NURS 6670 Treatment of Personality Disorders

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Week 3: Personality Disorders

I cannot believe these people. Don’t they know who I am? I deserve better treatment than this. That hostess should have seated me immediately, but I had to wait for 10 minutes and then she put me at this table right by the kitchen. I see an empty table right in the middle where I should be. I am just going to get up and move there. I don’t care what the hostess says, rules don’t apply to me.

Ashley, age 25

Personality disorders represent perhaps the most challenging disorders that the psychiatric mental health nurse practitioner will have to address in their professional careers. Personality disorders can co-occur in every mental health disorder and, in some cases, can mask as disorder . Although difficult to treat, the PMHNP must be able to identify personality disorders and endeavor to work with the client to not only recognize the disorder, but to treat a disorder that clients often do not believe they have.

This week, you will explore the many personality disorders and use the DSM-5 criteria for diagnosing individuals with specific personality disorders. You will use the Decision Tree format to diagnose and treat a client with a personality disorder. You also will complete the Fitzgerald University Exit Comprehensive Exam to determine your readiness for the certification exam.

Learning Resources

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

  • Standard 12 “Leadership” (pages 76-77)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

  • Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)
  • Chapter 22, “Personality Disorders” (pp. 742–762)
  • Chapter 13, “Psychosomatic Medicine” (pp. 465–503)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

  • Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”
  • Chapter 69, “Antisocial Personality Disorder”
  • Chapter 70, “Borderline Personality Disorder”
  • Chapter 71, “Histrionic Personality Disorder”
  • Chapter 72, “Narcissistic Personality Disorder”
  • Chapter 73, “Cluster C Personality Disorders

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  • “Personality Disorders”

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry: Interpersonal & Biological Processes, 76(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Rees, C. S., & Pritchard, R. (2015). Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52(1), 45–55. doi:10.1037/a0035158

Required Media

Laureate Education. (2017a). A woman with personality disorder [Interactive media file]. Baltimore, MD: Author.

Optional Resources

Kernberg, O. (n.d.). Psychoanalytic psychotherapy [Video file]. Mill Valley, CA: Psychotherapy.net.

Discussion: Treatment of Personality Disorders

Personality disorders occur in 10–20% of the population. They are difficult to treat as individuals with personality disorders are less likely to seek help than individuals with other mental health disorders. Treatment can be challenging as they do not see their symptoms as painful to themselves or others.

In this Discussion, you will explore personality disorders in greater detail and discuss treatment options using evidence-based research.

Learning Objectives

Students will:
  • Analyze diagnostic criteria for personality disorders
  • Analyze evidence-based psychotherapy and psychopharmacologic treatments for personality disorders
  • Analyze clinical features of clients with personality disorders
  • Align clinical features with DSM-5 criteria
  • Compare differential diagnostic features of personality disorders

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • By Day 5 of Week 2, your Instructor will have assigned you a personality disorder, which will be your focus for your initial post for this Discussion.
  • Review the Learning Resources.

By Day 3

Post:

  • Explain the diagnostic criteria for your assigned personality disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.
  • Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.
  • Support your rationale with references to the Learning Resources or other academic resources.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned. What are their similarities and differences? How might you differentiate the two diagnoses?

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 3 Discussion

Assignment 1: Decision Tree

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

Learning Objectives

Students will:
  • Evaluate clients for treatment of mental health disorders
  • Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

** Assigned in Week 3 and submitted in Week 4

Examine Case 1: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

  • Decision #1: Differential Diagnosis
    • Which Decision did you select?
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
  • Decision #2: Treatment Plan for Psychotherapy
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
  • Decision #3: Treatment Plan for Psychopharmacology
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

By Day 7

Submit by Day 7 of Week 4.

Assignment 2: Fitzgerald Health Education Associates (FHEA) PMHNP 150 University Exit Comprehensive Exam

In Weeks 1 or 2 of this course, you received an e-mail from Fitzgerald Health Education Associates (FHEA) explaining how to access the Fitzgerald Health Education Associates (FHEA) PMHNP 150 University Exit Comprehensive Exam. Please follow the directions FHEA provided and complete the exam. You must complete the exam by Day 7 of Week 3 to receive a grade. Each exam is worth 100 points and 10% of your grade. The 3-hour exam is required and will provide you with an overall view of your preparedness for the certification exam.

Note: Your Instructor receives the results and will inform you when the results are available. Do not e-mail the Fitzgerald site.

Making Connections

This week, you explored the many personality disorders and used the DSM-5 criteria for diagnosing individuals with specific personality disorders. You used the Decision Tree format to diagnose and treat a client with a personality disorder. You also completed the Fitzgerald University Exit Comprehensive Exam to determine your readiness for the certification exam.

Next week, you will analyze clients presenting for treatment of substance-related and addictive disorders and evaluate effectiveness of therapeutic approaches for clients diagnosed with substance-related and addictive disorders.