Running head: PMHNP Case Study

PMHNP Case Study

Name of Student

Name of University
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Diagnosis

The DSM 5 defines the Antisocial Personality Disorder (ASPD) as the behavioural patterns

resulting in the manipulation and violation of others by an individual. The development of the

disorder is generally seen in the case of the children under the age of 18 years, which is

continued until childhood if not appropriately diagnosed (Wygant et al. 2016). The patterns of

behaviour include the disregard for law and authority, violation of the rights of others,

exploitation of laws and regulations as well as causing harm to others.

The clinical symptoms include frequent bursts of anger, arrogance, kleptomania, compulsive

lying, aggression, disregard for the law, non-remorseful and disregard for personal as well as

other's safety (Patrick & Brislin, 2014).

The differential diagnosis with respect to oppositional defiant disorder as per DSM-5 include: the

frequent loss of temper, engaging in argument with adults, deliberate means to irritate others,

blazoning other people for the negative behavioural implications, anger issues, extreme

resentment, spiteful towards authority and vindictive in most scenarios when confronted (Riley

et al., 2016).

In order to make a correct decision, it is expected that the patient would be able to meet the

following criteria based on the DSM-5 diagnosis. The patient must show evidence where

physical assault has been caused to others, frequency of physical fights, utilisation of weapons to

threaten others, cruelty against animals or others, stealing or robbing with or without

confrontation, random acts of vandalism, causing damage to property, escaping from residency,

staying late at nights despite parental prohibitions and truancy (Patrick & Brislin, 2014). Most of

the characteristics match the description of the child in the provided case study. The reported
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cases of absenteeism, shoplifting, disregard for parental prohibitions, the damage of the rooms in

his own bedroom, alcohol abuse, etc., show that the patient has developed antisocial behaviour

rather than an oppositional defiant disorder (ODD). The 14-year-old patient did not show any

empathy or remorsefulness towards his actions. The severity of unlawful behaviour is due to

alcohol abuse, which is frequent for the patient. The reason for stealing and shoplifting habits

can be confronted with the need to abuse alcohol, which otherwise would not be provided by the

parents (Scott, 2015). The cause of the ASPD within the patient in the case study could be a

result of unstable parenting. The father of the child is divorced and has another spouse in the

household, and the child is only allowed to see his biological mother on weekends. This might

create separation anxiety from his mother or the parental distrust towards the father. This can

also be a result of the abandonment issues where the child might be experiencing anger and

aggression from feeling rejected. Although self-destructive tendencies are observed within the

patient, suicidal tendencies remain undetected and denied by the patient upon inquiry.

Planning and Treatment

As per the norms of ICD-10, the treatment of ASPD is difficult where the care providers engage

in a different variety of psychotherapy and medication.

Depending on the nature of the patient, the psychotherapy includes the cognitive behavioural

therapy where the patient can get rid of the negative behaviour and thoughts. The assessor might

be able to replace those thoughts with positive and affirming thoughts. The increasing awareness

of the implications of the negative behaviours can help in bringing changes to the patient’s

behaviour (Wilson, 2014). The talk therapy or schema therapy can be introduced in the

treatment regimen for the patient. Many of the personality disorders are treated with the help of
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this therapy, especially in cases where the patient failed to respond or relapse from the behaviour

(Wilson, 2014). In severe cases, multi-systemic therapy could help in the improvement of the

patient condition. In this regards, the complete involvement of the family members is necessary

for success. The treatment of associated disorders is not overlapped with the treatment of ASPD.

The medication for the treatment of ASPD conditions is not well regulated by the FDA.

Therefore, the specific prescription of medications is not possible. However, fluoxetine (Prozac)

and sertraline (Zoloft), which are known Selective serotonin reuptake inhibitors (SSRIs) can be

provided to the patients in order to control the irritability and aggression (Wilson, 2014). The

control of the anxiety, depression and the mood swings of the patients have constrained the

power of the negative behaviour can be obtained.

In younger patients, as seen within the provided case study, it is essential that the therapist

complies with the assessment of the standards for treating minors. The privacy of the patient,

non-violence towards the minor patients and the presence of the parents during therapy are

essential. In order to change the destructive behaviour, the positive reinforcement, like

vocational training, physical exercise and relationship skills, can be provided.

Implementation and Coordination

It is essential to ensure the autonomy and choice of the patient which id facilitated by working in

partnerships with the patient and the parents. It is critical that the resolutions of the ASPD

triggers are discussed with the patient as well as their family. The care professionals need to

develop a positive and trusting relationship with their patients (Black, 2015). This will ensure

that the life choices available to the patients and the critical information of their actions are stated

to the patients. It is essential that the staffs working such patients take a positive approach rather
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than relying on corrective measures of behavioural treatment. The therapist needs to engage a

trustworthy relationship with the patient where they are at liberty to motivate them towards better

judgement. It is essential that the immediate family members are involved in the process of care

with respect to the consent and confidentiality of the treatment (Megnin-Viggars et al., 2015). It

needs to be ensured that the lack of access to the treatment is not limited to the family members.

The family members need to provide with the local community support, individual therapy

groups and teenage support groups to help the patient (Megnin-Viggars et al., 2015). The family

of the patient needs to be informed regarding the antisocial behaviour and the immediate threat

that the patient might cause within a family. The consequences of alcohol abuse and its

rehabilitation support need to be provided to the patient’s family. The parents need to be warned

and advised to safeguard and younger individuals in the group who may be victimized by the

individual with ASPD.

References

Bateman, A., O’Connell, J., Lorenzini, N., Gardner, T., & Fonagy, P. (2016). A randomised

controlled trial of mentalization-based treatment versus structured clinical management

for patients with comorbid borderline personality disorder and antisocial personality

disorder. BMC psychiatry, 16(1), 304.

Black, D. W. (2015). The natural history of antisocial personality disorder. The Canadian

Journal of Psychiatry, 60(7), 309-314.

Megnin-Viggars, O., Symington, I., Howard, L. M., & Pilling, S. (2015). Experience of care for

mental health problems in the antenatal or postnatal period for women in the UK: a

systematic review and meta-synthesis of qualitative research. Archives of women's mental

health, 18(6), 745-759.

Patrick, C. J., & Brislin, S. J. (2014). Antisocial personality disorder/psychopathy. The

Encyclopedia of Clinical Psychology, 1-10.

Riley, M., Ahmed, S. and Locke, A., 2016. Common Questions About Oppositional Defiant

Disorder. American family physician, 93(7).

Scott, S. (2015). Oppositional and conduct disorders. Rutter’s child and adolescent psychiatry, 6,

966-980.

Wilson, H. A. (2014). Can antisocial personality disorder be treated? A meta-analysis examining

the effectiveness of treatment in reducing recidivism for individuals diagnosed with

ASPD. International Journal of Forensic Mental Health, 13(1), 36-46.

Wygant, D. B., Sellbom, M., Sleep, C. E., Wall, T. D., Applegate, K. C., Krueger, R. F., &

Patrick, C. J. (2016). Examining the DSM–5 alternative personality disorder model

operationalization of antisocial personality disorder and psychopathy in a male

correctional sample. Personality Disorders: Theory, Research, and Treatment, 7(3), 229.