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NURS 3514 - Mental Health > Week 11 Cognition > Flashcards

Week 11 Cognition Flashcards

1
Q

define: personality

A
  • the collection of emotional and behavioral traits that characterize a person
  • imbedded psychological characteristics that are largely not conscious and not easily altered; express themselves automatically
  • ways to perceiving, thinking, and feeling about self, others, and the enviro
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2
Q

what are some features of a healthy personality (4)

A
  • adaptable
  • stable
  • resilient
  • self-aware
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3
Q

what is a personality disorder according to DSM V?

A
  • “The essential feature of a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture and is manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control.
  • The enduring pattern is inflexible and pervasive across a broad range of personal and social situations and leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning ….”
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4
Q

generally, a personality disorder is… (4)

A
  • manifested in cognition, affect, interpersonal functioning, and/or impulse control
  • long standing pervasive maladaptive patterns of behavior and relating to others
  • behavior deviates from the norms of one’s socio-cultural background
  • causes distress to the person
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5
Q

what is the onset of personality disorders (2)

A
  • adolescence

- early adults

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6
Q

what are the 10 identified personality disorders in the DSMV

A
  • paranoid
  • schizoid
  • schizotypal
  • avoidant
  • narcissistic
  • dependent
  • obsessive-compulsive
  • histioric
  • borderline

these can also be clustered

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7
Q

what cluster is Borderline Personality Disorder (BPD) apart of?

A
  • cluster B
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8
Q

how many clusters of personality disorders are there

A

three

  • cluster A
  • cluster B
  • cluster C
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9
Q

describe cluster A of personality disorders; what are some examples?

A
  • cognitive and perceptual disorders

ex. paranoid, schizoid, schizotypal

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10
Q

describe cluster B of personality disorders (3); what are some examples (4)?

A
  • dramatic
  • emotional
  • erratic cluster
    ex. antisocial, borderline, histionic, narcissistic
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11
Q

describe cluster C of personality disorders (2); what are some examples (3)?

A
  • fearful
  • anxious cluster
    ex. avoidant, dependent, obsessive-compulsive
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12
Q

what are the 4 features of BPD

A
  • affective
  • cognitive features and sense of self
  • interpersonal relationships
  • impulse control
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13
Q

describe the affective features of BPD (7)

A
  • difficulty in regulating emotions
  • intense dysphoria that doesn’t last very long
  • can become quite angry or enraged (over-reaction to a perceived interpersonal situation)
  • difficulty controlling anger
  • quick shifts in affect (i.e labile)
  • “moody”
  • extreme stress & anxiety can induce psychotic symptoms (usually short-lived)
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14
Q

describe the “cognitive features & sense of self” feature of BPD (8)

A
  • may misinterpret experiences such as someone being late as abandonment –> can precipitate intense feelings & behavioral rxns
  • trouble accurately interpreting social cues
  • experience dichotomous thinking (see individuals as all good or all bad, difficulty appreciating complexity)
  • experience dissocitation (“spacing out”, “unreality”, forget blocks of time)
  • may not experience a clear or stable sense of self
  • shift in terms of self-image, goals, career interests
  • may not be able to clearly describe self, what they like, want in life
  • chronic feelings of emptiness or boredom may reflect identity disturbance
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15
Q

what is BPD

A
  • a pervasive pattern of instability in interpersonal relationships, self-image & affects, and marked impulsivity
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16
Q

describe the DSM-V criteria for BPD (9)

A

indicated by 5 or more of the following:

  • frantic efforts to avoid real or imagined abandonment
  • pattern of unstable, intense relationships characterized by extreme of idealization & devaluation (either the “best” or “worst”., get close too fast, can’t tolerate flaws)
  • identity disturbance –> unstable sense of self
  • impulsivity in 2 or more areas that are self-damaging (eating, sex, substance abuse)
  • recurrent suicidal behavior, gestures, threat or self-harm, self-mutilating behaviors
  • affective instability - emotional dysregulation
  • chronic feelings of emptiness
  • inappropriate and intense anger
  • transient, stress-related paranoid ideas or dissociative symptoms
17
Q

what is a primary defense mechanism in BPD

A
  • splitting
18
Q

describe: splitting

A
  • inability to synthesis positive and negative aspects of self & others
  • split closely connected behaviors, thoughts, or feelings
    ex. splitting of staff: seeing 1 HCP as all good, others as all bad
19
Q

what is idealizing r/t BPD

A
  • idealize people (ex, nurse) when they meet the needs of the individual
20
Q

what is devaluing r/t BPD

A
  • extreme devaluing of person when needs are not being met
21
Q

why do individuals w BDP engage in self-harm behaviors (6)

A
  • thought to be a way of coping w numbness/emptiness as a way to feel
  • can occur during a dissociated state
  • way to cope w difficult emotions & self-hatred as a way to punish the self
  • way to self-soothe
  • gain relief from distressing thoughts and emotions
  • intent is NOT to die, but cope
22
Q

is there a risk of suicide when someone has BPD?

A
  • yes always a risk - 10%
23
Q

what causes BPD

A
  • often history of childhood trauma or abuse (abandonment, lack of stability)
  • biosocial theory of BDP
24
Q

describe the biosocial theory of BPD (5)

A
  • suggests that there is a complex interaction of biological and psychosocial factors that contribute to or place a person at risk for developing BPD
  • biological vulnerabilities combined w invalidating psychosocial enviro during early child development are thought to contribute
  • serotonin dysregulation & decreased activity of the frontal lobe may contribute
  • biologically determined emotional vulnerability (emotional sensitivity and reactivity, slow return to baseline)
  • invalidating enviro (rejecting, trivializing, abusive)
25
Q

stats about BPD

A
  • Approx. 2% of general population
  • Females - 4 times the rate of males
  • 25% of psychiatric inpatients
  • 10% of clients in MH outpatient clinics
  • Frequently seen in emergency departments (suicide attempts, gestures, self-mutilation)
  • High Suicide Risk
  • Co-morbidity occurs (anxiety, depression, eating disorders)
  • Effective Treatments –-> DBT and Psychodynamic Therapies
  • Course –> features decrease as the individual grows older
26
Q

describe treatment for BPD (8)

A
  • short in-pt hospitalization for crisis
  • ensure a team approach (if not, splitting occurs), all staff aware of care plan
  • must have clear boundaries & goals in treatment
  • address self harm
  • psychotherapy & dialetical behavioral therapy (DBT)
  • crisis planning
  • coping strategies
  • meds may be needed in crisis situation
27
Q

what is the current treatment of choice for BPD

A
  • DBT
28
Q

what are some management strategies to teach a pt with BPD (3)

A
  • anger mngmt
  • coping skills
  • consideration for boundaries
29
Q

what meds are used for pts w BPD (3)

A
  • SSRIs –> for depression, emotional dysregulation, impulsivity
  • anticonvulsants
  • lithium
30
Q

what is dialectical behavior therapy (DBT) (3)

A
  • empirically-support “modified” cognitive behavioral treatment for BPD
  • involves giving the pt the means to gain a sense of responsibility and control in their own lives –> sense of empowerment
  • provides tools & strategies to improve QOL, facilitate change, manage crises, eliminate dysfunctional behaviors
31
Q

what are the goals/focus of DBT (2)

A
  • increase the person’s ability to manage distress and improve interpersonal effectiveness
  • developing skills to help w affective stability or regulate emotions
32
Q

DBT has a particular efficacy in consumers w… (2)

A
  • chronic suicidal or self-harming behaviors
33
Q

what skills do pts learn in DBT (10)

A
  • mindfulness
  • alternative coping skills
  • learn to correct cognitive distortions
  • healthy interpersonal skills
  • managing emotions
  • toleratiing distress
  • communicating needs
  • support groups
  • “reframing the world” thru CBT
  • validating the individual
34
Q

typically, DBT occurs where and for how long?

A
  • outpt programs

- occurs over time w opportunities to practice skills that are learned

35
Q

what are the wise mind accept skills?

A
  • online self-help site that offers info and self-help for those living w BPD or interested in DBT
36
Q

what strategies are highlighted in wise mind accept skills (7)

A 
Activities
Contributing
Comparing
Emotions
Pushing away
Thoughts
Sensations
37
Q

what can nurses do to help an individual identify other ways to cope & to express emotions in a healthier way (4)

A
  • maintain a calm approach
  • use harm reduction strategies for self harm
  • dont give specific times for when you’ll be back, or they may watch the clock and feel abandoned
  • be careful to follow thru w your commitments, or be clear that you are delegating them to someone else
38
Q

describe nursing intervention principles for pts w BPD (9)

A
  • work as part of a team
  • have clear treatment goals & include client
  • consider safety & suicide prevention
  • assist pt in learning healthier coping, problem solve, and mitigate crisis, develop awareness of behaviors
  • be matter-of-a-fact yet
    empathetic, consistent
  • maintain boundaries
  • facilitate access to long-term therapy, resources, supports ex. DBT
  • educate individuals about BPD
  • consider needs of families
39
Q

what are some components of a crisis safety plan (5)

A
  • wellness plan
  • identification of symptoms/triggers
  • ways to prevent a crisis
  • symptoms that occurs when a crisis is occurring
  • crisis plan

NURS 3514 - Mental Health (11 decks)

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