Cyclothymic Disorder Therapy Nursing Essay

Cyclothymic Disorder Therapy Nursing Essay

  • : Differential Diagnosis

Which Decision did you select?

 Cyclothymic disorder  ---This is the correct answer

  • 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.Cyclothymic Disorder Therapy Nursing Essay.
  • 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?Cyclothymic Disorder Therapy Nursing Essay 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?
    • ORDER A PLAGIARISM-FREE PAPER NOW

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.Cyclothymic Disorder Therapy Nursing Essay

Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night)Cyclothymic Disorder Therapy Nursing Essay, but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep.

You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks.

Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states:Cyclothymic Disorder Therapy Nursing Essay “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!”

 

OBJECTIVE

Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.

 

MENTAL STATUS EXAM

Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations.Cyclothymic Disorder Therapy Nursing Essay. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented.

At this point, please discuss any additional diagnostic tests you would perform on Stefanie.

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 STEFANIE?

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.

 ertain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Bipolar I, current phase, depressed

 Bipolar II, current phase, hypomanic

 Cyclothymic disorder  ---This is the correct answer

Bipolar I, current phase, depressed

Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Begin Depakote 250 mg orally three times daily

Begin Abilify 10 mg orally daily-----This is the correct answer

Arrange to see Stefanie every 3 months for routine follow-up

Bipolar II, current phase, hypomanic

Decision Point Two

Cyclothymic Disorder Therapy Nursing Essay

Begin Abilify 10 mg orally daily

 

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Stefanie reports that her mood seems a bit more “stable.” She states that she notices that she has not been as “sad” since she started taking the medication. She does report that for the first 2 weeks, she noticed that whenever she went from a lying or sitting to a standing position, she felt “lightheaded.”
  • She does report that the side effect was quite concerning at times. However, she reports that this is no longer happening.

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

 

Maintain current dose of Abilify

Increase Abilify to 15 mg orally daily

Discontinue Abilify

 

Maintaing the does is the current answer Cyclothymic disorder

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Guidance to Student

In order to meet the criteria for a major depressive episode, the client needs to have five or more symptoms (refer to DSM–5 major depressive episode criteria)Cyclothymic Disorder Therapy Nursing Essay. She only demonstrates criteria # 1: depressed mood most of the day, nearly every day, as indicated by either subjective reports (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful); criteria # 6: “fatigue or loss of energy nearly every day”; and criteria # 8: “diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)Cyclothymic Disorder Therapy Nursing Essay.” Thus, Stefanie does not meet the criteria for a major depressive episode as she only has three out of the needed five criteria for the diagnosis of a major depressive episode.

In order to meet criteria for a hypomanic episode, the client needs to have a period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. Stefanie’s symptoms last 3 days. Additionally, during the period of mood disturbance, the person must have three or more of the qualifying symptoms. Stefanie only has an increase in goal-directed activity and distractibility. Thus, Stefanie does not meet criteria for a hypomanic episode as she only has a decreased need for sleep and an increase in goal-directed activity.Cyclothymic Disorder Therapy Nursing Essay.

Since Stefanie has symptoms of both hypomania and depression (but does not meet the criteria for a major depressive or hypomanic episode), and since these behaviors do not occur in the context of a drug/substance or medical condition, Stefanie meets the diagnostic criteria for cyclothymic disorder.

Some providers will treat cyclothymic disorder with pharmacologic agents used to treat bipolar disorder because individuals with cyclothymic disorder have a higher risk of progression to bipolar disorder. However, there is no consensus in the literature as to the optimal treatment, or if prophylactic psychopharmacologic treatment is beneficial in consideration of the side effects associated with antipsychotics and mood stabilizers. Lithium in this case may be a bit ambitious. Similarly, the starting dose of Lamictal is also a bit ambitious in consideration of Stefanie’s overall symptom profile.Cyclothymic Disorder Therapy Nursing Essay. Also, the Lamictal dose listed is too high and risk of adverse drug rashes increases if Lamictal is initiated at too high a dose. Lamictal should be initiated at 25 mg orally daily, and slowly titrated up to achieve symptomatic control.

In this case, Stefanie did not like the counselor she began working with. The PMHNP knows that in the case of cyclothymic disorder, counseling could help with depressive symptoms. If a client does not like or get along with their counselor, the PMHNP should encourage the client to find another counselor and try working with that person. The therapeutic alliance is an essential component of counseling and if the client perceives absence of alliance, the likelihood of an effective working relationship decrease.

WK 4 Assignment 3: Decision Tree: Case 1: A Woman with a Personality Disorder

Antisocial Personality Disorder

Antisocial personality disorder has afflicted and visited misery upon numerous persons and their family members. The condition is one of the most devastating mental disorders and its diagnosis has proven complex. However, with the concerted application of various tools, healthcare professionals can accurately diagnose the condition and subsequently recommend the necessary intervention. Such an intervention is impacted by factors such as safety, simplicity and effectiveness. In the present paper, Rhonda, a mentally disturbed person whose DMS-5 symptoms indicate antisocial personality disorder will be examined. Additionally, the available interventions for the condition will be compared and a decision made from them.Cyclothymic Disorder Therapy Nursing Essay

Decision Point One

According to the DSM-5 criteria, a PMNHP would diagnose Rhonda with antisocial personality disorder. The presence of significant personality functioning that are manifested by self-functioning impairments are critical indicators of the disorder according to the DSM-5 criteria (American Psychiatric Association, 2013)Cyclothymic Disorder Therapy Nursing Essay. Rhonda displays this when she does not seem to conform to normative ethical behavior. She also displays traits of egocentrism, which drives her self-esteem that is obtained from personal pleasure. Further, she lacks empathy for others and also displays pathological behaviors of antagonism and specifically deceitfulness and callousness. According to the DSM-5 criteria, Rhonda has displayed all the characteristics of antisocial personality disorder and as such, a practitioner needs to eliminate borderline personality disorder and histrionic personality disorder. Histrionic patient does not have a history of Conduct disorder (Sadock, Sadock, & Ruiz, 2014).

By making the diagnosis, a Practitioner would be expected to formulate a necessary intervention therapy. According to studies, disorders such as antisocial personality disorder are manageable. However, the formulation of an effective therapy for such conditions is dependent on making accurate diagnosis (Thylstrup et al., 2017). The diagnostic evaluation of these conductions is conducted using tools such as the DMS-5, which enumerates certain criterions that certain mental disorders need to attain. Therefore, by using the DMS-5 to reach the conclusion, the PMNHP anticipated to formulate a coherent and effective intervention for the condition.

The PMNHP  expected to use the DMS-5 criteria to make a diagnosis on Rhonda’s condition. According to the instrument, each of the above conditions has distinct characteristics (Tobin & House, 2016)Cyclothymic Disorder Therapy Nursing Essay. Therefore, the decision to elect the antisocial personality disorder was supported by the DMS-5 criterion. Thus, the nurse expected the condition to be confirmed by the instrument and this is exactly what happened.

Decision Point Two

Selected decision

Refer to psychologist for psychological testing

Reason for selecting

As already mentioned, accurate diagnosis of a antisocial personality disorder is paramount to the formulation of an effective treatment plan. According to the analysis thus far, the subjective data that has been drawn from the patient has pointed towards the existence of ASPD. However, a psychological evaluation that explores the family history, behavior patterns, relationships, feelings, and thoughts is necessary to confirm the presence of the condition (Howard, Khalifa, & Duggan, 2014)Cyclothymic Disorder Therapy Nursing Essay. Such a confirmatory test can only be conducted by a psychologist. Thus, beginning Haldol 5 mg orally daily or referring to psychodynamic psychotherapy are not recommended at this stage as the condition has not been confirmed beyond reasonable doubt.

Expected results

            The purpose of referring Rhonda to a psychologist is to eliminate other medical conditions. Given that the DMS-5 criteria have already indicated antisocial personality disorder, a psychological testing is expected to confirm the presence of the condition. The testing is this expected to confirm that the thoughts, behavior patterns, family history, and feelings (Howard, Khalifa, & Duggan, 2014) demonstrated by Rhonda are indicative of antisocial personality disorder.Cyclothymic Disorder Therapy Nursing Essay.

Differences between Expected Results and Actual Results

That Rhonda would be referred to a psychologist for confirmatory testing is a standard procedure of the diagnostic process of antisocial personality disorder. By making the decision, a nurse would expect that the psychologist is going to fortify their own diagnosis using the DMS-5 criteria. Using pertinent psychological testing instruments, a psychologist will address every mental aspect of the condition to confirm or repudiate its existence (Tobin & House, 2016). Accordingly, it is expected that an effective intervention will be undertaken afterwards. Again, confirming the accuracy of the first diagnosis is in coherence with standard diagnostic procedure for ASPD.

Decision Point 3

Selected decision

Refer to group based cognitive behavior therapy

Reason for selection

Group-based cognitive behavior therapy has been indicated as amongst the most effective ways of combating antisocial personality disorder. CBT puts emphasis on emboldening patients to confront their core beliefs as well as gain novel insights into the manner in which their feelings and thoughts impact their behavior. The approach is thus effective and simple to administer without the risk for side-effects (Hatchett, 2015)Cyclothymic Disorder Therapy Nursing Essay. On the other hand, the psychopharmacological intervention involving Latuda could not be used as the condition was not severe and the drug generally is characterized by side-effects that might escalate an already bad situation. Also, dialectical behavior therapy was not recommended as it is a complicated intervention. Similarly, the dialectical behavior therapy’s overall effectiveness has been questioned with researchers asserting that it can only reduce self-harm tendencies in ASPD patients (Hatchett, 2015). Therefore, the correct decision is to take the patient to a cognitive group-based therapy.Cyclothymic Disorder Therapy Nursing Essay

Expected results

By using a cognitive group-based therapy, the patient is expected to show reduced symptoms of the antisocial personality disorder. The lack of empathy and deceitful and callous behavior that Rhonda has demonstrated are expected to reduce with this intervention. As a consequence, her functional outcomes are expected to improve by the end of the therapy (Holas et al., 2016)Cyclothymic Disorder Therapy Nursing Essay.

Differences between expected results and actual results

After accurately diagnosing a condition such as ASPD, the next step entails the formulation of interventions. Whereas there are many therapies available for managing the condition, it is always advisable to adopt the less dangerous and easily administered intervention (Hatchett, 2015). Conventionally therefore, the cognitive group-based therapy was in conformity to the standard procedure.

Conclusion

Therefore, antisocial personality disorder is a condition with devastating effects on many parties surrounding a person suffering from it. This calls for accurate diagnosis of the situation, with confirmatory testing necessary in some situations. These diagnostic processes influence the therapeutic interventions that will be undertaken by a PMNHP or a psychologist. Out of all the therapies, cognitive group-based behavior therapy is considered the best due to its safety, simplicity and effectiveness.

 

 

References

American Psychiatric Association., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.

Hatchett, G. T. (2015). Treatment Guidelines for Clients with Antisocial Personality Disorder. Journal Of Mental Health Counseling, 37(1), 15-27.Cyclothymic Disorder Therapy Nursing Essay

Holas, P., Suszek, H., Szaniawska, M., & Kokoszka, A. (2016). Group Cognitive-Behavioral Therapy for Anxiety Disorders With Personality Disorders in Day Clinic Setting. Perspectives In Psychiatric Care, 52(3), 186-193.

Howard, R. C., Khalifa, N., & Duggan, C. (2014). Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample. Journal Of Forensic Psychiatry & Psychology, 25(6), 658-672.

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.

Thylstrup, B., Schrøder, S., Fridell, M., & Hesse, M. (2017). Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs. BMC Psychiatry, 171-10. doi:10.1186/s12888-016-1165-2

Tobin, R. M., & House, A. E. (2016). DSM-5 diagnosis in the schools. Newy York, NY: The Gillford Press.Cyclothymic Disorder Therapy Nursing Essay