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NSG 322 > Topic 3: Personality Disorders > Flashcards

Topic 3: Personality Disorders Flashcards

1
Q

Cluster A personality disorders symptoms

A

odd/eccentric

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2
Q

types of Cluster A personality disorders

A

paranoid, schizoid, schizotypal

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3
Q

Cluster B personality disorders symptoms

A

dramatic, emotional, erratic

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4
Q

types of Cluster B personality disorders

A

antisocial, borderline, histrionic, narcissistic

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5
Q

types of Cluster C personality disorders

A

avoidant, dependent, obsessive compulsive

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6
Q

Cluster C personality disorders symptoms

A

Anxious, fearful

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7
Q

In general, personality disorders are associated with:

A

*problems in interpersonal relationships,
*a limited capacity to respond effectively to stress,
*limited availability of social support,
*higher health service use and a lower quality of life

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8
Q

core symptoms of personality disorder

A

-behavior deviates markedly form the norm
-onset in adolescence or early adulthood
-pattern leads to significant distress for the person or impairment in functioning

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9
Q

Disorders of personality usually emerge in…..

A

adolescence

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10
Q

psychological factors that could lead to personality disorders

A

Childhood trauma:
*Excessively harsh and erratic discipline, alcoholic parent(s), and abusive and chaotic home life are risk factors for borderline PD (BPD) and antisocial PD (APD) in particular.
*Sexual abuse is a risk factor for BPD.

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11
Q

which groups are at higher risk for personalities disorder

A

*Native Americans
*African-Americans
*Young adults
*Lower socioeconomic status
*Divorced, separated, widowed, or never married

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12
Q

groups with lower rates of personality disorders

A

*Asian families
*Jewish families
(Might be attributed to stronger family ties)

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13
Q

paranoid personality disorder is characterized by…

A

-characterized by a pervasive distrust of others, including even friends, family, and partners
-Hold grudges (can be litigious)
-display pathologic jealousy
-dwell on past slights

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14
Q

Schizoid Personality Disorder

A

-do not seek out or enjoy personal relationships
-natural tendency to direct attention towards self
-may appear detached, aloof, cold
-restricted range of emotional expression and fail to reciprocate gestures or facial expressions

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15
Q

Schizotypal Personality Disorder

A

characterized by oddities of appearance, behavior, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia
-People with schizotypal PD often fear social interaction and think of others as harmful EXCESSIVE SOCIAL ANXIETY

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16
Q

which personality disorder has a higher than average probability of developing schizophrenia

A

schizotypal PD

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17
Q

Antisocial Personality Disorder (APD)

A

*Pervasive pattern of disregard for or violation of the rights of others
*Deceitfulness
*Irritability and aggressiveness
*Irresponsibility
*Reckless disregard for the safety of others
*Lack of remorse
*Impulsiveness; risky behaviors to “feel alive”

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18
Q

Histrionic Personality Disorder

A

*Characterized by a pattern of excessive emotionality and attention seeking - the ‘Drama Queen’
*flirtatious or seductive, need to be center of attention
*flamboyant and theatrical with an exaggerated degree of emotional expression
*appear disingenuous and insincere
*Flighty, fickle
*Highly suggestible and easily influenced by others
*Difficulty cultivating intimate personal relationships due to behavior

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19
Q

Narcissistic Personality Disorder

A

*Grandiose sense of self-importance
*Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
*Believes s/he is “special” and unique and can only be understood by (or should only associate with) other special or high status people
*Requires excessive admiration
*Sense of entitlement
*Is interpersonally exploitative
*Lacks empathy
*Often envious of others or believes that others are envious of him
*Arrogant, haughty behaviors or attitudes

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20
Q

Borderline Personality Disorder (BPD)

A

DSM5: “pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity, beginning in early adulthood”
Often present in crisis
*Powerless, vulnerable and inherently unacceptable
*High sensitivity to emotional triggers
*Inappropriate or intense anger
*Strong fear of abandonment
*Intense and unstable relationships
*Impulsivity (substance abuse and indiscriminate sexual activity)
*Compulsive shopping or shoplifting
*Frequent suicidal ideation and gestures, self harm (cutting)

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21
Q

frequently in BPD, there is a history of

A

childhood abuse and neglect

22
Q

Avoidant Personality Disorder

A

Persons believe that they are socially inept, unappealing, or inferior, and constantly fear being embarrassed, criticized, or rejected.
*Avoids occupational activities involving significant interpersonal contact
*Unwilling to get involved with people unless certain of being liked.
*Shows restraint within intimate relationships (fear of being shamed or ridiculed).
*Preoccupied with being criticized or rejected in social situations.
*Inhibited in new interpersonal situations because of feelings of inadequacy.
*Unusually reluctant to take personal risks or to engage in new activities because they may prove embarrassing.

23
Q

Dependent Personality Disorder

A

*Strong need to be cared for by others
*‘Clingy’ behavior
*Easily submits to the desires and wishes of others
*Goes to great lengths to avoid conflict
*Vulnerable to manipulation and abuse
*Finds it very difficult to be alone

24
Q

Obsessive-Compulsive(Anankastic) Personality Disorder

A

*Preoccupied with details, rules, lists, order, organization, or schedules
*Perfectionism interferes with task completion
*Excessively devoted to work & productivity (to the exclusion of leisure activities and friendships)
*Overly conscientious, scrupulous, and inflexible
*Often unable to discard worn-out or worthless objects
*Reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
*Miserly spending style
Shows rigidity and stubbornness

25
Q

nursing care for an individual with PD

A

*Develop relationship based on empathy and trust, while maintaining appropriate boundaries
*Remain alert to suicide risk
*Promote effective coping and problem solving
*Promote development and engagement with their support network
*Work collaboratively with staff to ensure consistency in treatment and approach
*Support and promote self care and coping for families or significant others of the client

26
Q

types of therapy for PD

A

*Psychotherapy
*Psychodynamic Therapy
*Cognitive Behavioral Therapy
*Dialectical Behavior Therapy
*STEPPS

27
Q

Dialectical Behavior Therapy (DBT) primary focus:

A

*Stabilizing client, achieving behavioral control, regulating emotions, developing distress tolerance skills, and constantly using crisis interventions

28
Q

Dialectical Behavior Therapy (DBT) target behaviors include decreasing:

A

*Life-threatening suicidal behaviors
*Therapy-interfering behaviors
*Quality-of-life interfering behaviors

29
Q

Systems Training for Emotional Predictability and Problem Solving (STEPPS)

A

a 20 week manual driven program (2 trainers and 6-10 participants) for reducing the intensity of those with BPD

30
Q

Challenges in Working with Clients with Personality Disorders

A

*Clients’ problems can overwhelm staff, leading to feelings of confusion, helplessness, anger, and frustration
*Clients are abusive of authority and successful in splitting staff in an attempt to defend against the client’s own feelings of frustration and powerlessness.
*When splitting occurs, conflict ensues
*Untrained staff members are particularly susceptible
*May become vengeful in response to a perception of the client’s a sense of entitlement, manipulation, dependency, ingratitude, impulsivity, and rage

31
Q

Importance of Teamwork & Collaboration in patients with PD

A

*Have frequent communications among staff members
*SET LIMITS on client behavior
*Strive for CONSISTENCY and limit setting
*Provide necessary support when behavior of client starts to affect confidence, feelings, behaviors, and effectiveness of staff members.
*Assess your own reactions toward the client
*Have frequent discussions with peers

32
Q

once manipulative behaviors are identified, how should they be documented

A

*Behaviors should be objectively documented (time, date, circumstances)

33
Q

how to manage maladaptive behaviors

A

*Provide clear boundaries and consequences
*Enforce consequences

34
Q

what should be avoided when managing maladaptive behaviors

A

*Discussing yourself or other staff members with client
*Promising to keep a secret
*Accepting gifts from client
*Doing special favors for client

35
Q

what medications can be used for those with PD

A

*Treating the symptoms can be helpful
*Benzodiazepines (maintenance dosing) for anxiety are not appropriate because of the potential for abuse and overdose; they may be used in emergency situations

36
Q

Selective serotonin reuptake inhibitors (SSRIs) treat

A

*co-morbid depression and panic attacks

37
Q

Trazodone and venlafaxine have

A

low toxicity in overdose

38
Q

Carbamazepine targets

A

impulsivity and self-harm

39
Q

*Lithium, anticonvulsants, SSRIs

A

*minimize aggression

40
Q

*Atypical antipsychotics

A

*help with psychotic features in BPD under stress.

41
Q

Guidelines & Tx: Paranoid PD

A

*d/t inherent distrust; all prearranged promises, appointments, and schedules should be STRICTLY adhered to
*not too nice; be clear & straightfwd
*use simple language; neutral, kindly affect
*if PT exhibits threatening behavior, SET LIMITS

Tx: psychotherapy (1st line). indiv therapy focuses on prof. & trusting relationship. SET LIMITS. Group therapy for social skills.
Meds: antianxiety w/ diazepam; sev. agitation w/ haloperidol (short term); paranoid ideation w/ pimozide

42
Q

Guidelines & Tx: Schizoid PD

A

*avoid being too nice/friendly
*AVOID effort to promote PT socialization
*PT may be open to discussing coping and anxiety
*assess to identify symptoms the PT is reluctant to discuss
*protect against ridicule from group members d/t PT interests/ideas

Tx: psychotherapy, indiv. therapy 1st, then group.
Meds: No specific; however, depressive s/s tx w/ bupropion, emotional express w/ risperidone or olanzapine

43
Q

Guidelines & Tx: Schizotypal PD

A

*respect PT need for social isolation
*nsg aware of PT suspiciousness
*careful assess. of SI
*awareness of strange beliefs/activities are norm

Tx: no specific; help identify cognitive distortions, though usually avoid tx d/t anxious paranoia; may be active in unusual cults
Meds: antipsychotic w/ risperidone or olanzapine; MDD/anxiety s/s tx w/ SSRI or anxiolytics

44
Q

Guidelines & Tx: Histrionic PD

A

*NSG understand that seductive behavior is a STRESS response
*comms & inact. = always professional
*PT may exaggerate s/s
*encourage and model CONCRETE and descriptive language
*help PT clarify their own feelings
*teach and model ASSERTIVENESS
*ass. SI

Tx: Psychotherapy = clarify feelings, group therapy (could be good and bad, d/t distracting s/s)
Meds: no specific; antidepressants for depressive/somatic s/s; antianxiety; antipsychotics for delusions

45
Q

Guidelines & Tx: Narcissistic PD

A

*nsg remain neutral & recognize source of behavior (shame & fear of abandonment)
*help to identify goals and develop stronger self-identity
*use therap. nsg-pt relation to model meaningful interactions
*avoid power struggles or defensiveness
*do not directly challenge grandiose statements
*model empathy

Tx: indiv. CBT; group therapy; otherwise not likely to seek tx
Meds: lithium dec. mood swings; antidepressants

46
Q

Guidelines & Tx: Avoidant PD

A

*nsg friendly, accepting, reassuring
*pushing them into social situations = sev. anxiety
*convey acceptance of PT fears
*provide exercises to enhance social skills (use caution)
*assertiveness training to help express needs

Tx: indiv and group for anxiety; psychotherapy for trust and assertiveness
Meds: antianxiety, beta blockers (atenolol), SSRI (citalopram)/SNRI (venlafaxine)

47
Q

Guidelines & Tx: Dependent PD

A

*help pt identify/address current stressors
*awareness that countertransference may develop d/t clinginess
*nsg-pt relation = testing ground for increase assertiveness

Tx: psychotherapy (1st line); CBT can supplement
Meds: no specific; antidepress/antianxiety; TCA (imipramine) for panic attacks

48
Q

Guidelines & Tx: Obsessive-Compulsive

A

*guard against power struggles (need for ctrl is high)
*pt difficulty with unexpected change
*provide structure yet allow extra time for rituals
*help PT identify ineffective coping and develop better ways

Tx: group, CBT, DBT to learn better coping skills
Meds: Clomipramine to reduce obsessions/anxiety/depression; fluoxetine

49
Q

Guidelines & Tx: Borderline PD

A

*ass. SI/violence twd others; if present, immediate attn
*nsg neutral & matter-of-fact
*staff splitting
*SET LIMITS & CONSISTENCY

Tx: CBT, DBT, Schema-focused therapy
Meds: no specific; SSRI, anticonvulsants, lithium for mood regulation; naltrexone for reduce self-harm; 2nd gen antipsych for anger ctrl

50
Q

Guidelines & Tx: Antisocial PD

A

*nsg maintain consistency, support, boundaries, and limits
*they tend to be angry, manipulative, and aggressive d/t limited freedom
*be direct when discussing concerns
*assist pt to recognize anger and triggers; actively listen and show empathy to defuse

Tx: CBT (MBT long term), DBT, group therapy
Meds: no specific; lithium or valporic acid for aggression/depression/impulsivity; SSRI: fluoxetine & sertraline ro irritability; benzo (w/ caution); methylphenidate if ADHD

NSG 322 (12 decks)

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