Final Exam Flashcards
Personality Disorders
pts. with personality disorders exhibit impairments in self-identity or self directionn and interpersonal functioning
Risk Factors:
-often have comorbid substance use disorders and can have history of violent and non-violent crimes, including sex offenses
- psychosocial influences such as childhood abuse, trauma and developmental factors with a direct link to parenting
- biological influences include genetics and biochemical factors
Expected findings:
one or more of the following
- inflexibility/maladaptive responses to stress
- compulsiveness and lack of social restraint
- inability to emotionally connect in social and professional relationships
- tendency to provoke interpersonal conflict
- ability to merge personal boundaries with others
Defense mechanisms of Personality disorders
Repression:
Suppression:
Regression:
Undoing :
Splitting: inability to incorporate positive and negative aspects of oneself or others into whole imagine (commonly associated with borderline personality disorder)
Personality disorder Clusters ( 10 personality disorders in 3 clusters)
Cluster A ( odd or eccentric traits)
- paranoid
- schizoid
- schizotypical
Cluster B ( dramatic, emotional, or erratic traits)
- antisocial
- borderline
- historionic
- narcissistic
Cluster C ( anxious or fearful traits; insecurity or inadequacy)
- avoidant
- dependent
- obsessive-compulsive
Cluster A
paranoid- characterized by distrust, suspiciousness towards others based on unfounded beliefs that others want to harm, exploit or deceive them
schizoid- characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism, often uncooperative
Schizotypical-
characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance and magical thinking or perceptual distortions that are not clear delusions or hallucinations
Cluster B
Antisocial- disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, failure to accept personal responsibility. Sense of entitlement, manipulative, impulsive, seductive, non adherence to traditional moral and values, verbally charming and engaging
borderline-
instability of affect, identify and relationships. Splitting behaviors, often self-injurious potentially suicidal, ideas of reference are common, impulsivity
histrionic-
attention-seeking behavior, need to be center of attention, often seductive or flirtatious
narcissistic-
arrogance, grandiose views of self-importance, need for consistent admiration, lack of empathy for others, sensitive to criticism
Cluster C
avoidant- social inhibition, avoidance of all situations with interpersonal contact, despite wanting close relationships. extreme fear of rejection, anxious in social situations.
Dependent-
extreme dependency in a close relationship, urgent search to find replacement when one relationship ends
obsessive-compulsive-
perfectionism with focus on orderliness and control to the extent that the pt won’t be able to finish a given task
Nursing Considerations
- self assessment is important- patients with personality disorders can evoke intense emotions in the nurse
- awareness of personal reactions to stress
- therapeutic communication
- milieu management focuses on appropriate social interaction in a group context
- SAFETY is the priority concern because of self-injury and risk of violence
Communication strategies for Personality Disorders
- firm, yet supportive an consistency will build a therapeutic relationship
- offer realistic choices to enhance clients sense of control
- limit setting an consistency are essential with clients who are manipulative ( especially clients with borderline and antisocial)
- assertiveness training and modeling for pts with histrionic and dependent
- respect need for isolation of patients with schizoid and schizotypical
- professional boundaries and communication with histrionic patients
- for dependent personality disorders, self-assess frequently for countertransference reactions
Medications for Personality disorders
psychotropic agents antidepressants anxiolytics antipsychotics mood stabilizers
Substance use disorders
repeated use of chemical substances, leading to clinically significant impairment during a 12-month period.
- alcohol
- caffeine
- cannabis
- hallucinagents
- inhalants
- opioids
- sedatives/hypnotics/anxiolytics
- stimulants
- tobacco
- other
- characterized by loss of control, participation that continues despite continuing associated problems and a tendency to relapse back into the substance use or behavior
- denial is common
Risk Factors:
- genetics
- chronic stress, socioeconomic factors
- history of trauma, abuse, combat experience
- lowered self-esteem
- lowered tolerance for pain and frustration
- few meaningful relationships
- few life successes
- risk-taking tendencies
Socio cultural theories-
- Alaska natives and Native American groups have higher instances of alcohol use disorder
- asians have low rate
- peer pressure and sociological factors can influence likelihood of abuse
- adults at higher risk
Expected findings: blackout or loss of consciousness changes in bowel movements weight loss or gain experience of stressful situations sleep problems chronic pain concern over substance use
Goal -cutting down on consumptions or behavior
Nursing Considerations:
-ask open-ended questions to find out:
- type of substance or addictive behavior
- pattern/frequency of use
- amount used
- last use
- age of onset
- changes in occupation/school performance
- changes in use patterns
- periods of abstinence?
- previous withdrawl manifestations
Addictive disorders
non-substance related disorders ( behavioral or process addictions)
- gambling
- sexual activity
- shopping
- social media
- internet gaming
- etc.
Mental health issues of children and Adolescents
- not always easily diagnosed, resulting in delayed or inadequate interventions
- comorbid conditions
-childs behavior is problematic when it interferes with home, school and interactions with peers
Disorders that appear during childhood
- depression
- anxiety
- trauma and stress related disorders
- substance use disorders
- feeding and eating disorders
- disruptive, impulse control and conduct disorders
- neuro-developmental disorders
- bipolar and related disorders
- schizophrenia spectrum and other psychotic disorders
- non-suicidal self injury and suicidal behavior disorders
-impulse control disorders
