This case involves Rhonda, a 32-year-old Hispanic female who is visiting a psychiatric specialist for her first appointment. From her own account, Rhonda seems to be impulsive and her aggressive behaviors show clear signs of a specific personality disorder. Subsequently, the essay provides an inclusive diagnosis and explanations to accurately assess Rhonda’s condition. Correspondingly, the decision for care for Rhonda will include a comprehensive treatment plan based on the medical evaluation provided by the PMHNP (Psychiatric/Mental Health Nurse Practitioner).
Decision Point One: Antisocial personality disorder
Why and Why not:
Derefinko & Widiger (2016) defines antisocial personality disorder as a mental condition that slows down an individual’s inherent ability to think, feel and behave. The disorder is predominantly common during the early stages of adolescence and early childhood.
Rhonda shows no sign of remorse for her actions and consistently ignores other peoples’ opinions and feelings. According to Derefinko & Widiger (2016), the diagnosis of antisocial personality disorder is majorly based on the assessment of personal experiences and behaviors that evidently digress from the generally accepted codes of conduct. Some common symptoms associated with this disorder include the inability to discern social rules on interactions and increased disregard for others’ feelings. Individuals diagnosed with this type of mental disorder are also more impulsive, hostile, irresponsible, arrogant, and deceitful, and tend to be in abusive relationships.
The decision to diagnose Rhonda with antisocial personality disorder was based on the patient’s own accounts during her visit the specialist and based on the assessments of the PMHNP. For example, during the interview, Rhonda is depicted to be highly agitated as she paces around the offices using wild hand gestures to explain herself to the specialist. Rhonda is also depicted as having recurring challenges with the lawmaking authorities given her history of incarcerations for numerous criminal activities such as illegal possession of a firearm and drugs. Notably, Rhonda’s persistent problems with the law and her inability to be remorseful are common characteristics of antisocial personality disorder ((Glenn, Johnson & Raine, 2013).
Once an accurate assessment of Rhonda’s situation has been made, it is expected that relevant plans and course of actions will be established to help in the treatment processes. Rhonda and any other close relative will also be informed of the common symptoms associated with the established mental condition. Remarkably, from the interaction and medical assessment of Rhonda, there was a general expectation of a diagnosis of an antisocial personality disorder.
Decision Point Two: Refer Rhonda to a psychologist for psychological testing
Why and Why not:
Upon consent, Rhonda will be referred to a psychologist who will conduct further psychological testing. Such tests are necessary because there are no clearly certified medical treatment procedures for antisocial personality disorders. Medical care for Rhonda will involve psychotherapy with more focus on helping her to understand and control her emotions. The psychologist will help the patient to find better ways of dealing with her aggression and comprehending the negative impacts of her behaviors (Glenn, Johnson & Raine, 2013).
However, certain extreme symptoms associated with an antisocial personality disorder such as depression, anxiety and the possession and abuse of illegal substances can be treated using an antipsychotic medicine called clozapine.
Rhonda will be expected to return to the clinic in four weeks for more psychological tests. As expected, the psychologist conducted a comprehensive psychological battery to specifically clarify the postulated diagnosis. The final outcome showed that indeed Rhonda possessed certain common symptoms of multiple personality disorders, with relatively higher scores in antisocial personality traits. Therefore, psychological tests accurately suggested that Rhonda was suffering from an antisocial personality disorder. Upon her return to the clinic after 4 weeks, Rhonda seemed upset and the initial psychological testing results were affirmed, and this further explained why she needed more specialized care treatment.
Decision Point Three: Refer to group-based cognitive behavior therapy
Why and Why not:
The decision to refer Rhonda to a psychologist for more psychological tests aimed at providing a clear diagnosis of her conditions. Undoubtedly, the psychological tests clearly showed that Rhonda was suffering from an antisocial personality disorder, but there was a higher likelihood of more personality disorders.
Therefore, according to Jauhar et al. (2014), a referral to a group-based cognitive behavior therapy is a viable decision that significantly suppresses extreme symptoms. For example, a DBT (Dialectical Behavior Therapy) which focuses on group skills and personal psychotherapy can be used. However, a Dialectical behavior therapy is not recommended for individuals with antisocial personality behavior. Similarly, introducing Latuda which is a typical antipsychotic drug is not appropriate. Dialectical behavior therapy and Latuda are not FDA-approved medications and any related prescriptions may result into misuse.
For accurate diagnosis and design of a treatment plan, PMHNP should refer to the psychologist report on the additional psychological test results. In addition, PMHNP should clearly explain to Rhonda how the recommended treatment option will be conducted and other related consequences. The patient should also be introduced to lessons on behavior modification among other important social skills to reduce risk future risks of advanced antisocial personality disorder.
Derefinko, K. J., & Widiger, T. A. (2016). Antisocial personality disorder. In The medical basis of psychiatry (pp. 229-245). Springer, New York, NY.
Glenn, A. L., Johnson, A. K., & Raine, A. (2013). Antisocial personality disorder: a current review. Current psychiatry reports, 15(12), 427.
Jauhar, S., McKenna, P. J., Radua, J., Fung, E., Salvador, R., & Laws, K. R. (2014). Cognitive-behavioral therapy for the symptoms of schizophrenia: systematic review and meta-analysis with an examination of potential bias. The British Journal of Psychiatry, 204(1), 20-29.