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nursing theory 32 > psych wk 2-personality disorders > Flashcards

psych wk 2-personality disorders Flashcards

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1
Q

t or f personality disorders are unstable and flexible

A

f they are stable and inflexible and pervasive

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2
Q

t or f the pts personality disorder can be asymptomatic and then flare up when under stress

A

t

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3
Q

common fts and diagnostic criteria of Personaty disorder

A

Maladaptive cognitive schema
Affectivity and emotional instability
Impaired self-identity and interpersonal functioning
Impulsivity and destructive behaviour

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4
Q

what are maladaptive cognitive schema

A

their perception/interpretation of the world is skewed. They misinterpret the world incorrectly eg make assumptions that are incongruent witht he reality
• They often have dysfunctional responses to things. Misinterpret innocent gesture and have extreme reaction

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5
Q

t or f women are more likley to have personality disorders

A

f. it is seen to be equal in both genders

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6
Q

what kind of impulsive behav might a pt with personality disorder display and why do they often end up being seen by drs

A

often suicide attempts

often seen by drs due to destr behaviour

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7
Q

what are speculated et of personality disorders

A
  • Temperament
  • Environment
  • Co-morbidity
  • Genetic
  • Emotional/Behavioural
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8
Q

what is temperament and how will they look at this

A

pt can have anxious, attached, relaxed, mellow temperament). Temperament has to do with adaptability. They will look all the way back to the infant and often temperamnt will show at this time

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9
Q

what kind of childhood might result in personality disorder

A

maltreatemet and childhood neglect. It significantly inc the risk of personality disorder

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10
Q

which meds indicate that there is a biologic influence in PDisorders

A

SSRIs–pts on these tend to have dec incidence of PDs

people w schizotypal PD can espond to atypical antipsychotics

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11
Q

what is one of the more common PDs we see in hospital

A

borderline PD

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12
Q

Cluster a b or c

Which has anxious, fearful thinking or behavior

A

Cluster c

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13
Q

Cluster a b or c

Odd or eccentric and often socially awkward or withdrawn

A

Cluster a-

a is for awkward and alone

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14
Q

Cluster a b or c
Orderly and anxious when in isolation
May display passive aggression

A

Cluster c

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15
Q

Cluster a b or c

Dramatic emotional and erratic

A

Cluster b

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16
Q

Cluster a b or c

Which is characterized by distorted thinking and what does this entail

A

A

Delusional or paranoid thoughts

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17
Q

What are general feat of cluster b

A

Dissociation or denial
Abusive behav both physical and emotional
Splitting or dichotomous thinking–no grey area just black and white
Emotional dysregulation-react before thinking and don’t modulate emtitions well

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18
Q

How might aggression manifest differently in cluster b and c

A

Cluster b
Abusive behav that is verbal and physical

Cluster c
Passive aggression-indirect displays of hostility

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19
Q

Beyond being orderly, anxious, fearful and passive aggressive what characteristics might you see in cluster c

A

Self chosen failure-they’ll take on things they know they can’t complete
Masochistix
Dysthymic-mild depression symptoms but can still fx in daily life

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20
Q

Cluster a disorders are

A

Paranoid PD
Schizoid
Schizotypal PD

Cluster A-pss

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21
Q

cluster B disorders

A

cluster B
-bhan

borderline PD..
histrionic
antisocial
narcissistic

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22
Q

cluster c disorders

A

avoidant PD
dependent PD
obsessive compulsive PD

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23
Q

OCPD vs OCD which would be more perfectionistic and orderly

A

OCPD

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24
Q

char of OCPD

A
  • inhibited stubborn, rigid and -perfectionist\preoccpied w orderliness or perfection
  • excess devotion to work-excluding recreation and friendships
  • reluctant to delegate to tohers
  • might have difficulty discarding worthless object
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25
Q

when something doesnt go their way does OCPD get anxious or angry

A

likely more angry than anxious

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26
Q

which PD might adapt their personality to please others and often needs excessive advice or reassurance

A

dependent personality disorder

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27
Q

dependent personality disorder how do they present

A

they have diff making own decisions and seek out help of others for all trivial decisions
-have a need to be taken care of
-submissive behav
-urgently ned to replace on relationship when another one ends
-will adapt their personality to please others

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28
Q

why are dependent PD pts submissive and what does this put them at risk of

A

they are submissive because they fear loss of support ordisapproval and abandonment

this puts them at risk of abuse

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29
Q

which PD is desperate for relationships but does not engage in social contact d/t shyness and sense of inadequacy

A

avoidant PD

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30
Q

which cluster is avoidant PD

A

C

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31
Q

char of avoidant PD

A

socially inhibited, shy and lonely

  • sense of inadequacy w low self esteem
  • desperate for relationships but avoid social contact
  • reluctant to take risks or try new activities as they might be embarassed
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32
Q

are avoidant PD avoidant d/t performance anxiety

A

no. they are avoidant and their default is just not to deal with things as a maladaptive way to avoid the world

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33
Q

what is parasuicide

A

the deliberate self-injury w the intent to harm oneself

  • compulsive self injurious behav
  • episodic self-injurious behav
  • repetitive self-mutilation
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34
Q

is parasuicide a way of showing their needs tothe world

A

no its an intimate private way of self soothing.

its a maladaptive form of coping that causes a numbing effct from endorphins and natural opiates

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35
Q

what is a common reason that people might use parasuicide as a coping method

A

people who have been sexually abused or abused in toher ways dont want to live in their bodies and dont feel anything. then they self harm and can feel something

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36
Q

what kind of compulsive self injurious behaviour is there and what is it often relieving

A

trichotillomania (hair pulling out), skin picking

these are often anxiety related

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37
Q

when someone has a parasuicide event what must you assess

A

the intent behind the action. do a suicide risk assessment

38
Q

which personality disordr is often highly litigious and holds grudges

what cluster is it

A

paranoid PD

cluster a

39
Q

paranoid PD char

A

pervasive distrust and suspiciousness of other people

  • assume oters are out to get them, harm them or humiliate them
  • hold grudges, are litigious, may display pathological jealousy
40
Q

why are paranoid PD often brought in to mental health facility

A

because they call the police on someone else

41
Q

why is Tx a challenge with paranoid PD

A

they mistrust everyone

in rder for Tx to be success they must have insight

42
Q

what kind of med can work for some paranoid PD and why do they not work for others

A

antipsychotics

often dont work because the delusions are so entrenched that they cant get out

43
Q

what personality disorder might be mistaken for schizophrenia, they get taken into hospital and put on antipsychotics but they dont improve

A

schizotypal PD

44
Q

what characterizes schizotypal PD

whcih cluster is it

A

perceptual distortion and eccentricity

  • ideas of reference
  • odd beliefs or magical thinking
  • flat or incongreunt emotional responses

cluster A

45
Q

what do ideas of reference mean (schizotypal PD)

A

they might think that eg a news anchor is sending them some coded messages that only they can understand. they will take tiny bits of that info and make lg connections from it.

46
Q

d/t their flat or incongruent emotional responses how might a schizotypal pt present

A

they might seem to be on autism spectrum. they can be avoidant and live in their own world

47
Q

are schizotypal pts often overtly distressed

A

not gen

they mght get paranoid in a bout of distress and be hsopitalized

48
Q

which PD is indifferent to praise or criticism and often lacks a desire for intimacy

A

schizoid

49
Q

schizoid PD what characteristics does it have

A

pervasive social detachment-dont really have opinion of relationships

  • tend to be socially isolated and often chose solitary activities
  • indifferent to praise or critisism. they just dont care
  • lacking a desire for intimacy
50
Q

which PD often has difficulty appreciating pleasure and what is this called

A

schizoid PD

anhedonia

51
Q

do schizoid pts often present in hospital

A

no

52
Q

which PD can be describe relationships as more intimate than they are and thinks any attention is good even if the attention is for negative reasons

A

histrionic

53
Q

char of histrionic

A
  • inappropriate sexually seductive or provocative
  • seek excitement and attn
  • outwardly they may seem charming and lively but inwardly they have threatened self esteem and sense of attractiveness
  • describe relationships as more intimate than they are
54
Q

what could be a consequence of histrionic PD needing attn and reactions from others (in terms of what the pt might do)

A

they might self harm if not getting the validation theyneed

they might fall in love right awayand be too intensely focused on the relationship which pushes the othr person away

55
Q

histrionic-what are they vulnerable to

A

coercion and higher risk behav

56
Q

which PD is characteriazed by grandiosity

What does this mean

A

narcissistic PD

They expect recognition and think they should be seen as superior to others without cause or reason
Think they are special or unique and can only be understood by high status people or institutions

57
Q

Why might a narcissistic PD not want to talk to the nurse

A

They think they an only be understood by high status people or institutions

58
Q

What kind of people might narcissistic of pts surround themselves with

A

Pts with low self esteem who will validate their need for constant admiration

59
Q

What char does narcissistic pd have

A

Grandiosity!!
Think they’re special and only understood by high status people or institutions
Sense of entitlement
Need constant admiration
Lack empathy and take advantage of others to achieve their own needs

60
Q

What happens when narcissistic PD needs aren’t being met

A

They can react abusively

61
Q

What approach to use w narcissistic PD

A

Be direct
Firm
Set limits around behaviour
Iron clad care plan!

62
Q

What might narcissistic PD try to do

A

Split the staff for their manipulative needs

Bend the rules

63
Q

How much insight do narcissistic PD pts have. Consequence of this

A

Very little

The Tx outlook is not hopeful for them because they don’t see anything wrong with themselves

64
Q

Which PD has behaviour that is a self fulfilling cycle and causes exactly what thy fear- abandonment

A

Borderline pd

65
Q

Which PD must have hx of conduct disorder before age 15

A

Antisocial pd

66
Q

Antisocial PD how does it present

A

Disregard and violate the rights of others
-no remorse for wrongdoing and no empathy
-irritability and aggressiveness
-marked readiness to blame others or to offer plausible rationalization a for their behavior
History of a conduct disorder before age 15

67
Q

Why can antisocial PD pass lie detector tests

A

They don’t care

They won’t get the Hr or BP inc

68
Q

What might be a precursor to conduct disorder and when does it occur

A

Ages 6-11 they might have oppositional defiant disorder in which the kid struggles in school, gets in trouble and is aggressive

69
Q

ODD can turn into conduct disorder

What is conduct disorder

A

Violent and criminal behaviour eg arson, property crimes, break and entering ABUSE AND TORTURE OF ANIMALS!

70
Q

What is the difference between sociopathy and psychopathy

A

Psychopaths commit crimes against a particular person and sociopaths commit crimes against society in gen eg hurler

71
Q

Does antisocial PD think anything is wrong with their health

A

No. Thy rarely seek help directly

72
Q

What do interventions focus on for antisocial PD

A

Often treatment of addiction
Not curative treatment
The treatment is mandatory user parole (70% of inmates have this condition)

73
Q

What are the key assessments to do for pt with antisocial PD

A

Quality of relationship that you’re having with that person
Impulsivity
Violence risk

74
Q

What kind of impulsive behav might antisocial Pd pt have

A

Often other directed violence when pts needs aren’t being met

75
Q

What could trigger violence in antisocial Pd

A

When pt perceives disrespect which occurs when they think that their needs aren’t being met

76
Q

How is it best to manage antisocial PD

A

Structures consistent environment
Nurse must be self aware (pt might try to manipulate
Hold pt accountable to their behav
Sit down and write care plan with them..this is what the behaviour will be, this is what we hope the outcome will be. Disclose the rationale

77
Q

Why is the hospital environ not great for borderline pd pt

A

They must continually make and end relationships

78
Q

Borderline pd what characterizes this

A

Unstable relationships self image and affect
-impulsivity
-mood lability
Fear of rejection
-unstable and intense interpersonal relationships
Recurrent suicidal behav, threats self mutilation, and gestures

79
Q

Borderline pd what does their impulsivity often lead to

A

Default is to hurt themselves

80
Q

What is a significant risk factor for borderline

Other risk factors

A

Maltreatment eg physics and sexual abuse!

Parental abandonment and alienation

81
Q

Et of borderline

A

Might be genetic link as it is more common in first degree relatives

  • fmri shows frontal limbus dysfunction
  • psychological theories suggest that if kids exposed to abusethy develop maladaptive cog processes
82
Q

What is the priority for borderline

A

70% of borderline pts have suicide attempt in their lifetime and 10% conplete.
Self harm risk is always very high

83
Q

Char of borderline

A 
Affective instability
Identity disturbances
Unstable personal relationships
cognitive dysfx
Dysfx or maladaptive behav
84
Q

what do borderline pd fear most

A

abandonment

85
Q

how might borderine pt think of their nurse

A

they might idolize them youre my favoroite nurse

86
Q

how does cognitive dysfx mandifest in borderline

A 
black and white thinking
extreme interpretation of events
disorganzied thoughts
misconstrue env
pathologic jealousy
mild dissociative

highly sensitive to criticism
struggle to find happiness internally

87
Q

what kind of dysfunctional or maladaptive behav might borderline pt have

A

impulsivity and self injury or parasuicide

88
Q

Tx of borderline PD

A

primary tx is Dialectical behav therapy

low dose antidepressant or mood stabilizer could be used

89
Q

what is dialectical bheav therapy

A

dev from buddhist principles this aims to reconnect w body

  • there is a skills roup which is often run by someone with BPD in recovery and they teach skills such as describing emotions without judgement
  • interpersonal effectiveness skills-conflict mgmt, empowerment, self worth, self esteem
  • mindfulness skills
  • distress tolerance-helping them feel distress is a normal part of life
90
Q

if pt self harms what do you do

A

put steri strips on it and move on

nursing theory 32 (14 decks)

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