg orally daily
Guidance to Student

Referral to a psychologist should be considered 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.

Based on a diagnosis of APD, psychoanalysis has not been found to be beneficial in treatment.

There are currently no FDA-approved medications to treat APD, and Abilify has been associated with an increase in impulse control issues (such as gambling). Therefore, Abilify should be stopped, not increased. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.


Refer to a psychologist for psychological testing
Guidance to Student

Referral to a psychologist should be considered 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.

Based on a diagnosis of APD, psychoanalysis has not been found to be beneficial in treatment.

There are currently no FDA-approved medications to treat APD, and Abilify has been associated with an increase in impulse control issues (such as gambling). Therefore, Abilify should be stopped, not increased. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.