Personality Disorders Chap 24 Flashcards
At which age can a personality disorder be diagnosed
18
Personality Disorders a long time behavior that deviants from cultural norm.
Affects these 4 areas
Cognition (perceiving & interpretation)
Affectivity (range, intensity, lability)
Interpersonal functioning
Impulse control
Cluster A:
Describe
3 diagnosis
Odd, eccentric
Schizotypical
Schizoid
Paranoid
Cluster B:
Describe
4 types
Drama, Erratic , Emotional
Antisocial
Borderline
Histonic
Narcissistic
Cluster C:
Describe
3 examples
Obsessive- compulsive Personality
Avoidant
Dependent
Mistrust, restricted affect, guarded
Suspicious & Bears grude
Paranoid
Projection is their primary defense mechanism
Tend to reject treatment
Psychotherapy is treatment of choice
Paranoid
Detachment from social relationships
Chooses to be alone
Cold & Detached
Schizoid Batman
This disease
Group / Therapy not helpful- cannot relate to others
Problem solving is treatment of choice
Schizoid Batman
Short-term
Risperdal / Zyprexa if under extreme stress
Wellbutrin to increase pleasure in life
Schizoid Batman
Magical thinking
Severe interpersonal anxiety & interpersonal defects
Schizotypical Will Wonka
Primary defense of borderline personality
Splitting
All good or All bad
Profound lack of empathy
Shallow, unexpressive, & superficial affect
Antisocial personality
How to handle antisocial personality
Set limits on behavior with consistency
Speak: Matter of Factly - No I statements
Support care manager
This personality disorder will respond well to mood stabilizer to help with aggression & Impulses
Antisocial ted bundy
Intolerant with abandonment, frantic to avoid
Chronic suicide attempts
Cutting
Sex & Drugs
Borderline
Diabetes
HTN
Back pain
Fibromyalgia
Arthritis
Comorbidies for….
Borderline
Seperated from mother at <1 yr
Borderline
Identify & change false core beliefs about themselves…
CBT
Difference between CBT & DBT
CBT: Identify & change false core beliefs about themselves
DBT: Uses CBT & mindfulness
Grandioso
Lack of empathy
Self-Esteem is Low
Narcissistic
Which personality type is most likely to have a high prestige career
Narcissistic
Life of the party
Over the top
Overdressed, flirtatious, seductive
Histrionic
High need to be taken care of by others
Dependent
How do we manage dependent personality disorder
Psychotherapy
Promote independence & limit setting
Desires relationships but has low self esteem and poor social functioning
Fears rejection
Avoidant
Avoidant personality wants relationships but fears rejection
Treatment
Group & ind therapy
Assertiveness training
Meds…
SSRI & SNRI
B-adrenergic (Atenolol) reduce autonomic hyperactive
Perfectionist
Not bothered by their own behavior
Think it is correct
OC personality disorder
Avoid power struggles- need for control is high
Meds
Clomipramine & SSRI
Risperdone
Aripiprazole
OC personality Disorders
_________ is used to evaluate personality
Minnesota multiphasic personality inventory
Difference between antisocial & narcissistic personality disorder
Narcissistic has low self esteem
Antisocial has high self esteem
Which cluster can become psychotic from stress
Odd
Schizoid, Schizotypical, Paranoid
Psycho therapy and benzos maybe used in this personality Disorder
Paranoid
Never use Lithium for narcissistic
T or F
F use it
Don’t use benzos
Delirium is always 2nd to another condition
T or F
T
What is the most common mental disorder found in medical practice
Delirium
Most common type of hallucinations in delirium
Visual
Severe social anxiety & interpersonal deficits
Rarely seeks help unless for depression
Genetically linked to schizophrenia
Schizotypical
Gray matter in prefrontal cotrex & temporal lobes diminished
Genetic abnormalities with MAOA: Cannot break down DA or S
Antisocial
In antisocial personality disorder use “I” statements to convey messages
False
Don’t use I statements. They don’t care about you
PD most likely to have sex, cut self, suicide. Fear of abandonment
Borderline
Mood stabilizers, low dose antipsychotics, Omega 3, & Naltrexone has been found to stop self injury behavior
This PD
Borderline
Begins at 3 - 5 with a intense attachment to opposite sex parent and fear of retaliation from same sex parent
Histrionic
Does delirium wax and wane?
Yeppers
Does dementia change levels of consciousness?
No
It changes Cognitive function & intellect
A model that aims to provide effective mental health services by taking into account a person’s past experiences with trauma
Trauma informed care
Give some of the principles of trauma informed care (6)
Safety: Ensuring the physical and emotional safety of the patient
Trustworthiness: Establishing trust through consistent, candid, and friendly demeanor
Empowerment: Helping patients make their own choices and tap into their strengths and resilience
Inclusiveness: Ensuring that all people are included, including those from historically marginalized groups and people with disabilities
Collaboration: Developing care plans collaboratively between staff and service users
Peer support: Providing opportunities for people to support each other through grieving and mourning
Can PTSD have genetic components
Yes
When experiencing trauma, the ____ release CRH, which attaches to the Pituitary Gland to release adrenocorticotropic hormone ACTH.
ACTH stimulates the adrenal glands to release….
Hypothalamus
Cortisol
Elevated stress hormones affect these (2) systems
Immune
Inflammatory
The Polyvagal theory siggest the autonomic NS has 3 responses and is governed by this never
CN 10 Vagus
Child dissociative checklist
Trauma symptoms checklist for children
Child sexual behavior inventory
All can be used to assess for…
PTSD
First nursing diagnosis for PTSD in youths
2nd?
3rd
1st: post trauma response
2nd: impaired caregiver-child attachment
3rd impaired adolescente development
3 staged model for trauma includes
Reducing arousal and regulating emtion through symptom reduction & memory work. Finding comfort in others, tolerating affect, integration of disallowed emotions, accepting ambivalence, working with memories and transferring memory
Developmental skills catchup by enhancing problem solving skills, nurturing self-awareness, social skills training, Development of Value system, Coping Skills to deal with Trauma, Development and integration into healthy social support system
Providing safety and Stabilization through a predictable environment, stop self-destructive behavior, Provide education about trauma and its effects
Which Stage?
- Reducing arousal and regulating emtion through symptom reduction & memory work. Finding comfort in others, tolerating affect, integration of disallowed emotions, accepting ambivalence, working with memories and transferring memory
- Developmental skills catchup by enhancing problem solving skills, nurturing self-awareness, social skills training, Development of Value system, Coping Skills to deal with Trauma, Development and integration into healthy social support system
- Providing safety and Stabilization through a predictable environment, stop self-destructive behavior, Provide education about trauma and its effects
Windows of tolerance….
Is balance between sympathetic and Parasympathetic NS
When can PTSD symptoms begin to appear
1 month After incident. Before 1 month it is an Acute Stress Reaction
Standard treatment for PTSD
Adults & Children
Stage model treatment
SSRIs that are approved for PTSD
Sertraline & paroxetine
When can Acute Stress Disorder be diagnosed
3 days - 1 month After traumatic event
Key psychological symptom of Acute Stress Disorder that sets it apart from PTSD
Derealization- sense the environment isn’t real
Key nursing diagnosis for Acute Stress Disorder
Post trauma response
Also
Impaired adaption/ anxiety
Events such as retirement, chronic illness, or a breakup may cause this disorder
Adjustment Disorder
Standard interview for Adjustment Disorder.
Goal…
Reality orientation, crisis intervention, family therapy, group treatment
Goal: encourage verbalizing of emotions related to the stressor
