Chronic Venous Insufficiency and Deep Venous Thrombosis Essay

Chronic venous insufficiency and deep venous thrombosis are both conditions that affect the veins .Veins carry deoxygenated blood back to the heart, to effect this important function there are valves which prevents backflow of blood, pooling, and clotting in the lumen. These conditions both affect the legs ie the calf muscle and the lower extremities in different ways. Here we evaluate the conditions on the following topics, epidemiology, pathophysiology, clinical presentations, diagnosis, and treatment

According to(Gulati, 2013) Chronic venous insufficiency is estimated to affect 40%of people living in the united states and highly occurs in women of more than 50yrs of age. This is due to the continued inability of the veins to carry blood back to the heart. This happens when the calf muscle does not contract regularly to compress the veins and aid in an upward flow of blood Chronic Venous Insufficiency and Deep Venous Thrombosis Essay. Hence increased pressure is applied on the valves which are positioned to stop the backflow blood i.e. one-way valves. this causes damage to the valve, as a result, the blood flows back and pools in veins lumen .the pooling are known as stasis .When a clot is formed it blocks the flow causing more pressure to the smaller vein that can easily burst .When this happens a reddish-brown, sensitive to bump swelling occurs and if broken a very painful ulcer occurs.

This is common due to the high population of aged people in unites states, also a very sedentary lifestyle that many have adopted or sometimes the cause may be secondary to pelvic tumors. Idiopathic chronic venous insufficiency is also common Chronic Venous Insufficiency and Deep Venous Thrombosis Essay.

The common signs and symptoms of chronic venous insufficiency include edematous ankles and calf muscle, newly formed varicose veins, aching or always tried legs, lathery-looking and itching skin on the legs, static ulcers

This can be diagnosed by use of duplex ultrasound, this simply placing a small device on the skin where you will be able to visualize the blood flow by use of waves .x rays can also come in handy if the duplex ultrasound is not available

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The most common treatment for chronic venous insufficiency is a lifestyle change; this includes wearing of compression stocking, exercises that involve the calf muscle e.g. walking. Avoid standing or sitting for long hours. In medical management, the physician may give some antibiotics if ulcers have formed. Anticoagulants to stop clot formation. pain killers to relieve pain if they are painful. Management may also involve non-invasive methods like sclerotherapy, a procedure where the doctor injects a solution into affected to scar and eventually cause bypass of the affected vein. Technologically treatment has improved to Endovenous thermal ablation where radio waves are used to heat and close the affected vein Chronic Venous Insufficiency and Deep Venous Thrombosis Essay. Vein ligation, vein repair, vein transplant, and vein bypass can be done.

Deep venous thrombosis condition affects a vein deep inside the body, the pathophysiology of deep venous thrombosis formation of a clot which in turn blocks the vein causing pooling in vein.

The major cause of DVT is a blood clot. Which may result from various reasons these include; injury to a blood vessel, drugs that encourage blood clotting, surgery: this happens when clot escapes the eye of the surgeon before suturing. and reduced movement either by age or sickness.

According to a center for diseases control and prevention( CDC), deep venous thrombosis have the following symptoms; swelling of the ankle or general foot, cramping pain starting from the calf muscle, warmth on the affected area, and change of color on the affected area.these are symptoms for lower extremities but if one has deep venous thrombosis on hands one may experience neck pain, shoulder pain, and sometimes general weakness on the affected hand.

To diagnose deep venous thrombosis you can perform the following ;a compression test where one gets to express pain on compression,checking of temperature on the painful area. A venous dropper ultra sounded and dimmers blood test can also be done

The methods of treatment for deep venous thrombosis are both invasive and non-invasive methods. These methods include the use of compression stockings, insertion of filters in the large abdominal vein known as venacava to prevent clots from moving to the lungs and cause a pulmonary embolism. The physician commonly prescribes the use of warfarin to dissolve clots and advice on reduced exercise to stop the clots from moving up to the lungs Chronic Venous Insufficiency and Deep Venous Thrombosis Essay.

In comparison, the major difference in Chronic Venus Insufficiency and Deep Venous thrombosis is that Deep venous thrombosis is the formation of a be a blood clot within a deep vein causing blockage and Chronic Venous Insufficiency is a decrease in blood flow from the legs to the heart. Deep venous thrombosis can be cured while chronic venous insufficiency does not have a cure. They also have a no of similarities these include they cause edema, pain, and discoloration. The risk for both conditions are related and be caused by similar conditions. Inactivity can cause an increase in both conditions and can be prevented by increasing daily activity. Diagnosis of CVI and DVT can be done by use venous Doppler ultrasound and D-Dimer blood test Chronic Venous Insufficiency and Deep Venous Thrombosis Essay.

References

Introduction to the study of deep venous thrombosis. (2008). The Aetiology of Deep Venous Thrombosis, 1-9. https://doi.org/10.1007/978-1-4020-6650-4_1

Lawrence, P. F., & Gazak, C. E. (2000). Epidemiology of chronic venous insufficiency. Chronic Venous Insufficiency, 3-8. https://doi.org/10.1007/978-1-4471-0473-5_1

Gulati, O. (2013). Pycnogenol® in Chronic Venous Insufficiency and Related Venous Disorders. Phytotherapy Research, 28(3), 348-362. https://doi.org/10.1002/ptr.5019 Chronic Venous Insufficiency and Deep Venous Thrombosis Essay

 

Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.
Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper. Chronic Venous Insufficiency and Deep Venous Thrombosis Essay

 

CBT vs REBT Essay

Cognitive Behavioral Therapy versus Rational Emotive Behavioral Therapy

Introduction

According to the World Health Organization, mental and behavioral health disorders are a global public health concern that affects more than 70 million people at one point in life. This estimate contributes to approximately 10% of the global disease burden and is expected to increase by the year 2030 (David et al., 2018).  In the United States, behavioral and mental disorders affect close to 50 million adults. However, despite the high prevalence, highly recognized therapies are effectively being used to alleviate this problem resulting to improved health outcomes CBT vs REBT Essay. The best examples of therapies being used are: cognitive behavioral therapy and rational emotive behavioral therapy.

Cognitive behavioral therapy is a treatment approach used to manage people with different mental and behavioral health problems based on thoughts, behavior and emotions. In comparison, rational emotive behavioral therapy emphasizes on rational thinking for the development of healthy expressions and emotional behavior. This paper discusses the similarities and differences between the two behavioral therapies and how the differences might impact my clinical practice as a mental health counselor. CBT vs REBT Essay To add on, I will discuss about the version of cognitive behavioral therapy I would use with clients with supporting reasons.

Similarities Between Cognitive Behavioral Therapy (CBT) And Rational Emotive Behavioral Therapy

Cognitive behavioral therapy and rational emotive behavioral therapy use theories which are founded from the ABC model. Therefore, the two therapies have similar beliefs in terms of development and maintenance of psychopathology (Brown  & Gaudiano, 2013) CBT vs REBT Essay.  To add on, the practical applications of both CBT and REBT are the same more so in terms of organization and interrelations of beliefs which may either be labeled as irrational or dysfunctional. The last similarity is that the major notions of CBT and REBT uphold that human behavior and emotions are highly dependent on individual beliefs, ideas, thinking and attitude and not by the sole occurrence of events. Therefore, for behavioral and emotional change to occur, one has to change his/her thinking.

Differences Between Cognitive Behavioral Therapy (CBT) And Rational Emotive Behavioral Therapy

A major difference between CBT and REBT is that REBT addresses the irrational thoughts and philosophical basis of emotional disturbance based on a client’s personality, which results to solutions that involve unconditional self-acceptance. On the contrary, CBT addresses irrational thoughts based on a client’s disorder through reinforcement of positive qualities which leaves many pitfalls in case of a client’s poor performance (David, Lynn & Ellis, 2010).  CBT insists on psychoeducation as an early vital component of treatment while REBT is highly reliant on psychoeducation in the entire period of treatment CBT vs REBT Essay.

With regards to the therapeutic relationships, CBT emphasizes on having a high quality therapeutic relationship for good treatment outcomes whereas REBT does not recognize the necessity of a therapeutic relationship. In terms of reasoning, CBT utilizes inductive reasoning by laying emphasis on inferential thinking. In contrast, REBT maximizes on deductive thoughts with a focus on evaluative reasoning (Sapp, 2014) v. Generally, these differences would help to gauge the best case practice scenarios that one therapy may be well suited to adequately address a client’s needs as in comparison to another for a mental health counselor.

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The Version Of Cognitive Behavioral Therapy I Might Use With Clients

The version of Cognitive Behavioral Therapy that I might use with clients is Dialectical Behavioral therapy. This form is highly reliable in being able to identify the triggers which result to negative tendencies and thoughts such as self-harm, suicidal thoughts and drug abuse (Craske & American Psychological Association, 2017).  It also provides a mental health counselor with a framework for identifying the irrational and dysfunctional behavior in a client and the tools that can effectively be used to counteract it CBT vs REBT Essay.

Conclusion

From this discussion on the similarities and differences between REBT and CBT, it is rather evident that the latter is more advantageous as compared to the former CBT vs REBT Essay. A perfect example is in the management of self-esteem, the establishment of a therapeutic relationship and thinking style. With this knowledge, mental health counselors are able to apply the most effective therapies depending on a client’s needs.

References

Brown, L., & Gaudiano, B. (2013). Investigating the similarities and differences between

practitioners of second-and third-wave cognitive-behavioral therapies. Behaviour Modification.

Craske, M. G., & American Psychological Association,. (2017). Cognitive-behavioral therapy.

David, D., Cotet, C., Matu, S., Mogoase, C., & Stefan, S. (2018). 50 years of rational‐emotive

and cognitive‐behavioral therapy: A systematic review and meta‐analysis. Journal of Clinical Psychology, 74(3), 304–318 CBT vs REBT Essay.

David D., Szentagotai A., Lupu V., & Cosman D. (2013). Rational emotive behavior therapy,

cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six‐month follow‐up. Journal of Clinical Psychology, 64(6), 728–746.

David, D., Lynn, S. J., & Ellis, A. (2010). Rational and irrational beliefs: Research, theory, and

clinical practice. New York: Oxford University Press.

Sapp, M. (2014). Cognitive-behavioral theories of counseling: Traditional and nontraditional

approaches. Springfield, Ill: C.C. Thomas.

 

Assignment 1: Cognitive Behavioral Theory Versus Rational Emotive Behavioral Theory

While cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) have many similarities, they are distinctly different therapeutic approaches CBT vs REBT Essay. When assessing clients and selecting one of these therapies, you must recognize the importance of not only selecting the one that is best for the client, but also the approach that most aligns to your own skill set. For this Assignment, as you examine the similarities and differences between CBT and REBT, consider which therapeutic approach you might use with your clients.

Learning Objectives

Students will:

• Compare cognitive behavioral therapy and rational emotive behavioral therapy
• Recommend cognitive behavioral therapies for clients

To prepare:

• Review the media in this week’s Learning Resources.
• Reflect on the various forms of cognitive behavioral therapy CBT vs REBT Essay.

The Assignment

In a 1- to 2-page paper, address the following:

• Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.
• Explain at least three differences between CBT and REBT. Include how these differences might impact your practice as a mental health counselor.
• Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature CBT vs REBT Essay.

Case Study on Biomedical Ethics in the Christian Narrative

Applying the Four Principles: Case Study

Part 1: Chart (60 points)

Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information using bullet points or a well-structured paragraph in the box. Gather as much data as possible.

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Medical Indications Beneficence and Nonmaleficence	Patient Preferences Autonomy
The principle of beneficence and non-maleficence is among the major five ethical principles outlined by APA. The beneficence principle states that psychologists should only engage in activities, which are beneficial to others (Young, 2017). On the other hand, the principle of non-maleficence states that practitioners should ensure that no one is hurt during their practices (Singh & Ivory, 2015). They should expose clients to the minimum harm to obtain the best outcomes. In the case study, the incidents of beneficence and non-maleficence are as described below. ·         The physician suggested immediate dialysis for James during the first visit due to his elevated blood pressure and fluid buildup, ·         Placing James on regular dialysis during the second visit to stabilize his deteriorating condition, ·         Proposing a kidney transplant to be performed within the next one year despite James being in a stable state currently, ·         Informing Mike and Joanne that the church members were not potential donors due to mismatch of their tissues, and ·         Suggesting for Mike and Joanne of a donor that was an ideal tissue match, James’ brother Samuel.	Autonomy is another major ethical principle, which psychologists and healthcare providers are required to adhere to. This ethical principle states that everyone is entitled to the right to independence, self-determination, and freedom to make their own choices without being influenced (Motloba, 2018). In the healthcare sector, the principle of autonomy states that clients have a right to make decisions about their own health without being influenced by care providers. Therefore, healthcare providers should respect autonomy even if they are not in agreement with the decision made by the client. The case study portrays various incidents of autonomy as illustrated below. Case Study on Biomedical Ethics in the Christian Narrative   v  The physician did not interrupt when Mike and Joane were making decisions regarding James’ medication, v  The physician did not interrupt when Mike and Joane were making a decision to forego the dialysis and place their faith in God, and v  The physician did not interrupt when Mike and Joane were making a decision whether to let Samuel donate a kidney to James or perhaps wait for God to do a miracle this time around.
Quality of Life Beneficence, Nonmaleficence, Autonomy	Contextual Features Justice and Fairness
v  The physician did not consider Mike or Joanne as ideal kidney donors to James since they were not compatible donors, v  The physician did not consider any of the church members as an ideal donor since their tissues did not match with those of James, v  The physician advised Mike and Joanne to ensure a kidney transplant was done in the next year despite James’ current stable state, v  The physician proposed Samuel as an ideal kidney donor, and Case Study on Biomedical Ethics in the Christian Narrative v  The physician allowed Mike and Joanne to make a decision about Samuel donating one of his kidneys to his brother, James.	This APA general principle holds that individuals are entitled to the advancements, which have been made within a particular field of practice such as psychology or healthcare (APA, 2020). Justice and fairness are portrayed in the case study in one major incident. v  The physician allowed James to use the dialysis machine. This machine was used to perform daily rounds of dialysis to stabilize his condition.

 

 

Part 2: Evaluation

Answer each of the following questions about how principlism would be applied:

1. In 200-250 words, answer the following: According to the Christian worldview, which of the four principles is most pressing in this case? Explain why. (45 points)

In the context of the Christian worldview, the principle of autonomy would be considered as the most pressing in this case. Autonomy states that everyone is entitled to the right to independence, self-determination, and freedom to make their own choices without being influenced (Singh & Ivory, 2015). In the healthcare sector, the principle of autonomy states that clients have a right to make decisions about their own health without being influenced. Case Study on Biomedical Ethics in the Christian Narrative. Therefore, healthcare providers should respect autonomy even if they are not agreed with the decision made by the client regarding treatment procedures. In this case, parents (Mike and Joane) are entitled to the independence of thought, and action when making any decision regarding the health care procedures of the patient since he is a minor. Thus, the physician respects their decision even if he was not in an agreement with it. The physician does not interrupt their decision to taking James home and wait for a miracle even if he was proposing for immediate dialysis due to his deteriorating condition. Additionally, he does not influence their decision when they decided to believe in God rather than making their son, Samuel loses his kidney. These two decisions were wrong and they were putting James’ life in danger. He could end up losing his life while they were waiting for God’s best time to perform a miracle for them Case Study on Biomedical Ethics in the Christian Narrative. Therefore, the Christian worldview considers autonomy as the most pressing principle among the four principles evidence in the case study.

 

2. In 200-250 words, answer the following: According to the Christian worldview, how might a Christian rank the priority of the four principles? Explain why. (45 points)

A Christian would rank the principles in order. The principle of Non-maleficence, which advocates for less harmful procedures would be ranked as the first one (Ediger, 2015). This principle ensures that healthcare practitioners expose clients to minimize harm to get the best results. The second principle is justice or fairness. This principle holds that individuals are entitled to the advancements, which have been made within a particular field of practice such as psychology or healthcare. Therefore, this principle will give Christians an opportunity to benefit from technological advancements while receiving treatment. The third is the principle of beneficence, which advocates for good intentions towards the patients (Al-Bar & Chamsi-Pasha, 2015). Therefore, Christians should consider a decision that accrues the most benefits to them. Thus, the principle is against the Christians who fail to seek medication on time due to their faith. This behavior makes their health condition deteriorate like in the case of James. The principle of autonomy would be ranked as the last one. This ethical principle states that everyone is entitled to the right to independence, self-determination, and freedom to make their own choices without being influenced Case Study on Biomedical Ethics in the Christian Narrative. In this case, parents are entitled to the independence of intention, thought, and action when making any decision regarding health care procedures since the patient is a minor. The healthcare practitioner, therefore, is not supposed to use false during the decision-making process. This principle risks the health of most Christians who based their health decisions on faith rather than on facts.

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References:

Al-Bar, M. A., & Chamsi-Pasha, H. (2015). Beneficence. In Contemporary Bioethics (pp. 129-139). Springer, Cham.

APA. (2020). Ethical Principles of Psychologists and Code of Conduct: Including 2010 and 2016 Amendments. Retrieved from https://www.apa.org/ethics/code/

Ediger, M. J. (2015). Teaching Clinical Ethics Using the Four Topic Method. International Journal of Athletic Therapy and Training, 20(6), 10-13. Case Study on Biomedical Ethics in the Christian Narrative

Motloba, P. D. (2018). Understanding the principle of Autonomy (Part 1). South African Dental Journal, 73(6), 418-420.

Singh, J, P & Ivory, M. (2015). Beneficence/Nonmaleficence. The Encyclopedia of Clinical Psychology. 1-3.

Young, G. (2017). The Five Core and the Five Supplementary Ethical Principles and Their Sub-principles. In Revising the APA Ethics Code (pp. 63-91). Springer, Cham.

 

Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve Case Study on Biomedical Ethics in the Christian Narrative.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis Case Study on Biomedical Ethics in the Christian Narrative. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then.

Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.

James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?” Case Study on Biomedical Ethics in the Christian Narrative

 

This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles of principlism.
Based on the \”Case Study: Healing and Autonomy\” and other required topic study materials, you will complete the \”Applying the Four Principles: Case Study\” document that includes the following:
Part 1: Chart
This chart will formalize principlism and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.
Part 2: Evaluation
This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.
Remember to support your responses with the topic study materials.
APA style is not required, but solid academic writing is expected.
Applying the Four Principles: Case Study
Part 1: Chart (60 points)
Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points or a well-structured paragraph in the box. Gather as much data as possible.

Medical Indications
Beneficence and Nonmaleficence Patient Preferences
Autonomy

Quality of Life
Beneficence, Nonmaleficence, Autonomy Contextual Features
Justice and Fairness

Part 2: Evaluation
Answer each of the following questions about how principlism would be applied:
1. In 200-250 words answer the following: According to the Christian worldview, which of the four principles is most pressing in this case? Explain why. (45 points)

2. In 200-250 words answer the following: According to the Christian worldview, how might a Christian rank the priority of the four principles? Explain why. (45 points) Case Study on Biomedical Ethics in the Christian Narrative
References:

 

Personality disorder Decision Tree

Decision Tree

Introduction

Personality disorders are characterized by inflexible and unhealthy thinking patterns, as well as unhealthy functioning and behaviors. People with personality disorders experience problems when it comes to the perception and relating to people and situations. This leads to significant problems and challenges in social activities, relationships, academics, and even work (Ekselius, 2018) Personality disorder Decision Tree. People with personality disorders might not be aware of their personality disorders because their way of thinking and behavior seems normal to them. They may even put the blame other individuals for their issues and problem. Personality disorders normally start during adolescence or early adulthood. There are various types of personality disorders. The 32-year-old client, in this case, the study presented with symptoms of being manipulative, exploitative, lack of remorse, blaming other people for her mistakes, irresponsibility, stealing, and often breaking the law Personality disorder Decision Tree. These behaviors started manifesting during the client’s childhood. The purpose of this paper is to identify the differential diagnosis for the client, evaluate the available treatments and finally present decisions about the diagnosis and treatment for the client.

Decision #1: Differential Diagnosis

The diagnosis for this client is an antisocial personality disorder. This decision was selected because the client manifests symptoms consistent with the symptoms outlined in DSM-5 diagnostic criteria for antisocial personality disorder. According to the DSM-5 diagnostic criteria, the characteristic symptoms of the antisocial personality disorder include disregarding and violating the law and rights of other people; manipulating and deceiving others; problems with maintaining interpersonal relationships; blaming other people for self-mistakes; irresponsible behaviors; and lack of remorse (Grenyer et al., 2018) Personality disorder Decision Tree. The client in the case study manifests symptoms such as disregarding the law; manipulative and exploitative behaviors; disregard for the law as indicated by imprisonment; blaming third-parties for her mistakes; delinquent behaviors such as stealing; lack of remorse; relationship behaviors; aggression; illegal possession of a gun; and recklessness as indicated by her inability to manage finances. Moreover, the behaviors started manifesting since childhood and hence confirming the diagnosis of antisocial personality disorder.

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Selecting antisocial personality disorder as the diagnosis for this client hoped that the correct diagnosis for the client was made. Therefore, this facilitates the right treatment for this client. The correct diagnosis ensures that there is no misdiagnosis and thus an individual receives treatment for the ailment (Singh et al., 2017).

Since the client exhibits symptoms of antisocial personality disorder as per the DSM-5 diagnostic criteria, there is no difference between the achieved outcome and the expected outcome Personality disorder Decision Tree.

Decision #2: Treatment Plan for Psychotherapy

The second decision is to refer the client to a psychologist for psychological testing. The reason for referring the client for psychological testing is to have her undergo a comprehensive assessment. The psychological assessment should include the administration of psychological tests to the client to objectively, comprehensively and consistently assess her behavior (Bornstein, 2015).  Therefore, the client will be administered with some clinical, behavioral and psychological assessment tools that will identify any cognitive problems, behavioral problems, or personality problems (Jadhakhan et al., 2019).

The expected outcome by referring the client for psychological testing is that the diagnosis (antisocial personality disorder) would be verified. Secondly, it is anticipated that the administration of psychological tests would identify other mental health conditions or comorbidities that could be contributing to the symptoms the client is manifesting (Jadhakhan et al., 2019) Personality disorder Decision Tree.

According to the findings from the comprehensive psychological battery test, the client exhibits symptoms of various personality disorders. However, the highest score was on the traits associated with antisocial personality disorder and this, therefore, is suggestive that the diagnosis for this client is an antisocial personality disorder. Therefore, there is no difference between the achieved outcome and the expected outcome. This is because as was expected, the psychological testing revealed that the client’s diagnosis was an antisocial personality disorder. Moreover, the psychological testing indicated a probability of other comorbidities for the client as demonstrated by the results showing that the client has symptoms of personality disorder Personality disorder Decision Tree. Evidence demonstrates that the majority of individuals with one personality disorder also manifest symptoms and signs of other personality disorders (Grenyer et al., 2018). This explains why the client manifests symptoms for multiple personality disorders, even though the score was highest for antisocial personality disorder.

Decision #3: Treatment Plan for Psychopharmacology

The third decision that was selected is to refer Rhoda to group-based cognitive behavior therapy. This decision was chosen because the group-based cognitive behavior therapy (G-CBT) has been demonstrated to be effective in improving symptoms and treating many personality disorders such as antisocial personality disorder. According to CBT, antisocial personality disorder results from the maladaptive beliefs as well as environmental factors that facilitate and promote the problematic behaviors associated with the disorder (Mancke et al, 2018). Additionally, the lack of the appropriate skills to adjust and respond suitably to situations is associated with the development of antisocial personality disorder. Therefore, the CBT utilizes different therapeutic techniques to change the negative thinking patterns and beliefs and thus eventually modify the behavior. Also, CBT equips people with the necessary skills to adapt, handle and respond suitably to situations (Mancke et al, 2018). More importantly, the CBT is a group-CBT and thus this will allow the client to interact with other members of the group (Mancke et al, 2018). This will improve the client’s social skills and thus improve her ability to maintain interpersonal relationships.

The selection of G-CBT for this client hoped that the behavioral deficits and symptoms the client is manifesting would greatly improve. The G-CBT will alter and modify the negative thinking pattern and maladaptive beliefs for this client. Additionally, a G-CBT will equip her with the essential social skills. G-CBT will lead to the client adopting a maladaptive thinking pattern and thus result in behavior change, and at the same time, the client will adopt the socially accepted behaviors (Mancke et al, 2018) Personality disorder Decision Tree.

Ethical Considerations

The first ethical consideration that the therapist should consider is informed consent. The PMHNP should obtain informed consent from the client before starting any assessment or treatment. The autonomy of the client should also be respected and therefore is she refuses any treatment, the PMHNP should accept the client’s decision. Thirdly, any information that the client reveals during the therapy including issues associated with breaking the law should be kept confidential and private (Warrender, 2017). Lastly, evidence shows that people with personality disorders may sometimes fail to respect the boundary issues and the therapeutic relationship. Therefore, the PMHNP should ensure that the client is educated about the expected boundaries during the treatment. Boundary issues common among people with personality disorders include irrational demands associated with the availability and accessibility of the therapist, irrationality, disrespect, and excessive phone calls to the therapist (Warrender, 2017). Therefore, it is the responsibility of the PMHNP to identify the honest needs of this client and maintain firm boundaries to ensure the provision of ethical and competent treatment. Personality disorder Decision Tree.

Conclusion

The diagnosis for this client was identified as an antisocial personality disorder. This decision was selected since the client reported and manifested symptoms associated with antisocial personality disorder according to the DSM-5 diagnostic criteria. The second decision that was chosen was to refer the client to a psychologist form comprehensive psychological testing to confirm or rule out the diagnosis of antisocial personality disorder and any other associated comorbidity. The final decision was to refer Rhoda to a G-CBT due to the intervention’s efficacy in the treatment of personality disorders. In conclusion, the ethical considerations during the treatment for this client involve autonomy, informed consent, as well as boundary issues Personality disorder Decision Tree.

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References

Bornstein R. (2015). Personality Assessment in the Diagnostic Manuals: On Mindfulness, Multiple Methods, and Test Score Discontinuities. J Pers Assess, 97(5), 446–455.

Ekselius L. (2018). Personality disorder: a disease in disguise. Upsala journal of medical sciences, 123(4), 194–204. https://doi.org/10.1080/03009734.2018.1526235.

Grenyer, B., Lewis, K. L., Fanaian, M., & Kotze, B. (2018). Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial. PloS one, 13(11), e0206472. https://doi.org/10.1371/journal.pone.0206472.

Jadhakhan, F., Lindner, O. C., Blakemore, A., & Guthrie, E. (2019). Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis. BMJ Open, 9(9), e028295. https://doi.org/10.1136/bmjopen-2018-028295.

Mancke F, Schmitt R, Winter D, Inga N, Sabine H & Scmahl C. (2018). Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder. J Psychiatry Neurosci, 43(3), 171–181.

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.

Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J. (2017). The global burden of diagnostic errors in primary care. BMJ quality & safety, 26(6), 484–494. https://doi.org/10.1136/bmjqs-2016-005401.

Warrender D. (2017). Borderline personality disorder and the ethics of risk management: The action/consequence model. Nursing Ethics, 25(7), 918-927. Personality disorder Decision Tree

 

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 Personality disorder Decision Tree
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
o Which Decision did you select?
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o 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
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Personality disorder Decision Tree
o 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
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o 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 Personality disorder Decision Tree.
By Day 7

A woman with personality disorder Case #1 A woman with personality disorder SUBJECTIVE Rhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help. Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you. She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!” Rhonda explains that her current financial situation is also precarious. She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft. “It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.” Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.” OBJECTIVE Rhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant Personality disorder Decision Tree. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons. She was also arrested for cashing checks under an alias, for which she spent 120 days in jail. Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police. MENTAL STATUS EXAM Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation. Decision Point One BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO RHONDA? In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis. Decision Point One Borderline Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin dialectical behavior therapy Begin treatment with Abilify 5 mg orally daily Decision Point One Histrionic Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin Seroquel 25 mg orally at bedtime Refer to group therapy for personality-disordered individuals Decision Point One Antisocial Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin Haldol 5 mg orally daily Refer for psychodynamic psychotherapy Borderline Personality Disorder Histrionic Personality Disorder Antisocial Personality Disorder Personality disorder Decision Tree