Fletcher is a 29-year-old male referred for court-ordered counseling. He has a long history of repeated offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet caused any serious injury or death to the victims. An interview with his wife reveals that for the last few years he has lied about almost everything; he is able to get hired for jobs because he is very engaging and likeable, and then invariably he gets fired because he misses work and doesn’t do his job properly when he is there. According to the wife, they have known each other since high school where Fletcher was very happy and well-adjusted. He was on the soccer team, liked by teachers, and never demonstrated the tendencies he does now. Apparently in college he got involved with a fraternity that was notorious for alcohol and drug abuse, and he started drinking heavily; it was “all downhill from there.” The PMHNP considers that: 

A. History and symptoms are most consistent with antisocial personality disorder

B. Fletcher needs a neurological workup to include an EEG and assessment for neurological soft signs

C. Consistent with his symptoms Fletcher will likely respond well to a stress interview

D. It is likely that substance abuse is the underlying cause of symptoms and should be explored further
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YouTube: https://www.youtube.com/watch?v=GINQB976rx4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=18