Assignment:

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned. What are their similarities and differences? How might you differentiate the two diagnoses? Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Respond # 1

Diagnostic Criteria for Boderline Personality Disorder

Patients suffering from Borderline Personality Disorder have a fear of abandonment or difficulty in sustaining being left alone (Gunderson et al., 2018). It usually starts at a minor age and worsen in young adulthood but may resolve with age later in life. Persons with borderline respond well to the treatment and can live satisfying lives for long. A client with borderline personality disorder has a pattern of unstable interpersonal relationships, poor self-image, impulsivity, and unstable mood and affect (Sadock, Sadock, & Ruiz, 2014).  Diagnostic and Statistical Manual of Mental Disorders (DSM 5) notes that five or more criteria should be met which include affective instability, inappropriate anger, impulsivity, unstable relationships, feelings of emptiness, paranoia or dissociation, identity disturbance, abandonment fears, and suicidality or self-injury (Hall & Riedford, 2017). Hall and Riedford (2017) also note that most client display all these characteristics.

Evidenced-based Psychotherapy and Psychopharmacologic treatment for Boderline Personality Disorder

When one is diagnosed with a borderline personality disorder, there are several treatment modalities that the patient may be taken through. Psychotherapy is the mainstay treatment for borderline personality disorder. Also referred to as talk therapy, is use of psychological ways like personal interaction, listening to individual talk about their problems, also helping one overcome their obstacles (Borderline personality disorder – Symptoms and causes., 2018). “Several types of psychotherapy include; dialectical behavior therapy which is skills-based to enable educate individuals on how to handle their challenges and to tolerate stress. Schema-focused therapy, is focused on dealing with the unmet needs of the individual that might promote positive living. Transference-focused psychotherapy, assist the individual in understanding their emotions and difficulties through creating a relationship with the therapist” (Gunderson et al., 2018).

At the moment there are no specific drugs meant to manage borderline personality disorder, but treatment-using drugs might be done in the management of a patient presenting with depression, anxiety and impulsiveness (Gunderson et al., 2018). Aripiprazole has shown effectiveness in reductions in anger, impulsivity, depression, and anxiety (Parker & Naeem, 2019). Olanzapine has demonstrated some small improvements in anger and anxiety (Parker & Naeem, 2019). Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can be help with symptoms of depression for clients with borderline personality disorder (Sadock, Sadock, & Ruiz, 2014).

Clinical Features from client that led to diagnosis of Boderline Personality Disorder

Symptoms of borderline personality disorder can be challenging to both the individual and the people living around them (Livesley, & Larstone., 2018). Therefore, when a nurse or a doctor diagnoses one with a borderline personality disorder, they should be cautious in delivering the diagnostic message. One because it might spoil the therapeutic relationship, and two because they have a wide range of mood and the suicidal thought which might cause self-injury. The patient is taken through the condition and its complications; then it’s made known to them that they are suffering from the disorder. The nurse will reassure the patient and assist them in coping with the condition.

I remember a former client who had a history of self injurious behavior, chronic passive suicidal ideation, erratic mood swings, unstable personal relationships, lack of insight, and fear of abandonment. She was ultimately diagnosed with borderline personality disorder. She embodied most of the DSM-5 criteria with at least 7 or more of the characteristics. When you meet a client with these characteristics, you will know almost instantly that they have Borderline Personality Disorder

Colleagues Respond # 2

Week 3 Main post-Paranoid, schizotypal and schizoid personality disorders

The personality disorders assigned to me are paranoid, schizotypal, and schizoid personality disorders. According to Hasan, Kirchner, Nolden, &Roeh (2018) schizotypy is a heterogenous syndrome with two types which are neurodevelopmental schizotypy with relatively stable traits and significant brain and neurocognitive impairments that predispose to schizophrenia, and pseudoschizotypy, a pronounced psychosocial entity with more symptom fluctuation that is unrelated to schizophrenia. Paranoid personality disorder is a psychiatric diagnosis assigned to individuals who persistently perceive interpersonal threats and danger without sufficient evidence or cause (Lewis & Ridenour 2020).

Diagnostic Criteria for Paranoid, schizotypal and Schizoid Personality Disorder.

Individuals with schizotypal personality disorder has a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior beginning by early adulthood (American psychiatric association 2013). The criteria  for the diagnosis are indicated by the presence of  five or more of the following such as ideas of reference excluding delusions of reference, odd believes or magical thinking that influences behavior such as superstitiousness, belief in clairvoyance, telepathy or sixth sense which are inconsistent with the subcultural norms, unusual perceptual experiences including bodily illusions, odd thinking and speech such as vague, circumstantial, metaphorical, overelaborate, stereotyped speech, suspiciousness or paranoid ideation, inappropriate or constricted affect, behavior or appearance that is odd, eccentric or peculiar, lack of friends or confidents other than first degree relatives, excessive social anxiety that does not diminish with familiarity and tend to be associated paranoid fears than negative judgement about self (American psychiatric association 2013)

The essential feature of schizoid personality disorder which begins in early adulthood is a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings (American psychiatric association 2013). The diagnosis is made if the individual meet four or more of the criteria such as neither desire or enjoy close relationships including being part of the family, always choose solitary activities, little interest in having sex with another person, experience pleasure in few activities, lacks close friends or confidants other than first degree relatives, appears indifferent to the praise or criticism of others and shows emotional coldness, detachment or flattened activity. It should not occur during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, another psychotic disorder or autism spectrum disorder and is not attributable to any physiological effect of another medical condition (American psychiatric association 2013)

The essential feature of paranoid personality disorder is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent and it begins by early adulthood (American psychiatric association 2013).  The diagnosis is based on the presence of four or more of the criteria such as suspects without sufficient basis that others are exploiting, harming or deceiving him or her, is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates, is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her, reads hidden demeaning or threatening meanings in to benign remarks or events, persistently bears grudges such as unforgiving of insults, injuries or slights, perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack (American psychiatric association 2013).    

Evidenced-Based Psychotherapy and Psychopharmacologic Treatment for Paranoid, Schizotypal, and Schizoid Personality Disorders.

Individual psychotherapy can be effective to certain extent for individuals with paranoid personality disorder. Paranoid person will assume hostility more readily than friendliness as they are poor at empathic mindreading (Gabbard 2014). They lack capacity for empathy and mind-reflection which makes the individual psychotherapist job more arduous to help them gain insight, and in making them salutary changes in their interaction with others and it is occasionally successful. The best approach to these clients is supportive therapy than psychoanalytically oriented individual psychotherapy (Gabbard 2014). Cognitive-behavior therapy also is effective where the focus is on patient’s distorted assumptions. Paranoid individuals because of their hypersensitivity, poor empathic skills, and tendency to misinterpret the motivations and attitudes of others, they are very uncomfortable in the group therapy session (Gabbard 2014). However, group therapy among paranoid patients in forensic hospitals are found effective against violence (Gabbard 2014). On the psychopharmacological treatment, use of antipsychotics on low doses such as risperidone 1-2 mg or Haldol 5mg/day can be effective (Gabbard 2014). However, the chances of being reluctant to accept the medication due to the paranoid believes are higher. In forensic hospitals, the chances of making use of court order for medication over objection would help overcome this problem (Gabbard 2014). Patients with nonpsychotic forms of paranoid personality such as entrenched racial or religious bigotry, pathological jealousy, litigious injustice collectors can never be expected to have therapeutic effectiveness through pharmacological treatment however evidence have shown positive results to pimozide (Gabbard 2014).

The schizotypal personality disorder (STPD) can be treated with individual psychotherapy such as individual, cognitive and supportive psychotherapy. According to Gabbard (2014) fewer schizotypal patients will reap significant benefits from analytically oriented or strictly behavioral interventions of individual psychotherapy. Group therapy for STPD can be an adjunct measure along with individual psychotherapy (Gabbard 2014). STPD who are more eccentric or odd appearing can be a challenge to conventional patients in the group. The family therapy will have a very useful impact in educating parents about the discrepancy between hopes and reality and help reduce the family’s impatience or negativity towards a schizotypal child (Gabbard 2014). The pharmacological treatment for STPD depends on the clinical presentation of the individual. As they have diverse clinical presentation, there is no one single medicine available to treat the condition (Gabbard 2014). STPD at the schizophrenic pole may be treated with antipsychotics at low doses for brief periods. They can be treated with anxiolytics if symptoms of anxiety present and with mood stabilizers for global functioning (Gabbard 2014).

Schizoid persons tend to function well in the community and in their occupation and never feel the need for psychiatric treatment. Feeling of shame is the usual problem for those who ever seek help. Supportive psychotherapy is effective and they tend not to interact in a group and it may not be useful to them and the same is applicable to family therapy. They do not need any pharmacotherapy (Gabbard 2014).

Among the three personality disorders the most amenable to therapy is schizotypal PDs as they are more prone to form relationships and seek help than the other two (Gabbard 2014).

Clinical Features of a Client who had Schizotypal personality disorder

Mr. DF who is a 34 years old male admitted in forensic psychiatric unit after committing first degree murder and the victim was his girlfriend. The individual has paranoid traits combined with schizotypal traits. He believed that her girl fiend has a relationship with another male and the other man comes to his house every day without his knowledge. He also believes that the name of the man with whom his girl-friend goes with has a specific name which has a special meaning in targeting his financial matters.  He believed that the doors can be opened with out him knowing as his girl friend has a special power in doing everything without his knowledge and she cheats him and attempts to get all his money and property. He also believes that when his girlfriend sleeps on the bed near him he have the capacity to read her mind and thoughts and that is his source of information. He acknowledged that he started using cocaine since the age of 24 and he started to use it almost every day before he killed his girl-friend by shooting her. He has no close friends or never shared anything with anybody other than to his parents.

Comparison of Clinical features with the DSM-5 criteria.

To diagnose with schizotypal personality disorder (STPD), the individual must have met four or more criteria in DSM5. The individual in the clinical picture has idea of reference where he is referring the name of the man who he believes comes to his house, has a specific intention in targeting his financial matter. He has the magical thinking that his house doors can be opened without his knowledge as his girl-friend had special power in doing it. He also believed that he has the capacity to read the mind of his girl-friend. He has paranoid delusions about his girl-friend saying that she and her male friend had attempted to cheat him which caused him to kill her. He also acknowledged that he used cocaine since the age of 24 for almost ten years. He did not maintain any close relationship with any friends. All these features are consistent with the DSM 5 criteria for schizotypal personality disorder.