Clinical Case Analysis: Tarlac State University College of Science

TARLAC STATE UNIVERSITY
COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines
CLINICAL CASE ANALYSIS

Name of Patient Patient APD Age: 56 Gender: Male
Address Victoria, Tarlac Date Admitted: 09/13/2021
Diagnosis Avoidant Personality Disorder
NURSING HISTORY:
Patient APD, a 56-year-old client, is a guard who used to work at night shifts and
recently got promoted, changing his working schedule to morning shifts. He was
referred by his primary health care provider for a mental health consultation.
Lifestyle
Given the nature of client’s past work, he rarely does social interaction with his
coworkers. However, because of his promotion, he was forced to interact with other
people. The client has reported that he has almost no friends, except for a cousin that
he has been close to since childhood has never had a significant romantic
relationship or sexual encounter. Majority of his free time is spent on surfing the
Internet, collecting stamps, or playing computer games by himself.
The client has no vices and reports that he eats properly, having at least 7 to 10
glasses of water a day, and at most 5 meals a day including snacks, usually
consisting of rice, vegetable, and meat.
Family History of Health and Illness

The client has reported no significant familial history of diseases.
History of Past Illness

The client has never consulted a mental health professional before. The client also
doesn’t have any history of hospitalization or have undergone any surgical procedure.
History of Present Illness

The client was referred by his physician for feeling “stressed” and overwhelmed for
the past months after his promotion. He reported that he is having difficulty and s not
doing well in his current job.
Upon conducting mental health assessment, the client is conscious and responds to
every question soundly. However, it is noted that the client is aloof with the examiner
reflected by his answers to the questions being asked. His answers are short and
limited even after asking prompting questions. The client cannot also maintain direct
eye contact. He appears calm, and his emotional range is flat despite saying he is
“stressed”.
PATHOPHYSIOLOGY:
Avoidant personality disorder is characterized by the avoidance of social situations or
interactions that involve risk of rejection, criticism, or humiliation (Zimmerman, 2021).
Diagram is attached after the table

DIAGNOSTIC PROCEDURES:
Avoidant personality disorder can only be diagnosed based on criteria outlined in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the
DSM-5, a person must have a consistent pattern of avoiding social contact, being
overly sensitive to rejection and criticism, and feeling inadequate, as displayed by at
least four of the following criteria:
 Avoidance of occupational activities involving significant social contact out of
fear of criticism, disapproval, or rejection
 Unwillingness to become involved with others unless you are certain that they
will like you
 Holding back in intimate relationships out of fear of being ridiculed or
humiliated
 Preoccupation with criticism or rejection in social situations
 Inhibition in new social situations due to feeling inadequate
 Feelings of being socially inept, unappealing, or inferior to others4
 Hesitation to take risks or do new things out of fear of embarrassment
MEDICAL MANAGEMENT:
Psychotherapy is the main treatment for avoidant personality disorder. This may
include
 Cognitive-behavioral therapy- is a type of psychotherapeutic treatment that
helps people learn how to identify and change destructive or disturbing thought
patterns that have a negative influence on behavior and emotions. It focuses
on changing the automatic negative thoughts that can contribute to and worsen
emotional difficulties, depression, and anxiety (Kendra, 2021).
 Supportive psychotherapy- is a talking-based therapy designed to allow a
person with mental health issues to voice their concerns, and receive
encouragement and help in finding practical solutions. Supportive
psychotherapy aims to reduce anxiety as well as help people with mental
health issues to discover their own resilience. It also attempts to increase a
person’s ability to adapt to situations that previously might have caused them
stress (Health Direct, 2019)
 Psychodynamic psychotherapy- focuses on the psychological roots of
emotional suffering. Its hallmarks are self-reflection and self-examination, and
the use of the relationship between therapist and patient as a window into
problematic relationship patterns in the patient’s life. Its goal is not only to
alleviate the most obvious symptoms but to help people lead healthier lives
(American Psychological Association, 2010).
Selective serotonin reuptake inhibitors- these agents initially block the presynaptic
reuptake of serotonin, thereby allowing more of the neurotransmitter to be available in
the synapse. SSRIs are greatly preferred over the other classes of antidepressants.
Because the adverse effect profile of SSRIs is less prominent, improved compliance
is promoted. SSRIs do not have the cardiac arrhythmia risk associated with tricyclic
antidepressants (Rettew et al., 2019).
 Zoloft and other SSRI medications are considered first-line treatment for APD
and social phobia. Benefits of SSRIs include relatively high tolerance, ease of
administration, and relative safety in overdose (Rettew et al., 2019).
Benzodiazepines- These agents bind to a specific benzodiazepine receptor on the

gamma-aminobutyric acid (GABA) receptor complex, thereby increasing GABA
affinity for its receptor. They also increase the frequency of chlorine channel opening
in response to GABA binding. GABA receptors are chlorine channels that mediate
postsynaptic inhibition, resulting in postsynaptic neuron hyperpolarization. The result
is a sedative-hypnotic and anxiolytic effect. High-potency benzodiazepines are likely
to be effective in treating social phobia in adults (Rettew et al., 2019).
 Clonazepam (Klonopin) are used clinically to treat social anxiety, although no
controlled studies have been conducted in this population to document its
efficacy. This medication is believed to work at the GABAa receptor in the
brain, particularly the limbic areas.
Name of Student: INSO, Krishcel C. & TUQUERO, Reiben G.
Date Submitted: 09/13/2021 C.I.’s Signature
Form No.: TSU-COS-SF-04 Revision No.: 00 Effectivity Date: June 22, 2016 Page 1 of 1
References:
American Psychological Association. (2010). Psychodynamic Psychotherapy Brings

Lasting Benefits through Self-Knowledge. Retrieved from American
Psychological Association:
https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy
Cherry, K. (2021, May 7). What Is Cognitive Behavioral Therapy (CBT)? Retrieved from
verywellmind: https://www.verywellmind.com/what-is-cognitive-behavior-therapy-
2795747
Cleveland Clinic. (2020, October 6). Avoidant Personality Disorder. Retrieved from
Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/9761-avoidant-
personality-disorder#management-and-treatment
Cuncic, A. (2020, August 8). What Is Avoidant Personality Disorder (AVPD)? Retrieved
from verywellmind: https://www.verywellmind.com/avoidant-personality-disorder-
4172959
Health Direct. (2019, September). Supportive psychotherapy. Retrieved from Health
Direct: https://www.healthdirect.gov.au/supportive-psychotherapy
Marchak, A. (2018, November 18). AVOIDANT PERSONALITY DISORDER (AVPD):
PATHOGENESIS AND CLINICAL FINDINGS. Retrieved from Calgary Guide:
https://calgaryguide.ucalgary.ca/avoidant-personality-disorder-avpd-
pathogenesis-and-clinical-findings/
Rettew, D., Jellinek, M., & Doyle, A. (2019, November 12). Avoidant Personality
Disorder. Retrieved from Medscape:
https://emedicine.medscape.com/article/913360-overview#showall
Zimmerman, M. (2021, May). Avoidant Personality Disorder (AVPD). Retrieved from
MSD Manual:
https://www.msdmanuals.com/professional/psychiatric-disorders/personality-
disorders/avoidant-personality-disorder-avpd

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TARLAC STATE UNIVERSITY

CLINICAL CASE ANALYSIS

Family History of Health and Illness

History of Past Illness

History of Present Illness

Diagram is attached after the table

Benzodiazepines- These agents bind to a specific benzodiazepine receptor on the

American Psychological Association. (2010). Psychodynamic Psychotherapy Brings

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