Case #1
A woman with personality disorder

A woman with personality disorder

 

Decision Point One


 Antisocial 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 disorders, 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.


Refer to group-based cognitive behavior therapy
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, Rhonda’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 “improvement” 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.


Begin Latuda 40 mg orally daily
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, Rhonda’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 “improvement” 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.


Refer for dialectical behavior therapy
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, Rhonda’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 “improvement” 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.


Begin Haldol 5 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Upon her return to your office, Rhonda reports that “I felt really sleepy after taking those pills, so I threw them away.” Rhonda reported that the medicine made her feel a bit calmer in the morning, but as the day progressed, her irritability returned. Rhonda is also upset over the weight gain she has experienced over the past month (almost 3 pounds).
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Refer to group-based cognitive behavior therapy
Guidance to Student

Neither DBT nor TFP have any evidence of efficacy among individuals with 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 for transference-focused psychotherapy (TFP)
Guidance to Student

Neither DBT nor TFP have any evidence of efficacy among individuals with 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 for dialectical behavior therapy
Guidance to Student

Neither DBT nor TFP have any evidence of efficacy among individuals with 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 for psychodynamic psychotherapy

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Rhonda states that the therapist she was referred to was “a complete waste of time. Do you know he wouldn’t even talk to me?” On further exploration, the PMHNP discovers that the psychotherapist asked Rhonda to talk, which she did, but he did not provide any feedback. Rhonda then states: “he told me that he wants to see me three times a week! Yeah, like that is going to happen!”
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Encourage Rhonda to continue with treatment three times/week
Guidance to Student

Psychodynamic therapy has no evidence base in APD, and effectiveness has only been described in case studies.

Beginning Asenapine 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.

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 Asenapine 10 mg orally daily
Guidance to Student

Psychodynamic therapy has no evidence base in APD, and effectiveness has only been described in case studies.

Beginning Asenapine 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.

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-based cognitive behavior therapy
Guidance to Student

Psychodynamic therapy has no evidence base in APD, and effectiveness has only been described in case studies.

Beginning Asenapine 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.

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.