I need about 100 words for each question and each question with its own references. Please, no Plagiarized work

Topic 1: Genomics

DQ 1

Name three essential structural elements of a functional eukaryotic chromosome and describe their functions. Discuss the implications related to research, health, and life span in terms of one of the structural elements.

DQ 2

Describe the difference among replication, transcription, and translation for both DNA and RNA.

Topic 2: Genetics I

DQ 1

Describe at least four factors that can be associated in a complex inheritance health issue.

DQ 2

Compare two genomic tests used for screening, diagnosis, and management of a disease. Describe whether outcome data exists related to the utility of these tests and what the data shows, if available.

Topic 3: Genetics 2

DQ 1

Contrast two models used for multigenerational family health histories. Which do you prefer and why?

DQ 2

Describe the importance of a comprehensive health and physical assessment that includes information on environment, and genomic influences. Frame this answer through your current role, whether as an Advanced Registered Nurse Practitioner (ARNP) with a practice, or a nurse executive overseeing nursing practice in an organization.

Topic 4: Personalized Genetic Medicine

DQ 1

Genetics testing is viewed as either positive or negative. When used to detect the genes for breast cancer, health insurance companies deny care based on genetics. Why? Describe one genetic test and its impact on health, prevention, screening, diagnostics, treatment selection, and treatment effectiveness.

DQ 2

Evidence-based practice and standardized clinical guidelines have improved organizations and the ability of providers to provide the care with the highest level of evidence to each patient. Describe one pharmacological agent with a protocol/clinical guideline that is used. Discuss how this protocol may not take into consideration genetic variations. What can be done to tailor care to each patient while providing standardized treatments?

Topic 5: Nutrition

DQ 1

Describe one health issue and discuss how nutrition can impact this health issue positively and negatively.

DQ 2

Choose one disorder of malnutrition. Discuss the genetic and environmental influences on this disorder, including prevalence rates, testing, treatment, and prognosis.

Topic 6: Aging

DQ 1

Discuss how genetic and genomics can play a role in a demand for new health services and how it may impact health care expenditures in the aging population. Give one example.

DQ 2

Describe one method that includes using evidence-based data to support a new or innovative ways to care for the aging now or in the future. How will it impact care and what are the anticipated outcomes?

Topic 7: Chronic Disease

DQ 1

Discuss how genetic and genomics can play a role in a demand for new health services and how it may impact health care expenditures in the chronic disease population. Give one example.

DQ 2

Describe one method that includes using evidence-based data to support a new or innovative way to care for those with chronic disease now or in the future. How will it impact care and what are the anticipated outcomes?

Topic 8: Ethical and Legal Considerations

DQ 1

Choose one recent (within last 2 years) news story about genetic or genomic technology. Describe the issue presented. From the perspective as an RN or APRN, describe the ethical, cultural, religious, legal, fiscal, and societal implication.

 

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NURS 3315 Holistic Health Assessment

©2017 UTA School of Nursing Page 1 of 2

Week 5

Culture and Healthcare

Learning about culture is interesting and fun…but how does that relate to

assessment? This is a HOLISTIC health assessment class, and we want you to be

able to consider the whole patient, including cultural aspects. How will knowing

about culture be important to the nurse? This week, on the discussion board, locate

a professional article from the UTA library website or from Google Scholar, from the

last 5 years, that addresses cultural beliefs and health care in some way.

Summarize/paraphrase the article, cite it according to APA standards, and then put

the reference at the bottom of the page. This should be done in no more than 2 – 3

paragraphs. COPY and PASTE your work into an entry on the discussion board—

opening attachment after attachment quickly becomes tedious. Entitle the

discussion entry with your name and the subject, for example: “Doe, Jane: Preterm

birth and culture”.

You will receive points as per the rubric and instruction template this week by

posting your summary, and by replying to 2 other students with a substantive

comment.

Rubric:

Module 5 Discussion Board Instructions

NURS 3315 Holistic Health Assessment

©2017 UTA School of Nursing Page 2 of 2

Levels of Achievement

Criteria Proficient Competent Novice Work

missing

Quality and

Timeliness

Weight 25.00%

100 % Submits one initial

response by

Wednesday in the

session.

75 % Submits a post of

some value but

lacking in

understanding or

depth.

25 % Post not

substantive, of

poor quality.

0 % Late or no

submission

Spelling and

Mechanics

Weight 25.00%

100 % No spelling,

grammatical, or

punctuation errors.

High-level use of

vocabulary and word

choice.

75 % Few (1 to 3)

spelling,

grammatical, or

punctuation errors.

Good use of

vocabulary and

word choice.

25 % Minimal (3 to 5)

spelling,

grammatical, or

punctuation errors.

Low-level use of

vocabulary and

word choice.

0 %

Demonstrates

knowledge and

understanding of

content and

applicability to

professional

practice

Weight 25.00%

100 % Post(s) and responses

show evidence of

knowledge and

understanding of

course content and

applicability to

professional practice.

Includes other

resources that extend

the learning of the

community.

60 % Post(s) show

evidence of

knowledge and

understanding of

course content and

applicability to

professional

practice.

20 % Post(s) show little

evidence of

knowledge and

understanding of

course content and

applicability to

professional

practice.

0 %

Responses to

others by

Saturday night at

2359

Weight 25.00%

100 % Submits two or more

thoughtful peer

responses which show

evidence of

understanding of

course content and

applicability to

professional practice.

50 % Submits one

thoughtful

response or two of

moderate quality

25 % Submits responses

of little value.

0 % No response

or just a

comment of

no educational

value. Late or

no submission

 

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The American Cancer Society (ACS) is a nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem. Together with its supporters, ACS is committed to helping people stay well and get well by finding cures and by fighting back.

Critical Thinking Questions:

1. Imagine that a family friend or colleague has just been diagnosed with cancer. Explain how the American Cancer Society might provide education and support. What ACS services would you recommend and why?
2. According to statistics published by the American Cancer Society, there will be an estimated 1.5 million new cancer cases diagnosed each year over the next decade. What factors contribute to the yearly incidence and mortality rates of various cancers in Americans? What changes in policy and practice are most likely to affect these figures over time
3. Select a research program from among those funded by the American Cancer Society. Describe the program and discuss what impact the research will have on the prevention or treatment of cancer.

 

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Correspondence: Alexander Chapman, PhD, Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 4Z1 Canada. Tel: (778) 782-6932. Fax: (778) 782-3427. E-mail: alchapma@sfu.ca

(Received 7 April 2011 ; accepted 5 May 2011 )

Psychotherapy for personality disorders

KATHERINE L. DIXON-GORDON , BRIANNA J. TURNER & ALEXANDER L. CHAPMAN

Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada

Abstract Personality disorders are widely prevalent among those seeking mental health services, resulting in substantial distress and a heavy burden on public assistance and health resources. We conducted a qualitative review of randomized controlled trials (RCTs) of psychosocial interventions for personality disorders. Articles were identifi ed through searches of electronic databases and classifi ed based on the focus of the psychological intervention. Data regarding treatment, participants and outcomes were identifi ed. We identifi ed 33 RCTs that evaluated the effi cacy of various psychosocial treatments. Of these studies, 19 focused on treatment of borderline personality disorder, and suggested that there are several effi cacious treat- ments and one well-established treatment for this disorder. In contrast, only fi ve RCTs examined the effi cacy of treatments for Cluster C personality disorders, and no RCTs tested the effi cacy of treatments for Cluster A personality disorders. Although other personality disorders, especially Cluster A, place heavy demands on public assistance, and in spite of recommendations that psychosocial interventions should be the fi rst line of treatment for these disorders, our review underscored the dearth of treatment research for many of these personality disorders. We highlight some obstacles to such research and suggest directions for future research.

Introduction

According to the DSM-IV, personality disorders (PDs) are defi ned as pervasive, non-normative patterns of thought and behaviour which are long- standing, and cause signifi cant impairment in rela- tionships and overall functioning (APA, 2000, p. 685). The DSM-IV includes ten PDs, organized into three clusters: Cluster A disorders, comprising schizoid, paranoid and schizotypal PDs, are charac- terized by odd or eccentric patterns of behaviour; Cluster B disorders, comprising antisocial, border- line, narcissistic and histrionic PDs, are character- ized by dramatic or impulsive patterns of behaviour; and Cluster C disorders, comprising avoidant, dependent, and obsessive – compulsive PDs, are char- acterized by anxious or fearful behaviours. PDs are highly prevalent, with 31 – 45% of psychiatric patients and 10 – 15% of the general adult population meeting criteria for at least one PD (Samuels et al., 2002; Zimmerman & Coryell, 1989).

Personality disorders are associated with substan- tial personal and interpersonal distress, functional impairment, and use of mental health resources (Perry, 1993; Perry & Vaillant, 1989; Skodol, Johnson, Cohen, Sneed, & Crawford, 2007). In fact,

individuals with PDs make up a substantial portion of mental health service consumers (Fyer, Frances, Sullivan, Hurt, & Clarkin, 1988; Markowitz, Moran, Kocsis, & Frances, 1992; Oldham, Skodol, Kellman, & Hyler, 1995; Skodol et al., 1993; Vaughn et al., 2010). Further, early literature documenting limited gains in psychotherapy among individuals with PDs compared to those without PDs (Diguer, Barber, & Luborsky, 1993; Fahy, Eisler, & Russell, 1993; Hardy et al., 1995; Karterud et al., 1992; Shea, Pilkonis, Beckham, & Collins, 1990; Woody, McLellan, Luborsky, & O ’ Brien, 1985) fuelled the assumption that individuals with personality disor- ders may be ‘ untreatable ’ (Lewis & Appleby, 1988).

Although people who hold this assumption have been taken to task with the emergence of mounting evidence for the effi cacy of treatments for PDs, PDs are associated with signifi cant challenges for psycho- therapy. For example, interpersonal, self and identity dysfunction are often hallmark features of various PDs (Livesley, 2003); thus, it is not surprising that the formation and maintenance of a positive working alliance can be a challenging endeavour (Benjamin & Karpiak, 2002; Colson et al., 1985; Muran, Segal, Samstag & Crawford, 1994). Individuals with PDs

International Review of Psychiatry, June 2011; 23: 282–302

ISSN 0954–0261 print/ISSN 1369–1627 online © 2011 Institute of Psychiatry DOI: 10.3109/09540261.2011.586992

Psychotherapy for personality disorders 283

often present to therapy with a variety of challenging behaviours that require attention, including sub- stance use, eating disorders, self-injury, suicidality, and violent or aggressive behaviour (Grant et al., 2004). Moreover, patients with particular PDs pres- ent to treatment with an average of roughly three co-occurring Axis-I disorders (Harned et al., 2009; McMain et al., 2009), making it diffi cult to defi ne and prioritize treatment targets, and to ascertain meaningful ‘ progress ’ . The clinical complexity of these patients can lead to distress, demoralization and burn-out on the part of therapist (Chapman, 2009; Rossberg, Karterud, Pedersen, & Friis, 2008). Individuals with PDs are also more likely to prema- turely terminate therapy compared to those without PDs (Karterud et al., 1992; Skodol, Buckley, & Charles, 1983). Thus, it is not surprising that work with these individuals is sometimes marked by frus- tration on the part of both therapist and patient regarding the rate of therapeutic progress (Murphy & McVey, 2010; Watts & Morgan, 1994).

Research indicates that many mental health pro- fessionals hold a variety of negative beliefs about individuals with PDs, including, for example, that these patients are challenging, attention-seeking, manipulative and even ‘ annoying ’ (Cleary, Siegfried, & Walter, 2002; Fraser & Gallop, 1993; Gallop, Lancee, & Garfi nkel, 1989; James & Cowman, 2007; Lewis & Appleby, 1988). Further, many mental health professionals believe that patients with PDs are less likely to respond to intervention, more likely to pose challenges for clinical management, and are less deserving of mental health resources than indi- viduals without personality disorders (Lewis & Appleby, 1988). Such negative beliefs about indi- viduals with PDs are associated with less empathic and respectful responses, use of punitive sanctions and an overall reduction in adherence to reasonable standards of care (Bowers, 2002; Fraser & Gallop, 1993; Gallop et al., 1989; Watts & Morgan, 1994). Thus, prior to the last 20 years or so, the initial pic- ture regarding psychotherapy for PDs looked gloomy indeed: not only did research suggest that individuals with PDs were among the most treatment resistant patients, but also some clinicians took these fi ndings to heart and often responded to these patients with hopelessness or negativity.

Despite this worrisome beginning, recent evidence supports a much more optimistic outlook regarding the effi cacy and effectiveness of psychotherapy for individuals with personality disorders. In fact, a range of psychosocial treatments seem to be associ- ated with positive outcomes among those with PDs (Livesley, 2003). One review of 15 psychotherapy outcome studies revealed large effect sizes for self- and observer-rated outcomes in both naturalistic and randomized, controlled trials (RCTs) examining

psychotherapy for a variety of PDs (Perry, Banon, & Ianni, 1999). Further, a meta-analytic review of psychotherapy for individuals with Cluster C disorders revealed that these patients signifi cantly improve with cognitive behavioural therapy, psycho- dynamic therapy and social skills training, and these treatment gains are often main tained into follow-up periods of 3 months to 3 years (Simon, 2009). Finally, several RCTs using varied modes and styles of therapy have revealed promising improve- ments with psychotherapy for individuals with PDs (Arnevik et al., 2009; Bateman & Fonagy, 1999, 2008; Giesen-Bloo et al., 2006; Linehan et al., 2006; Svartberg, Stiles, & Seltzer, 2004). Given the evidence that hopelessness or pessimism regarding the ability to treat PDs can negatively impact the care that these patients receive (Bowers, 2002; Gallop et al., 1989; Fraser & Gallop, 1993; Watts & Morgan, 1994), it is crucial that mental health professionals familiarize themselves with this devel- oping literature.

Evaluating psychotherapy

Over the past several decades, increasing attention and effort has been directed toward understanding whether psychotherapy works. To address this ques- tion, researchers undertook a scientifi cally rigorous examination of the effects of psychotherapy for numerous mental disorders, with accumulating evi- dence pointing to positive effects for a variety of therapies (Smith & Glass, 1977). In 1995, Division 12 (Clinical Psychology) of the American Psycho- logical Association began a Task Force on Promo- tion and Dissemination of Psychological Procedures and a Task Force on Psychological Intervention Guidelines in order to further understand and promote the scientifi c support for psychological interventions. A few years later, Chambless and Hollon (1998) published comprehensive guidelines for established that a particular therapy is ‘ empiri- cally supported ’ . Briefl y, Chambless and Hollon (1998) note that, in order to be considered effi ca- cious, a therapy must have been shown to be benefi – cial in at least two carefully controlled studies. Specifi cally, the authors recommend putting the greatest weight on evidence derived from random- ized, controlled trials (RCTs), or trials in which par- ticipants are randomly assigned to receive the therapy in question or to a comparison condition (e.g. wait- ing list, treatment as usual, etc.), with the next great- est weight going to carefully controlled single-case or group experiments. In contrast, uncontrolled studies do not have comparison groups, and non- randomized studies involve non-random assignment to treatment conditions. Studies conducted as RCTs provide the strongest evidence that the observed

284 K. L. Dixon-Gordon et al.

effects are due to the therapy in question, and not to other confounding or common factors. Further, to reduce potential allegiance effects, evidence of a therapy ’ s benefi ts must be found by at least two inde- pendent researchers. If only one study is available to support the therapy or if the studies have all been conducted by the same research team, the therapy may be considered ‘ possibly effi cacious ’ . Chambless and Hollon (1998) also outline a number of metho- dological considerations that should be evaluated in order to determine that the data is of suffi cient qual- ity as to ensure confi dence in the conclusions, and provide guidelines for evaluating effi cacy when there are confl icting results.

In addition to evaluating a treatment ’ s effi cacy, Chambless and Hollon (1998) recommend the consideration of two other criteria: specifi city and effectiveness. To be considered specifi c, the therapy must be effi cacious and must demonstrate superior effects when compared with a control condition that incorporates the nonspecifi c processes of psycho- therapy, such as warmth, attention, expectation of change, and therapeutic rituals and rationales, among other factors (Wampold et al., 1997). A common way to evaluate specifi city is to compare the psycho- therapy under consideration to a ‘ treatment as usual ’ condition, often defi ned as treatment by existing programmes or resources in the community. A more stringent test of specifi city is to compare the therapy against another bona fi de or manualized treatment. For a therapy to be considered effective, a treatment must be shown to produce benefi ts in ‘ the real world ’ of clinical practice, where many of the stringent controls that characterize RCTs may not be present. In addition, Chambless and Hollon (1998) recommend that researchers and clinicians attend to the generalizability, feasibility and cost- effectiveness of therapy in clinical practice.

In this paper, we provide a review of the empirical literature evaluating psychotherapy for PDs. Using PsycINFO and Google Scholar, we searched for papers using the following key words on their own and in combination: personality disorder, Cluster A, Cluster B, Cluster C, psychotherapy, intervention, treatment, randomized controlled trial. Specifi cally, we have focused our review on evidence gleaned from randomized, controlled trials (RCTs) (see Table I). We excluded treatments developed for co-occurring diagnoses (e.g. treatments developed for an Axis I disorder and co-occurring PD). Where no RCTs were found, however, we provide a brief review of uncontrolled or case studies. Although not reviewed here, it is important to note that a wealth of naturalistic and case studies have evaluated therapy outcomes in PDs, also suggesting promise for various psychological approaches.

Evidence-based treatments for personality disorders

Unlike the Axis I psychotherapy literature, which often focuses on the evaluation of the effi cacy and effectiveness of particular therapeutic approaches within discrete diagnostic groups (e.g. CBT for depression, prolonged exposure for PTSD), much of the literature on psychotherapy for Axis II disorders examines the effi cacy of a therapeutic approach for individuals who meet criteria for a range of PDs. This approach makes intuitive sense, given that PDs have high rates of co-occurrence with other PDs (Conklin & Westen, 2005; Critchfi eld, Clarkin, Levy, & Kernberg, 2008; Hillbrand, Kozmon, & Nelson, 1996; Zanarini et al., 1998) and with Axis-I pathology (Skodol et al., 2002b; Zanarini et al., 1998). One notable exception to this trend is the case of borderline personality disorder (BPD), for which specialized treatment approaches have been devel- oped. Studies evaluating treatments to reduce crim- inal recidivism often include substantial proportions of individuals with antisocial personality disorder (ASPD), given the high prevalence of ASPD in offender populations (Hart & Hare, 1989); however, few studies have evaluated the treatment of ASPD specifi cally, and few studies of offender treatment explicitly separate fi ndings for those with ASPD versus those without (Duggan, Huband, Smailagic, Ferriter, & Adams, 2007). A few studies have also evaluated the effi cacy of psychotherapy for Cluster C disorders. Thus, we will fi rst review the evidence for the effi cacy of psychotherapy for per- sonality disorders in general; next, we present a review of the effi cacy of therapeutic approaches that have been developed to target-specifi c PDs.

Randomized controlled trials for mixed personality disorders

After a review of the empirical literature, we identifi ed six RCTs that have examined the effi cacy and specifi city of psychotherapy for mixed PDs (cf. Duggan et al., 2007). Across studies, the most common personality disorder diagnoses included borderline (24.4 – 44.4%), avoidant (5.4 – 40.3%), and obsessive – compulsive (16.2 – 37%). Less fre- quent diagnoses included schizotypal, schizoid, dependant, histrionic, antisocial, and narcissistic PDs, although there was considerable variability across studies. Among these studies, psychodynamic therapies were the most frequently examined thera- peutic approach.

Of these studies, two utilized waiting list control conditions (Huband, McMurran, Evans, & Duggan, 2007; Winston et al., 1994). In the fi rst

Psychotherapy for personality disorders 285 T

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A PMHNP is using Gestalt therapy to communicate with a 50-year-old patient who is going through a divorce. As he is calmly sharing the details of his divorce, the PMHNP notices that Dave is tapping his fingers on his legs. What is an appropriate response by the PMHNP using the technique of focusing? A 25-year-old female states, “I really need to lose weight. I know I’m the cause of our problems,  if I could just lose weight he might be more attracted to me. Then we could start a family and we would be happy. I’m sure of it, right, we would definitely be happy!” Which statement shows the PMHNP’s ability to apply “summarizing”? As part of the PMHNP’s role in the clinic, the PMHNP oversees students that gain clinical experience at the agency. The student is instructed to use the supportive psychodynamic therapy approach with the patient. Which action made by the student causes the PMHNP to intervene, after observing the student interacting with the patient? A PMHNP is using motivational interviewing (MI) with a 50-year-old patient named Dave to commit to a healthy drug-free lifestyle. By using “change talk,” the PMHNP hopes to help the patient build self-esteem and hope.
True or false: If Dave is resisting change, the PMHNP should challenge his resistance in order for MI to be successful. The PMHNP is actively listening to Ms. Thomas who is detoxing from alcohol. Ms. Thomas is currently discussing with the PMHNP the reasons why she feels guilty about her drinking. Ms. Thomas tearfully states, “I have driven my family and friends away with this terrible habit. I have no one left. I had more than enough chances and now my children won’t even talk to me.” Which of the following statements demonstrate a simple reflection? A PMHNP is using Gestalt therapy to communicate with a 42-year-old patient who is upset with her mother. She says, “I want to tell her how hurt I feel when she doesn’t call me, but I don’t want to upset her.” What technique can the PMHNP use to help Sasha express herself? The PMHNP is meeting with an older, female adult patient and her daughter. The patient has early onset dementia. The daughter expresses concern, saying, “I don’t want you to just stick my mother in a home and give her medicine. I’m worried that’s what people are going to want to do.” What is the best response by the PMHNP to the daughter? The PMHNP meets with a 31-year-old woman who reports feeling as though she is “at her breaking point” with work. The PMHNP learns that the woman works 12-hour days, including one day on the weekend, because she is nervous about company layoffs. “I feel like I need to work myself to death in order to prove that I am valuable to the organization,” the woman says. Using the supportive psychodynamic therapy approach, how does the PMHNP respond? When preparing to terminate a patient, what does the PMHNP do to organize thoughts about the patient’s progress made during treatment? Linda is a 65-year-old patient who has completed initial treatment for alcohol addiction and anxiety problems. She is motivated to continue her treatment gains and have a healthy lifestyle. How would the PMHNP apply a mindfulness approach to this case? The PMHNP is caring for a young adult patient with whom the PMHNP decides to use a dynamic supportive therapy approach in addition to pharmacological intervention. Which therapeutic action will the PMHNP take to employ the strategy of holding and containing the patient? The PMHNP is caring for an adult male patient whose wife left him several months ago. He recently learned that his ex-wife is dating someone much younger. The man feels belittled, sad, and lonely. He talks about trying to meet other women, but says, “I can’t compete with the younger guys these days, with the cool clothes and the vegan diets. I’m bald and overweight, and what woman is going to want to be with me?” How does the PMHNP help raise the man’s self-esteem? A 43-year-old single mother is seeing the PMHNP at the request of her sister. “My sister thinks I need to come here to talk about my feelings,” the patient reports. The PMHNP learns that the patient has three children from three different men, but is unable to collect appropriate child support payments from any of the biological fathers. Additionally, the woman is barely able to afford her apartment or utilities payments. What is the appropriate response from the PMHNP when using the psychodynamic psychotherapy technique? The PMHNP has been providing interpersonal psychotherapy (IPT) for a patient who the PMHNP observes implementing new ways of being, such as interacting more with peers and being less isolated in social scenarios. The PMHNP understands that the patient is approaching termination. How does the PMHNP address termination with this patient? A PMHNP has been treating a 14-year-old patient using interpersonal psychotherapy. The patient has been depressed since the death of his grandmother. To help the patient recover, the PMHNP has told the parents: In the planning phase of change, a 42-year-old male client who struggles with gambling discusses how he plans to abstain from gambling. He tells the PMHNP, “I am no longer going to carry cash to the casino because you can’t spend what you don’t have.” The PMHNP uses an affirming communication skill when she states: The PMHNP is assessing a patient who has been receiving months of outpatient psychotherapy. According to the PMHNP’s assessment, the patient is nearing the termination phase of their therapeutic relationship because the patient’s symptoms have improved, and the patient shows progress managing behaviors and decision-making abilities according to the diagnosis. How does the PMHNP approach termination with this patient? The PMHNP is caring for a patient who is histrionic. Using the supportive psychodynamic therapy model, what is the best statement made by the PMHNP? A cocaine-addicted female patient is entering residential treatment for substance abuse. Using the 10 guiding principles of recovery, an appropriate step by the PMHNP is to ______________. A PMHNP is assessing a 40-year-old patient named Sarah who has a severe cocaine addiction and mild depression. Using the four-quadrant model, what would be the most appropriate setting to help the patient  A 21-year-old patient has been having trouble adjusting to college life. She tells the PMHNP that she had five alcoholic drinks at a party this past weekend. She also acknowledges that she drank the same amount of alcohol at a party the previous month. Based on this information, what would the PMHNP most likely recommend? A PMHNP is using emotion-focused therapy to help a 38-year-old patient who says, “I’ve been feeling angry lately, but I’m not sure why.” The first attempt by the PMHNP is to say: The PMHNP uses the Adult Attachment Interview (AAI) with a male patient who reports having had a difficult time being separated from his parents during his childhood. He explains that going to school or visiting his relatives without his parents was troublesome. The PMHNP characterizes the patient as unresolved/disorganized, according to his outcomes on the AAI. What does the PMHNP anticipate from the patient? The PMHNP is interviewing a patient who is in the process of successfully completing a substance abuse program. During the interview, the patient states, “I wish I was strong enough to keep the same friends I had before I came here for treatment. I’m really afraid of being discharged because I’ll probably run into my old friends again.” The PMHNP offers a complex reflection when she states the following: A PMHNP is using interpersonal psychotherapy with a 40-year-old patient having relationship problems with his extended family. The patient shares that he has been using the strategies they identified to reduce his distress, but they have not been helping. He is frustrated and is considering stopping treatment. What would be an appropriate step by the PMHNP? An 8-year-old has been having trouble making friends at school. His parents initiated treatment when he also started acting out at home. Which is the most appropriate step that the PMHNP takes during the assessment process when using an integrated approach? The PMHNP is treating an older adult patient who reports symptoms of late-life anxiety. What type of treatment(s) will the PMHNP consider? The PMHNP is assessing a patient who requires cognitive behavioral therapy (CBT). Which of the following statements made by the PMHNP approach the termination phase for this patient? A patient’s depression is affecting her relationship with her spouse. What might the PMHNP ask during the initial sessions of interpersonal psychotherapy treatment? A PMHNP is treating a 10-year-old boy who is exhibiting signs of aggression and attention problems. What type of intervention will the PMHNP consider using a common elements approach? The PMHNP who practices motivational interviewing understands its relationship to patient behaviors and/or outcomes to mean which of the following? A PMHNP is treating a 12-year-old girl who witnessed the physical abuse of her sibling. She has been anxious and irritable since the experience. After speaking with the PMHNP, the patient says she keeps having anxiety-causing thoughts about the experience. Using the PRACTICE technique, which skill will best help the patient interrupt these negative thoughts? The PMHNP is working with a patient who describes having a painful and traumatic childhood experience, which causes her to have anxiety as an adult. When asked how she manages her anxiety, the patient dismisses it and denies that it is a problem. Using the supportive psychotherapy approach, the PMHNP will do which of the following when assessing the patient’s ego strength? The PMHNP uses therapeutic communication skills while ensuring that the patient understands that he has choices. The PMHNP comprehends and practices motivational interviewing. This is best understood as which of the following? While assessing a patient using a humanistic-existential approach, a patient tells the PMHNP, “For the past few weeks, I’ve felt anxious almost every single day.” What would be an appropriate next step by the PMHNP? The PMHNP is meeting with a patient who has been diagnosed with depression. The patient is having trouble adjusting to her new job and hasn’t made any new friends there. What would an appropriate response be by the PMHNP using the interpersonal psychotherapy approach? A 38-year-old patient tells the PMHNP that her father went to jail for selling drugs when she was a child. The patient is visibly upset when discussing what happened. Using a humanistic-existential approach to psychotherapy, which of the following is the most appropriate response by the PMHNP? The PMHNP is assessing an older adult male patient with depression and comorbidities. According to the medical chart, the patient takes medication to manage joint and bone pain. The patient reports feeling “forgetful” and complains that he has a hard time remembering where he puts things. What is the primary action by the PMHNP? A 35-year-old male patient is being treated for alcohol addiction. He asks for the PMHNP’s cell phone number to use in case of an emergency. When the PMHNP responds that giving her number would be against therapeutic rules, the patient threatens an act of violence to the therapist. What would be the most appropriate response by the PMHNP? The PMHNP is caring for a geriatric patient who expresses symptoms of gastrointestinal problems, aches and pains, and loss of appetite. The patient reports feeling lonely, as more of his friends have been passing away over the recent months and years. The PMHNP focuses on which therapeutic approach for this patient? A 12-year-old girl was referred for treatment after witnessing the physical abuse of her sibling by their mother. The patient has been anxious and irritable since the experience. What evidence-based treatment would be most appropriate for the PMHNP to use? The PMHNP uses the cognitive behavioral therapy model with Gerald, an older adult patient who is being treated for depression and mood disorder. What will the PMHNP do with the patient during the first three sessions? The PMHNP is initiating a plan of care for a patient who requires comprehensive psychotherapy to manage his depression and mood disorder. Throughout the initial sessions, the patient reports feeling as though he cannot be helped. The PMHNP is concerned about premature termination initiated by the patient. What strategy can the PMHNP employ to prevent or reduce premature termination? How does the PMHNP approach termination with the patient who has been receiving intermittent therapy? A PMHNP is treating a 25-year-old patient who has a compulsive urge to exercise to excess. When asked to describe why she does so much exercise, she says, “I like the compliments I receive from others on my new level of fitness, and the excitement of getting more attention.” The PMHNP can use feeling-state therapy to help Monique ___________. The PMHNP is assessing a 30-year-old client who reports feeling stressed out due to his current employment situation. When asked about how he manages this work-related stress, the patient says that exercise helps him feel less anxious, so he often spends 2 or more hours at the gym each night. After completing the patient assessment, the PMHNP has determined that an existential psychotherapy approach may best benefit this client. What is the PMHNP’s goal in employing this treatment approach? The PMHNP is interviewing a patient with a history of substance abuse. He has attempted to stop abusing drugs three times before. He states to the PMHNP, “I just cannot change. How can you help me?!” As it applies to change, the PMHNP understands the principle of evocation to mean: A PMHNP has been working with a 50-year-old patient who has a stressful job and goes to the casino on weekends to play poker with his friends, which he says relieves his stress. Tim admits that he sometimes misses work on Monday when he stays out too late at the casino on Sunday nights. In addition, he once was an avid runner, and has given up running to spend more time gambling.
True or false: According to the PMHNP, the desired goal after treatment is not complete abstinence from gambling, but reaching a healthy level of the behavior. The PMHNP is caring for a patient who experiences depression caused by the traumatic experience of her dog passing away. She reports not being able to eat or sleep, and sometimes doesn’t want to leave the house at all. Which statement is most appropriate for the PMHNP to maximize the patient’s adaptive coping mechanisms? A 13-year-old patient and his parents are meeting with a PMHNP. When the PMHNP says hello, the boy just nods. His parents tell the PMHNP that he didn’t want to come to the session, but they insisted. They explain that their son has been moody and depressed at home, but is still getting good grades at school. Which of the following would be the best response by the PMHNP? The PMHNP is initiating a plan of care for Holly, a 73-year-old female patient who has late-life bipolar disorder and reports consuming alcoholic beverages four times per week. What is the focus of Holly’s therapy going to be? The PMHNP continues to meet with Gerald, who is the patient with depression and mood disorder. The PMHNP uses the CBT approach. Gerald is now meeting with the PMHNP for his fifth session and feels comfortable with how the therapy works. What does the PMHNP plan to do with Gerald over the course of the next several sessions? Mia is a 75-year-old patient who has completed initial treatment for depression. What might a PMHNP ask Mia when using a solution-focused therapy approach?

 

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