Nursing assignment 363

 The Assignment: Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.  In APA Format, Cite and Provide at least 2 references no more five year old for each responses. Colleagues Respond# 1  Paranoid Personality Disorder (301.0), which comes out of general personality disorder. These individuals have a constant distrust and suspicion of others around them, thinking that everyone has a motive against them. These patients start having problems from childhood and it presents in a variety of ways. Some of them are being apprehensive and doubtful of others thinking they are going to exploit, harm, or deceive them. Constantly preoccupied with unjustified doubts about the loyalty or trustworthiness of the people closest to them. Reluctant to confide with the fear that their information will be used maliciously against them. Persistently bears grudges, perceives attacks on their character when it is not so and quick to react with ager or counterattack (A.P.A., 2013).  These individuals or personality disorders are usually treated with cognitive behavioral therapy, which is a collaborative process of empirical investigation, reality testing, and problem-solving between the therapist and the patient (Wheeler, 2014). Depending on what other underlying issues or disorders they have, other therapeutic therapies can also be introduced but for the most part, CBT is the one that is used often for personality disorders. for PPD medication is usually not given and psychotherapy is the route, but depending on what other extreme symptoms the patient may have like anxiety or depression, then medications can be given for them. Unfortunately, these individuals don’t see that they have problems and usually don’t seek medical help, which makes for a poor quality of life for these individuals. It is common for them to have other comorbidities such as substance misuse disorder, major depressive disorder, agoraphobia and OCD (Vollm et al, 2011). The essential feature here with these patients is distrust and being suspicious of others and their surroundings, therefore in order to be able to have any kind of therapeutic or therapist relationship with them one has to first get their trust completely. Make them feel that you are completely on their side by sharing with them that you respect what they believe but you don’t share it or have the same belief, that you have nothing that can harm them, that you are genuine and are there only for them (Carroll, 2018). Once that is established, which may take some time and patience on the therapist part, then little by little we can point various things out to them to help them see that what they perceived as evil is not it and from these little examples that are clarified then we can explain to them the disorder or problem they have. Colleagues Respond# 2  Different types of personality disorders disturb an individual and thus affect the way they think, behave, reason, and act but in this week’s discussion Post, I chose to discuss Borderline Personality Disorder (BPD). Borderline Personality Disorder BPD is a severe personality disorder categorized by impulsivity, affective instability, relationship problems, and identity problems. It affects 1-2% of the overall population, 10% of the patients in outpatient settings, 15-20% of the patients in inpatients settings, and 30-60% of the patients diagnosed with personality disorders. This uncertainty often disrupts family and work life, long-term planning, and the individual’s sense of self-identity. Originally thought to be at the borderline of psychosis, people with BPD suffer from a disorder of emotion regulation. BPD is very normally considered according to the diagnostic and statistical manual of mental disorders. Additionally, evaluation of BPD geographies on a measurable or dimensional scale is gradually used (Jackson, & Westbrook, 2009). This disorder is frequently detected in women in clinical sections and young individuals and is often co-morbid with other personality and axis-I disorders. Researchers using eco­logical temporary calculation strongly indicates that these individuals react in abnormal ways to interpersonal convict (Fitzpatrick, Maich, Carney, & Kuo, 2020). Recently, neurobiological studies showed that symptoms and behaviors of BPD are partly associated with alterations in basic neurocognitive processes, involving glutamatergic, dopaminergic, and serotoninergic systems. Additionally, neuroimaging studies in BPD patients indicated differences in the volume and activity of specific brain regions related to emotion and impulsivity, such as the prefrontal cortex, cingulate cortex, amygdala, and hippocampus. According to the DSM-IV-R, an individual must have at least 5 out of 9 of the following symptoms present for an accurate diagnosis to be made. These are extreme efforts to avoid real or imagined abandonment, unstable and intense interpersonal relationships, identity disturbance, potentially self-damaging impulsivity, affective instability due to a marked reactivity of mood, chronic feelings of emptiness, and inappropriate intense anger or lack of control of anger (Jackson, & Westbrook, 2009). Therapeutic Approach There has not been any specific drug approved by the FDA to treat BPD, although some have broad product licenses that cover individual symptoms or symptom clusters. Where there is a diagnosis of comorbid depression, psychosis, or bipolar disorder, the use of antidepressants, antipsychotics, and mood stabilizers respectively would be within their licensed indications. Where there are depressive or psychotic symptoms, or affective instability, that fall short of diagnostic criteria for mental illness, the use of psychotropic drugs is largely unlicensed or ‘off-label’. Prescribing off-label places additional responsibilities on the prescriber and may increase liability if there is an adverse effect. As a minimum, off-label prescribing should be consistent with a respected body of medical opinion and be able to withstand logical analysis. The Royal College of Psychiatrists recommends that the patient be informed that the drug prescribed is not licensed for the indication it is being used for, and the reason for use and potential side effects fully explained (NCCMH, 2009). The mental healthcare nurse practitioner must do everything possible to avoid the use of psychotropic drugs for BPD but if the opposite becomes the fact, then treatment with both pharmacotherapy and psychotherapy can be utilized when treating this disorder. Pharmacological treatment is generally recommended in the acute treatment of the core symptoms of BPD and in cases with Axis I comorbidity and severe impulse bad control. Over the past decade, antidepressants, specifically SSRIs, in particular, have been considered the first pharmacological choice in the treatment of BPD and its associated comorbidities. While, more recently, meeting evidence specifies the efficacy of other composites such as mood stabilizers and atypical antipsychotics. Concerning psychotherapeutic interventions, long-term approaches including transference-focused psychotherapy, dialectical-behavioral psychotherapy, and mentalization-based therapy seem to be particularly beneficial ((Jackson, & Westbrook, 2009). Sharing Diagnosis Because people suffering from BPD have relative to the norm and thus react harshly to emotional systems, especially negative feeling states such as fear, rage, shame, sadness, guilt, and jealousy, what others might perceive to be relatively minor events can result in a powerful wave of emotion in individuals with them. To help avoid damaging the therapeutic relationship with these groups of individuals as a mental healthcare nurse practitioner, I would like to teach them that a diagnosis of BPD does not warrant a death sentence. That is something that can be treated, and once the symptoms are gone the person no longer has the disorder. Support Approach with Evidence-Based literature The reason that I would utilize dialectical behavior therapy (DBT) to treat my patient with BPD is that DBT is recognized as the gold standard for people with BPD. It centers on the theory of mindfulness and allocating care to the current emotion. The therapy teaches the skills to deal with intense emotions, reduce self-destructive behavior, manage distress, and improve relationships. It seeks a balance between accepting and changing behaviors. This proactive, problem-solving approach was designed specifically to treat BPD.  Research shows that DBT is proven to be effective. A study done in 2014 showed that 77% of participants no longer met criteria for BPD diagnosis after undergoing treatment. Research suggests that self-injurious behaviors occur for various reasons. Simeon et al. (1992) reported that seeking relief from tension is the most commonly cited reason for self-mutilation. Other reasons include releasing anger, exercising control, forming identity, influencing others, acknowledging self-hatred or guilt, releasing sexual feelings, and achieving euphoria. DBT has been shown to decrease self-injurious behavior. In a study by Linchan, Armstrong, Suarex, Alimón, and Heard (1991) individuals diagnosed with BPD were randomly assigned to either a DBT treatment group or a control group with treatment as usual and it was found that a significant reduction in the frequency of self-injurious behaviors among patients who received DBT compared to the control group with a rate over 1 year for the DBT group was 63.6% and for the control group was 95.5% (Alper, & Peterson, 2001).


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