THE ASSIGNMENT: FOCUSED SOAP NOTE
Personality and Paraphilic Disorders
- Select a child/adolescent patient from your clinical experience that presents with a significant concern. Create a focused SOAP note for this patient using the template in the Resources.
- Your presentation should include objectives for your audience, at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources from 2018-2022 to support your diagnostic reasoning and treatment plan.
- Be succinct in your presentation, and specifically address the following for the patient, using your SOAP note as a guide.
- Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
- Objective: What observations did you make during the psychiatric assessment?
- Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5-TR diagnostic criteria and is supported by the patient’s symptoms.
- Plan: What was your plan for psychotherapy (include one health promotion activity and patient education)? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Discuss an identified social determinate of health impacting this patient’s mental health status and provide your recommendation for a referral to assist this patient in meeting this identified need (students will need to conduct research on this topic both in the literature and for community resources).
- Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be.
- Case Formulation
REQUIRED LEARNING RESOURCES
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
- Chapters 31, “Assessing Personality Disorders”
- Chapter 32, “How to Educate Your Patient”
Controversy Associated with Personality and Paraphilic Disorders
There are numerous controversies associated with personality and paraphilic disorders. Most personality and paraphilic are malleable across diverse cultures, challenging mental healthcare providers in defining, diagnosing, and managing these disorders. Complications of personality and paraphilia can lead to severe health and societal problems. The disorders increase the risks of self-harm and others in society and can lead to imprisonment for crimes. Therefore, mental health providers should identify the controversies associated with the disorders to improve diagnosis and treatment. This paper will describe borderline personality disorder, potential controversies, professional beliefs, strategies for maintaining therapeutic relationships with patients, and ethical and legal considerations for the disorder.(Personality and Paraphilic Disorders Essay Example)
Patients with Borderline Personality Disorder (BPD) present fear of being alone, feelings of loneliness, emptiness, unpredictable outbursts of range, self-injurious/suicidal behavior, and severe instability. The conception of BPD has been controversial owing to the stigma linked with mental health practitioners’ diagnosis and therapeutic nihilism in managing highly prevalent patients with this mental illness (Campbell et al., 2020). There has been a long debate on whether BPD is understood as dimensional rather than categorical.(Personality and Paraphilic Disorders Essay Example)
While the debate extends to most psychiatric conditions, there is a rich tradition regarding personality traits as dimensional. The exact etiology of BPD remains unknown, although it has been linked with child trauma, invalidating environments, and temperament. Additionally, there is a controversy on the differentiation of BPD with other mental health conditions. Recent research developments have led to controversies since the assessable BPD variables remain unclear. Determining the severity and grade for most personality disorders has also been unclear, making management challenging without grading tools.(Personality and Paraphilic Disorders Essay Example)
Inadequate assessment and evaluation of patients’ symptoms render BPD management almost impossible. The disorder leads to a poor self-image and low self-esteem, affecting the patients’ interaction with others and behavior (Pohl et al., 2021). As a result, the patients encounter challenges maintaining positive relationships with others and have poor social interaction. Patients with BPD are also highly opinionated, leading to drastic changes in how they perceive others (Ratcliffe & Bortolan, 2020). As such, the patients’ opinions are likely to affect interpersonal relationships, hindering them from maintaining positive relationships. Stigmatization also elicits poor outcomes among BPD patients. Importantly, familial, functional, and structural brain, social, cultural, and environmental factors are instrumental in evaluating and managing patients with BPD. Therefore, mental health practitioners should conduct comprehensive patient assessments to devise appropriate interventions that meet patients’ needs. Health professionals should also research to obtain evidence-based information to provide the best available practices and promote interprofessional collaboration for effective BPD management (Gryesten et al., 2021).
Strategies for Maintaining Therapeutic Relationships
Comprehensive patient assessment aids in maintaining a therapeutic relationship with BPD patients. Health professionals should ensure they obtain as much information as possible during their first patient encounter. As such, the healthcare provider fully understands patients’ problems and needs to devise a diagnosis and intervention plan. The practitioners also create good rapport to foster effective communication that improves patient care. Secondly, interprofessional collaboration is instrumental in maintaining therapeutic relationships with BPD patients. Health and social care providers such as mental health nurses, social health workers, and practitioners collaborate with patients and their families/caregivers to address diverse patients’ needs. Interprofessional collaboration maintains therapeutic and positive relationships between patients and healthcare professionals by respecting patients’ values, beliefs, or preferences (Gryesten et al., 2021). Additionally, practitioners should be empathetic while handling patients. They should use open-ended questions to allow patients to express their problems fully. Mental health practitioners should also take immediate corrective actions against patients with self-harm or suicidal idealizations while showing social support to promote patients’ health and well-being.(Personality and Paraphilic Disorders Essay Example)
Ethical and Legal Considerations
Ethical clinical decision-making concerning psychiatric diagnosis challenges mental practitioners for several reasons. For instance, patients with BPD may present with suicidal thoughts and behaviors that inform mandatory hospitalization, one of the dilemmas for practitioners. BPD patients also have high-unmet needs from inadequate treatment and access to services. However, people with BPD and other mental health professionals should receive legal health services without discrimination. Subsequently, ethical considerations such as non-discrimination and patient care without judgment should be prioritized (Stavert & McKay, 2020). Mental practitioners should also uphold patient autonomy and informed consent during interventions. The patients should also be informed about their interventions, benefits, and risks, while their personal information remains confidential. The ethical and legal considerations ensure that patients receive quality care services and that their rights and privileges are protected while making mental health services accessible to promote healthier communities.(Personality and Paraphilic Disorders Essay Example)
Controversies associated with mental health disorders continue to affect diagnosis and effective management. Personality and paraphilic disorders are commonly challenging for mental health practitioners. For instance, the lack of clear assessable variables has made the diagnosis of BPD challenging. However, comprehensive patient assessment and EBP implementation will improve BPD diagnosis and management. Maintaining therapeutic relationships with patients through effective communication and observing ethical and legal considerations while diagnosing and managing BPD patients is vital for improved outcomes.(Personality and Paraphilic Disorders Essay Example)
Campbell, K., Clarke, K. A., Massey, D., & Lakeman, R. (2020). Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. International Journal of mental health nursing, 29(5), 972-981. doi: 10.1111/inm.12737
Gryesten, J. R., Brodersen, K. J., Lindberg, L. G., Carlsson, J., & Poulsen, S. (2021). Interpreter-mediated psychotherapy–a qualitative analysis of the interprofessional collaboration between psychologists and interpreters. Current Psychology, 1-14. https://doi.org/10.1007/s12144-021-01345-y
Pohl, S., Steuwe, C., Mainz, V., Driessen, M., & Beblo, T. (2021). Borderline personality disorder and childhood trauma: Exploring the buffering role of self‐compassion and self‐esteem. Journal of Clinical Psychology, 77(3), 837-845. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jclp.23070
Ratcliffe, M., & Bortolan, A. (2020). Emotion Regulation in a Disordered World. Time and Body: Phenomenological and psychopathological approaches, 177. https://doi.org/10.1017/9781108776660.015
Stavert, J., & McKay, C. (2020). Scottish mental health and capacity law: The normal, pandemic and ‘new normal.’ International Journal of Law and Psychiatry, 71, 101593. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305488/
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