Comprehensive Assessment and Treatment Planning A client is referred to your clinic following an inpatient hospitalization for treatment of opioid use disorder. The client complains of depression anxiety panic attacks and insomnia. How would you determine what the “actual” issue is with this client?, Discus the role of comprehensive assessment in the differential diagnosis with emphasis on how you would approach this assessment. Include a discussion of how DSM-5 criteria can help you to distinguish between these conditions.  What would the treatment plan be?  Be sure to include ethical/legal considerations in your response.

Purpose:

Application of information to advance practice nursing experiences promotes the analysis and use of principles, knowledge and information learned and related to real-life clinical situations. Interactive dialogue among instructors and peers fosters the development of a learning community as ideas, perspectives and knowledge is shared.

Differences Among Personality Disorders and Assessment Approaches

Borderline Personality Disorder (BPD): Characterized by emotional instability, intense fear of abandonment, impulsive behaviors, and unstable relationships. Individuals with BPD often exhibit mood swings, self-harm, and chronic feelings of emptiness.

Narcissistic Personality Disorder (NPD): Marked by grandiosity, need for excessive admiration, and lack of empathy. Individuals with NPD may exploit others, have an exaggerated sense of self-importance, and struggle with criticism or perceived failure.

Antisocial Personality Disorder (ASPD): Involves persistent disregard for others’ rights, deceitfulness, impulsivity, and lack of remorse. Those with ASPD may engage in manipulative behaviors, criminal activities, and show little regard for societal norms.

Comprehensive Assessment in Diagnosis

A thorough assessment includes:

• Clinical Interviews: Gathering a detailed history, including past behaviors, relationships, and emotional regulation patterns.
• DSM-5 Criteria Review: Each disorder has distinct diagnostic criteria that help differentiate them. BPD primarily involves emotional dysregulation, NPD centers on self-importance and lack of empathy, while ASPD is linked to persistent disregard for rules and others’ rights.
• Psychological Testing: Tools like the Minnesota Multiphasic Personality Inventory (MMPI) or Personality Assessment Inventory (PAI) can aid in diagnosis.
• Collateral Information: Input from family, friends, or past medical records may provide insight into longstanding patterns of behavior.

Ethical and Legal Considerations

• Stigma and Labeling: Personality disorders carry significant stigma, which may impact treatment and patient willingness to seek help.
• Informed Consent: Patients should understand the nature of the assessment and possible diagnoses.
• Risk Management: ASPD and BPD may present higher risks for self-harm or harm to others, necessitating careful monitoring and intervention.
• Confidentiality: While maintaining privacy is essential, situations involving harm to self or others may require legal reporting.