Week 5 (Personality disorders/Substance use disorders) Flashcards
Describe somatic symptom disorders
believe symptoms are medical, even with negative test findings
have difficult time accepting anxiety over physical symptoms
What are example of somatic symptom disorders?
illness anxiety disorder
functional neurological disorder
factitious disorder
What is illness anxiety disorder?
anxiety symptoms
hypochondriac (2 types)
1: goes to Dr. too much
2: will not go to Dr.
What is functional neurological disorder?
sudden loss of function
- no medical findings
- all of a sudden can’t walk, see, etc.
What is factitious disorder?
intentionally faking symptoms in order to assume sick role
want attention
AKA - munchausen syndrome
Define malingering
intentionally faking symptoms for a benefit
ex: getting out of work, criminal prosecution, medications
What will a nurse do for someone with factitious disorder?
encourage visitors
do not leave pt alone with parent
check on pt frequently/unexpectedly
What is the assessment for someone with any somatic symptoms disorders?
- full assessment (rule out anything physical
- dramatic terms used
- ability to meet basic needs
- family/work dynamic (stressor causing symptoms)
- childhood trauma (increased risk of suicide)
- ability to express feelings/needs
- dependence on medication
What is the outcome for someone with any somatic symptom disorders?
live a normal life as possible
articulate feelings
identify ineffective coping patterns
What will the nurse do during the implementation phase for someone with any somatic symptom disorders?
- do not imply symptoms are fake
- spend time w/ pt when they are NOT expressing physical complaint
- show concern, but avoid dependency
- reinforce strengths
- teach stress reduction
What will the nurse see during the evaluation phase for someone with any somatic symptom disorders?
goals met (even partially)
identified coping strategies
decreased somatic symptoms
able to function in daily life
Describe personality disorders
maladaptive patterns in behavior
lack of insight
tendency to blame others
they don’t see that they are the problem
What are the causes of personality disorders?
genetics
neurological
psychological (childhood trauma)
culture
When do symptoms begin for personality disorders?
early adulthood
How do people with personality disorders view others?
as all good or all bad (splitting)
What are examples of cluster A personality disorders?
schizotypal
paranoid
schizoid
(odd & eccentric)
Describe schizotypal personality disorder
social anxiety (awkward)
no need to socialize
magical thinking (weird ideas)
suspicious of others
Describe paranoid personality disorder
distrust of others
sees everything as attacks
can’t forgive insults
hostile to weak individuals
Describe schizoid personality disorder
mean/cold
unable to establish relationships
restricted emotions
enjoys animals (no humans)
What are examples of cluster B personality disorders?
antisocial
borderline
narcissistic
histrionic
only care about themselves
Describe antisocial personality disorder
sense of entitlement
lack of remorse (lying/manipulation)
impulsive (fail to plan ahead)
disregard for safety of others
How were those with antisocial personality disorder treated as children?
disciplined harshly
parents used substances
no supervision
Describe borderline personality disorder
chronically suicidal
mood instability (hard to calm down/sensitive)
unstable self-image and relationships
frantic efforts to avoid abandonment
What disorder is similar to borderline personality disorder? How can you differentiate?
bipolar
borderline has unstable relationships
Describe narcissistic personality disorder
arrogant
require excessive admiration
lack empathy
they think they are better than everyone
Describe histrionic personality disorder
theatrical
use physical appearance
they are the main character and only want attention
What are examples of cluster C personality disorders?
avoidant
obsessive-compulsive
dependent
Describe avoidant personality disorder
hypersensitive to criticism-avoid tasks
won’t take risks
imposter syndrome
avoids relationships, but need them
Describe obsessive-compulsive personality disorder
can’t break rules
rigid perfectionism
financially stingy
high achievers
Describe dependent personality disorder
clingy
excessively submissive
difficulty making decisions
hard time w/ conflict
tolerates abusive tx
What is done during the assessment phase for someone with personality disorders?
look for:
- primitive defenses (splitting, dissociation, projecting)
- suicide/self-harm
- aggressiveness (safety)
- substance use
- past-abuse
What are the outcomes for someone with personality disorders?
minimize self-destructive/aggressive behaviors
link consequences to behaviors
identify ways to prevent crisis
prevent regression
What is done during the implementation phase for someone with borderline and antisocial personality disorders?
set limits
reward positive behavior
for aggressive/manipulative pt:
- nurse will acknowledge, but not dismiss
What is done during the implementation phase for someone with dependent and histrionic personality disorders?
modeling good behavior
What is done during the implementation phase for someone with schizoid and schizotypal personality disorders?
respect need for isolation
What is done during the implementation phase for someone any personality disorders?
milieu therapy
give pt choices
Define dialectical behavioral therapy
Who can benefit from it?
addresses strategies for extreme mood swings
personality disorders
What will the nurse see during the evaluation phase for someone with any personality disorders?
minimized suicide and self-harm behaviors
What is the most used substance? What is the second most used?
1 - alcohol
2 - marijuana
Who is mostly likely to have substance use?
aka: comorbidities
anxiety disorders
PTSD
depressive disorders
mania
schizophrenia
What do those with substance use/addictive disorders have a higher risk of?
suicide
Define dual diagnosis
substance use disorders and mental disorders
What can happen with substance induced disorders?
intoxication
withdrawal
psychosis or delirium
Define addiction
chronic, relapsing brain disease characterized by compulsive behavior
all they care about is drugs
Define alcohol use disorder
problematic pattern of alcohol use
leads to impairment or distress
What is the CAGE assessment tool?
Cut down drinking or drugs?
Annoyed by ppl criticizing alc/drug use?
Guilty of alc/drug use?
Eyeopener? (drink or drugs first thing in the morning to calm nerves)
What criteria needs to be met from the CAGE assessment tool?
answer yes to at least 2
= alc or substance use disorder
What are medical issues that can result from alcohol use?
- gastrointestinal
- cardiovascular (dysrhythmias or stroke)
- wernicke-korsakoff’s syndrome (can’t make new memories)
- nervous system/brain damage
What is the legal limit for alcohol intoxication?
BAC .08%
How soon can alcohol withdrawal syndrome occur?
as soon as 2 hours after last use
Describe the signs of alcohol withdrawal syndrome
Autonomic
- elevated BP. pulse, temp
- sweating
- n/v/d
Motor
- tremors
- dysarthria
- seizures
Awareness
- agitation
- insomnia
- disorientation
Psychiatric
- anxiety
- hallucinations
- paranoia
What is alcohol withdrawal delirium?
medical emergency
peak 48-72 hours after last use
lasts 2-5 days
can lead to seizures
Describe opioid overdose
pinpoint pupils
respiratory depression
decreased LOC
Describe opioid withdrawal
can last up to 4 weeks
peak 3-5 days
low energy
irritability
flu-like
hot/cold sweats
severe muscle aches/pains
abd. cramping
What can a person who is addicted to nicotine experience?
abstinence syndrome (not life threatening)
- strong cravings
- impaired concentration
- restlessness
- increased appetite
What is done during the assessment phase for someone with substance/alc abuse disorder?
What did they take?
urine toxicology/BAC
toxicity/overdose symptoms
insight
injury
suicide/homicide
defense mechanisms (denial)
What are the outcomes for someone with substance/alc abuse disorder?
free from injury while withdrawing
increased insight
attend self help groups
develop relationships w/drug-free programs
demonstrate one new coping strategy
What is done during the implementation phase for someone with substance/alc abuse disorder?
be nonjudgmental/accepting
treat other disorders
active listening
health promotion
relapse prevention
