Case #1
A woman with personality disorder

A woman with personality disorder

 

Decision Point One


 Histrionic 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.
  • 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 cognitive behavioral therapy
Guidance to Student

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.

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.


Begin group-based cognitive behavior therapy
Guidance to Student

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.

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.


Begin Risperdal 0.5 mg orally twice a day
Guidance to Student

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.

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.


Begin Seroquel 25 mg orally at bedtime

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Upon her return to your office, Rhonda reports that “all those pills did were make me tired, but I sleep like I’m dead when I take them.” On further questioning, she reports that she feels a bit “calmer” during the morning, but as the day progresses, she gets more irritable. She is also concerned about a 2-pound weight gain that she has experienced following initiation of this medication.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Increase Seroquel to 50 mg orally at bedtime
Guidance to Student

The PMHNP should reconsider diagnosis, and should consider referral to a psychologist 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 as well.

Increasing Seroquel would not be appropriate, as there are currently no FDA-approved medications to treat APD; thus, Seroquel would not be useful. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Dialectical behavior therapy is not useful in APD. 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.


Reconsider diagnosis
Guidance to Student

The PMHNP should reconsider diagnosis, and should consider referral to a psychologist 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 as well.

Increasing Seroquel would not be appropriate, as there are currently no FDA-approved medications to treat APD; thus, Seroquel would not be useful. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Dialectical behavior therapy is not useful in APD. 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
Guidance to Student

The PMHNP should reconsider diagnosis, and should consider referral to a psychologist 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 as well.

Increasing Seroquel would not be appropriate, as there are currently no FDA-approved medications to treat APD; thus, Seroquel would not be useful. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Dialectical behavior therapy is not useful in APD. 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.


Refer to group therapy for personality-disordered individuals

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Rhonda returns and states “Geez, you must really think I’m a nut!” On further exploration, Rhonda explains: “There’s something wrong with those people. They are all victims. They sound like a pathetic bunch of slobs! The therapist was an idiot! I could run that group. I know more than all of them put together!” You learn that the heterogeneous nature of the group was not very appealing to Rhonda.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Discuss the purpose of the group with Rhonda and encourage her to continue for another month
Guidance to Student

The heterogeneous nature of a “personality disorder” group suggests that Rhonda would be in the same group with a number of people with different personality disorders. It is clear that Rhonda did not like the group, participants, leader, or group dynamics; thus, encouraging her to continue with the group would not be productive.

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.

Beginning Haldol would not be 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.


Refer Rhonda to a psychologist
Guidance to Student

The heterogeneous nature of a “personality disorder” group suggests that Rhonda would be in the same group with a number of people with different personality disorders. It is clear that Rhonda did not like the group, participants, leader, or group dynamics; thus, encouraging her to continue with the group would not be productive.

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.

Beginning Haldol would not be 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.


Begin Haldol 5 mg orally daily
Guidance to Student

The heterogeneous nature of a “personality disorder” group suggests that Rhonda would be in the same group with a number of people with different personality disorders. It is clear that Rhonda did not like the group, participants, leader, or group dynamics; thus, encouraging her to continue with the group would not be productive.

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.

Beginning Haldol would not be 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.