NR326 Mental Health Nursing

RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 1

Purpose The student will review, summarize, and critique a scholarly article related to a mental health topic.

Course outcomes: This assignment enables the student to meet the following course outcomes. (CO 4) Utilize critical thinking skills in clinical decision-making and implementation of the nursing process for

psychiatric/mental health clients. (PO 4) (CO 5) Utilize available resources to meet self-identified goals for personal, professional, and educational

development appropriate to the mental health setting. (PO 5) (CO 7) Examine moral, ethical, legal, and professional standards and principles as a basis for clinical decision-making.

(PO 6) (CO 9) Utilize research findings as a basis for the development of a group leadership experience. (PO 8)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible: 100 points

Preparing the assignment 1) Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

a. Select a scholarly nursing or research article, published within the last five years, related to mental health nursing. The content of the article must relate to evidence-based practice. • You may need to evaluate several articles to find one that is appropriate.

b. Ensure that no other member of your clinical group chooses the same article, then submit your choice for faculty approval.

c. The submitted assignment should be 2-3 pages in length, excluding the title and reference pages. 2) Include the following sections (detailed criteria listed below and in the Grading Rubric must match exactly).

a. Introduction (10 points/10%) • Establishes purpose of the paper • Captures attention of the reader

b. Article Summary (30 points/30%) • Statistics to support significance of the topic to mental health care • Key points of the article • Key evidence presented • Examples of how the evidence can be incorporated into your nursing practice

c. Article Critique (30 points/30%) • Present strengths of the article • Present weaknesses of the article • Discuss if you would/would not recommend this article to a colleague

d. Conclusion (15 points/15%) • Provides analysis or synthesis of information within the body of the text • Supported by ides presented in the body of the paper • Is clearly written

e. Article Selection and Approval (5 points/5%) • Current (published in last 5 years) • Relevant to mental health care • Not used by another student within the clinical group • Submitted and approved as directed by instructor

f. APA format and Writing Mechanics (10 points/10%)

2

NR326 Mental Health Nursing RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 2

• Correct use of standard English grammar and sentence structure • No spelling or typographical errors • Document includes title and reference pages • Citations in the text and reference page

For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library. Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned in the review module.

NR326 Mental Health Nursing RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 4 3

Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.

Assignment Section and Required Criteria

(Points possible/% of total points available)

Highest Level of Performance

High Level of Performance

Satisfactory Level of Performance

Unsatisfactory Level of

Performance

Section not present in paper

Introduction (10 points/10%)

10 points 8 points 0 points

Required criteria 1. Establishes purpose of the paper 2. Captures attention of the reader

Includes 2 requirements for section. Includes 1 requirement for section.

No requirements for this section presented.

Article Summary (30 points/30%)

30 points 25 points 24 points 11 points 0 points

Required criteria 1. Statistics to support significance of the topic to

mental health care 2. Key points of the article 3. Key evidence presented 4. Examples of how the evidence can be incorporated

into your nursing practice

Includes 4 requirements for section.

Includes 3 requirements for section.

Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Article Critique (30 points/30%)

30 points 25 points 11 points 0 points

Required criteria 1. Present strengths of the article 2. Present weaknesses of the article 3. Discuss if you would/would not recommend this

article to a colleague

Includes 3 requirements for section. Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Conclusion (15 points/15%)

15 points 11 points 6 points 0 points

1. Provides analysis or synthesis of information within the body of the text

2. Supported by ides presented in the body of the paper 3. Is clearly written

Includes 3 requirements for section. Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Article Selection and Approval (5 points/5%)

5 points 4 points 3 points 2 points 0 points

1. Current (published in last 5 years) Includes 4 Includes 3 Includes 2 Includes 1 No requirements for

NR326 Mental Health Nursing RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 4 4

2. Relevant to mental health care 3. Not used by another student within the clinical group 4. Submitted and approved as directed by instructor

requirements for section.

requirements for section.

requirements for section.

requirement for section.

this section presented.

APA Format and Writing Mechanics (10 points/10%)

10 points 8 points 7 points 4 points 0 points

1. Correct use of standard English grammar and sentence structure

2. No spelling or typographical errors 3. Document includes title and reference pages 4. Citations in the text and reference page

Includes 4 requirements for section.

Includes 3 requirements for section.

Includes 2 requirements for section.

Includes 1 requirement for section.

No requirements for this section presented.

Total Points Possible = 100 points

Running Head: THE DIAGNOSIS OF BIPOLAR DISORDER 1

The delay in the diagnosis of bipolar disorder

Chamberlain College of Nursing

NR 326: Mental Health

00/ 2018

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BIPOLAR DISORDER 2

Introduction

Bipolar disorder has a significant cause to morbidity and mortality rate. Although we

have an active treatment, there is an extensive wait before diagnosis and treatment are initiated.

This research was done to examine factors associated with the delay of bipolar disorder before

the diagnosis and the onset of treatment. Bipolar disorder is also called manic depression. This

disorder is characterized with the events of mood swings ranging from depressive lows to manic

highs. The history of bipolar disorder presents with depression, so initial episodes look very

similar to a major depressive disorder. Therefore, there is often a prolonged delay in the exact

diagnosis of bipolar disorder, and any significant wait influence the initiation of appropriate

treatment. This paper investigates whether the delay in the diagnosis of bipolar disorder is

inescapable. This means is the delay in diagnosing bipolar disorder unavoidable or unpreventable

(Fritz et al, 2017).

Article summary

Bipolar disorder frequently beings with an early diagnosis of depression. This creates a

delay in the exact judgement and treatment of bipolar disorder. Although research has focused on

predictors in the analytic change from the depression stage to bipolar disorder. The research on

this prolonged diagnosis is scant. These researchers examine the time it took to diagnose one

with bipolar disorder after an early diagnosis of major depressive disorder to understand the

patient features and psychological factors that may explain the delay. However, when manic

signs are evident, the diagnosis changes to be bipolar disorder. Research shows that the time

from diagnosing a major depressive disorder to the time of diagnosing bipolar disorder is about

10 years. This means before the optimal treatment for bipolar disorder can be made, there might

be a delay in treatment for almost a decade. This is one of many reasons why it is important to

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BIPOLAR DISORDER 3

investigate the cause, and the delay from the diagnosis of major depressive disorder to time of

bipolar disorder (Fritz et al., 2017).

One of the most common predictors of exploratory conversion from major depressive

disorder to bipolar disorder is with antidepressant treatment resistance. There is a rise in the rate

of diagnostic conversion to bipolar disorder after a failure to respond to two treatments with the

use of antidepressant. Another factor that is associated with the diagnostics change from major

depressive disorder to bipolar disorder is with the initial onset of depression. Studies show that

patients who were formerly diagnosed with major depressive disorder are likely to be diagnosed

with bipolar disorder if they had an early onset of depression and were unresponsive to

antidepressant treatment. Also, the conversion to bipolar disorder has been found related to the

patient family history, but the findings are not truly reliable (Fritz et al., 2017).

The information from the article could be used in nursing practice because it educates the

nurse on the factors that might affect the early diagnosis of bipolar disorder. For example, some

statistical data from this research proves the delay as it was stated in this article. The conversion

time from major depressive disorder to bipolar disorder was about 42.8% lesser in female than it

was in male. Also, for every 1-year increase in the initial diagnosis of major depressive disorder,

the time for bipolar disorder conversion decrease by 2.8%. This data was made after a clinical

evaluation of 382 patients by a psychiatrist and with the of use series of questionnaires. When

there is an increase in the diagnosis of major disorder there is a decrease in the diagnosis of

bipolar and verse versa. Another example is to understand those factors associated with the delay

in bipolar disorder which will help the nurse better understand why some patients are diagnosed

with bipolar and other patients showing the same behavior have not been diagnosed. This article

will help the nurse better understand the diagnosis and the delayed process of bipolar disorder

(Fritz et al, 2017).

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BIPOLAR DISORDER 4

Article critique

Based on the study done, the delay is due to the disease process and other factors that

prolong the diagnosis. This article is informative about the process it takes to diagnose bipolar

disorder. The researchers put together resources from various aspect from their research to

provide why the delay is present. For example, Fritz et al. (2017) found an undesirable

correlation between the age at which the disease is initialed to the time of diagnostic conversion.

This means the younger the age of the patient, the longer the delay in diagnosing the patient.

Therefore, understanding the patient’s features and psychological behavior are also reasons that

may delay bipolar disorder from being diagnosed after an early diagnosis of a major depressive

disorder (Fritz et al, 2017).

Weakness

I feel that although the article did tell us about the factors that are associated with the

delay to diagnose bipolar disorder, the researchers did not show how those factors can be

evitable. Within the article there should have been a clear picture or graph explaining ways to

reduce the long process to diagnosing one with bipolar disorder. The weakness I believe in this

article is not especially from the article presentation, but it is from the disease process. The

weakness in this article is seen in the length of time it takes to diagnose one with bipolar.

Recommendations

I will recommend this article to a colleague because it gave a detailed explanation of the

aim of this research. This article is a good starting point to know why there is a prolonged wait in

the diagnosis of bipolar disorder. As a nursing student, this article makes me understand why

most people who exhibit similar behavior with people diagnosed with bipolar disorder have not

been medically diagnosed. As it was explained in the article, age makes a big difference to

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BIPOLAR DISORDER 5

diagnose a person with bipolar disorder because of patient characteristics and psychological

factors. Younger patients are not mentally developed as an adult patient would be.

Conclusion

In conclusion, this study shows that certain individuals experience a significant delay in

diagnosis and treatment of bipolar disorder which varies depending on different factors. I believe

when there is a better understanding of the factors associated with the delay to diagnose bipolar

disorder, then there will be developmental strategies to reduce them. These findings indicate the

need for an early recognition and initiation of active treatment of bipolar disorder which will

most likely diminish disability and improve outcomes.

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BIPOLAR DISORDER 6

References

Fritz, K., Russell, A., Allwang, C., Kuiper, S., Lampe, L., Malhi, G., (2017). Bipolar disorder: Is

a delay in the diagnosis of bipolar disorder inevitable? 19, 396–400. doi:10.1111/bdi.12499.

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An Examination of Dependent Personality Disorder in the Alternative DSM-5 Model for Personality Disorders

Andrew S. McClintock1,2 & Shannon M. McCarrick1

Published online: 5 August 2017 # Springer Science+Business Media, LLC 2017

Abstract Although the diagnosis of dependent personality disorder (DPD) has demonstrated construct validity and clin- ical utility, little is known about how best to model DPD in the DSM-5’s new, alternative model for diagnosing personality disorders. The current research aimed to represent DPD using the 25 pathological personality traits of the alternative model. Self-report measures of the 25 pathological personality traits, DPD, avoidant personality disorder, borderline personality disorder, and maladaptive interpersonal dependency were ad- ministered to an undergraduate sample (N = 194). Results indicated that— as consistent with extant theory— anxious- ness, submissiveness, and separation insecurity were the three traits most strongly related to DPD symptoms. As a group, anxiousness, submissiveness, and separation inse- curity were more strongly related to DPD symptoms (r = 0.55) than were the remaining 22 personality traits (r = 0.34). This group of three traits was strongly asso- ciated, however, with avoidant personality disorder symptoms (r = 0.55), suggesting that additional scrutiny of DPD and avoidant personality disorder in the alter- native model may be needed. Limitations and directions for future research are presented.

Keywords Dependent personality disorder . Avoidant personality disorder . DSM . Alternative model

In light of frequent criticism of the personality disorder diag- nostic system in the DSM-IV (American Psychiatric Association 2000; for criticisms, see Widiger et al. 2009), the Personality and Personality Disorders Work Group pro- posed a novel approach to the diagnosis of personality disor- ders. This approach, titled the alternative DSM model for per- sonality disorders (AMPD), was not accepted as the official diagnostic system for the DSM-5 (American Psychiatric Association 2013) but rather was published in DSM- 5’s Section III (Bemerging measures and models^ p. 729). If the AMPD holds up to empirical scrutiny, and even outperforms established diagnostic criteria, then the AMPD may become the official system in future edi- tions of the DSM (Few et al. 2013).

In contrast to previous models, the AMPD is a dimensional trait model that represents personality disorders as combina- tions of core personality-related impairments and various con- figurations of 25 pathological personality traits (American Psychiatric Association 2013; Krueger et al. 2012; Morey and Skodol 2013; Skodol 2012). The pathological personality traits are organized into five higher-order domains (i.e., nega- tive affect, detachment, antagonism, disinhibition, and psychoticism) that align with the extensively validated five-factor model of general personality (McCrae and Costa 2003; see Gore and Widiger 2015). That is, the AMPD models personality disorders as extreme, mal- adaptive variants of the same traits that describe normal personality (Samuel et al. 2013).

Four personality disorders were excluded from the AMPD: paranoid personality disorder, schizoid personality disorder, histrionic personality disorder, and— as most relevant to the

* Andrew S. McClintock [email protected]

Shannon M. McCarrick [email protected]

1 Department of Psychology, Ohio University, 264 Porter Hall, Athens, OH 45701, USA

2 Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

J Psychopathol Behav Assess (2017) 39:635–641 DOI 10.1007/s10862-017-9621-y

current research— dependent personality disorder (DPD). According to developers of the AMPD (Skodol 2012), DPD was excluded because of lower prevalence estimates, relative- ly weak associations with functional impairment, and little evidence for discriminant validity. Consequently, individuals who exhibit the signs of DPD would be diagnosed in the AMPD as personality disorder- trait specified and would be described with the three pathological traits of anxiousness, submissiveness, and separation insecurity (American Psychiatric Association 2013; Skodol et al. 2011).

Some scholars, however, have disputed the decision to ex- clude DPD from the AMPD. Bornstein (2011) noted, for in- stance, that DPD prevalence rates are comparable to the prev- alence rates of personality disorders included in the AMPD. There is also evidence that the DPD diagnosis is clinically useful, as DPD symptoms are associated with suicidality, part- ner and child abuse, important elements of treatment process and outcome, and high levels of functional impairment (Bornstein 2012a, b). Indeed, Soeteman et al. (2008) reported that health care costs associated with DPD were higher than the costs associated with obsessive-compulsive, antisocial, and avoidant personality disorders (all included in the AMPD). Furthermore, although DPD overlaps with other per- sonality disorders, particularly avoidant personality disorder and borderline personality disorder (Bastiaansen et al. 2012; Disney 2013; Miller et al. 2015), DPD seems to have comor- bidity rates that are similar to those of personality disorders included in the AMPD (Bornstein 2011, 2012a, b; Disney 2013; Zimmermann et al. 2005).

Because DPD might be at least as valid and clinically useful as personality disorders retained in the AMPD (Bornstein 2011), empirical research is needed to model DPD with AMPD’s pathological personality traits. While theory impli- cates three pathological traits in DPD (i.e., anxiousness, submissiveness, and separation insecurity; Skodol et al. 2011), empirical support for this configuration is mixed. Bornstein (2011) astutely noted that much of the research in this area focuses on personality disorders retained in the AMPD, and thus the evidence base for these personality disorders tends to be larger than the evidence base for excluded personality disor- ders (e.g., DPD). Nevertheless, the data that do exist suggest that anxiousness and separation insecurity are integral to DPD (Anderson et al. 2014; Bornstein 2012b; Hopwood et al. 2012; Morey et al. 2016; Gore and Widiger 2015), whereas submis- siveness may (Bach et al. 2016a, b; Gore and Widiger 2015; Morey et al. 2016; Smith et al. 2009) or may not (Anderson et al. 2014; Bornstein 2012b; Fossati et al. 2013) be integral to DPD. Bornstein (2012b) reported that individuals with DPD can be quite assertive in certain contexts (e.g., when important relationships are threatened), and thus submissiveness should not be regarded as a core trait of DPD.

Even if the Personality and Personality Disorders Work Group is correct in their assertion that DPD is best

characterized by anxiousness, submissiveness, and separation insecurity (Skodol et al. 2011), it remains to be seen if this configuration is distinct from the configurations of other per- sonality disorders. There is evidence that anxiousness, sub- missiveness, and/or separation insecurity are elevated in avoidant personality disorder (APD) and borderline personal- ity disorder (BPD) (Anderson et al. 2014; Disney 2013; Fossati et al. 2013; Gude et al. 2004, 2006; Hopwood et al. 2012; Leising et al. 2006; Morey et al. 2016; Yam and Simms 2014), suggesting that the proposed configuration of DPD may lack discriminant validity.

The present research aimed to model DPD using AMPD’s pathological personality traits and to determine if this config- uration of personality traits is distinct from the configurations of APD and BPD. APD and BPD were selected because, of all 10 personality disorders, these two seem to be most strongly related to DPD (Bastiaansen et al. 2012; Disney 2013; Miller et al. 2015). In addition to the DPD measure, we included a measure of maladaptive interpersonal dependency to compare the DPD configu- ration with the maladaptive dependency configuration.

Method

Participants

Participants in the present study were 200 undergraduates at a large Midwestern university who received course credit for their participation. Six students were excluded for invalid responding, resulting in a final sample of 194 participants. The majority identified as female (66.0%), heterosexual (84.0%), and never married (98.5%). In addition, 84.0% of participants identified as Caucasian, 4.6% identified as African American, 3.6% identified as Asian American, 3.6% identified as Hispanic, 3.6% identified as multiracial, and 0.5% identified as American Indian. Participants had a mean age of 18.7 years (SD = 2.9).

Measures

The Personality Inventory for DSM-5 (PID-5; Krueger et al. 2012) is a 220-item, self-report questionnaire that assesses the 25 pathological personality traits (and five higher-order do- mains) of the AMPD. This measure asks participants to rate statements on a 4-point Likert scale from 0 (very false or often false) to 3 (very true or often true). A sample item is BI usually do things on impulse without thinking about what might hap- pen as a result.^ The PID-5 has demonstrated construct valid- ity, convergent validity, and discriminant validity in past re- search (e.g., Quilty et al. 2013; Wright et al. 2012). In the current research, the PID-5 scales exhibited acceptable to

636 J Psychopathol Behav Assess (2017) 39:635–641

good levels of internal consistency (Cronbach αs ranged from 0.75 [PID-5-Grandiosity] to 0.96 [PID-5-Eccentricity]).

The Personality Diagnostic Questionnaire 4+ (PDQ-4+; Hyler 1994) is a 99-item, self-report instrument used to screen for each of the DSM-IV personality disorders. In the present study, only the DPD (8 items), APD (7 items), and BPD (9 items) scales were administered. All items use a true-false response format. Representative items for each scale include BI prefer that other people assume responsibility for me,^ (DPD), BI avoid working with others who may criticize me,^ (APD), and BI’ll go to extremes to prevent those who I love from ever leaving me^ (BPD). In the present study, we chose to measure symptoms dimensionally as opposed to assessing personality disorders categorically, as dimensional scales tend to be more reliable and valid (Hopwood et al. 2012; Markon et al. 2011). Because PDQ-4+ response options are binary (i.e., true/false), we calculated Kuder-Richardson 20 coeffi- cients for the PDQ-4 + −DPD (0.58), PDQ-4 + −APD (0.71), and PDQ-4 + −BPD (0.54).

The Relationship Profile Test (RPT; Bornstein et al. 2003) is a 30-item, self-report measure of three interpersonal styles: healthy dependency, detachment, and overdependence. In the present study, only the Destructive Overdependence (DO) subscale (10 items) was administered. Each item is rated on a 7-point scale, ranging from 1 (not at all true of me) to 7 (very true of me). A representative item from the DO subscale is, BBeing responsible for things makes me nervous.^ The items were constructed based on the dependency literature and aim to assess the cognitive, emotional, motivational, and behav- ioral features of maladaptive dependency (Bornstein et al. 2003). The RPT has exhibited good construct validity in prior research (Bornstein et al. 2003; Haggerty et al. 2010). In the current study, the RPT-DO had acceptable internal consisten- cy (Cronbach α= 0.89).

Procedure

This study was conducted at a large Midwestern university during the 2015–2016 academic year. IRB approval was ob- tained, and all ethical standards were followed. Participants

completed the above measures online in partial fulfillment of research requirements for psychology courses.

Plan of Analysis

Correlational analyses were first employed to assess the rela- tionships between DPD, APD, BPD, and maladaptive inter- personal dependency. Next, correlations were used to deter- mine how DPD, APD, BPD, and maladaptive dependency are related to the 25 pathological personality traits. Given the large number of analyses, coupled with our goal of identifying the core traits of these conditions, we regarded correlations > .40 (and p values < .001) as meaningful (see Hopwood et al. 2012). Finally, we used correlations to examine the relation- ships between personality disorder symptoms, proposed trait configurations, and the remaining non-proposed traits. For these analyses, the following variables were created: DPD Proposed Traits (M of anxiousness, submissiveness, and sep- aration insecurity), DPD Non-Proposed Traits (M of 23 traits; all but anxiousness, submissiveness, and se