Week 6 - Personality disorders Flashcards
Derfine personality
The integration of
* subjective experiences of themselves and their environment
* conscious behaviours
* unconscious beliefs
Identify the 5 personality traits and their characteristics
Neuroticism - anger, anxiety, moody
Agreeableness - kindness, compassion, naivety
Extraversion - assertive, talkative, attention seeking
Openess - curious, creative, emotive
Conscientiousness - organised, reliable, self disciplined
Define General personality disorder
A condition associated with impaired cognition, and therefore affectivity, which leads to difficulty in impulse control and interpersonal functioning
What are the signs and symptoms of a general personality disorder
- general imbalanced or disordered presentation of personality traits
could be
* isolating or paranoid
* emotional
* manipulative
* unpredictable
* anxious
* fearful
Identify the three clusters of personality disorders and the characteristics of each cluster
Cluster A - detachment, paranoid, isolating, impaired perception of others which leads to lack of concern for others
Cluster B - emotional, impulsive, grandiosity, lack of empathy
Cluster C - anxiousness, fear, obsession with control, social withdrawal/inhibition
Define Antisocial personality disorder
A personality disorder characterised by impulsivity, lack of regard for others, and disordered behaviours of conduct
* behaviours often associated with illegal consequences - antisocial behaviours
Define conduct disorder
A disruptive impulse-control disorder where the person exhibits behaviours including
* aggression
* theft
* property damage
* rule violations
Identify signs and symptoms of antisocial personality disorder
- evicence of conduct disorder behaviours in adolescence (< 15)
- confidence
- lack of empathy
- lack of regard for consequences
- difficulty maintaining relationships
- arrogant
- impulsive
Biological causes of antisocial personality disorder
- The personality traits of APD are highly heritable
- White matter and frontal lobe differences
- poor nutrition -> negative impact on cognition and executive functioning
In conjunction with environmental factors
Psychological causes of antisocial personality disorder
- poor affective regulation
- personality traits of neuroticism and openess
Environmental causes of antisocial personality disorder
- dysfunctional family environment (child abuse, neglect, violence)
- substances in the home in childhood
- lack of parental discipline to regulate impulsive behaviours
- cycle of unemployment -> homelessness -> antisocial behaviour
Timeline of antisocial personality disorder
< 8 - disruptive behaviours may emerge (start of CD)
11 - symptoms of APD may begin developing
18 - potential diagnosis of APD from CD
Identify non pharmacological treatments for antisocial personality disorder
Medication not indicated
Important to understand consumers motivation to seek treatment - people with ADP rarely seek help
CBT
* puts strategies in place for consumer to refrain from antisocial behaviours
Psychoeducation
* consumer is educated about their condtion
* empowers and leads to more informed decision making
Reasoning and rehabilitation
* manages offending behaviours and trains social skills
* develops ideals necessary for positive engagement
* works on impulse control
Other concurrent treatments
* AOD treeatment
* behavioural modification
* social skills training
* anger management
Prevention
* of childhood trauma
* of behaviours through discipline
Identify nursing interventions and rationale for people experiencing antisocial personality disorder
MSE and risk assessment
Develop trusting therapeutic relationship
Psychoeducation
Set clear boundaries and limitations
Intervene in antisocial behviours where safe and appropriate to help support employment of coping strategies
* eg developing social skills, calming techniques
encourage commitment to therapies and provide words of support
Provide resources to assist consumer when recovering whilst in community
Define borderline personality disorder
A personality disorder characterised by abrupt mood fluctuations, impulsivity, and dysfunctional emotional regulation. See people as GOOD or BAD (fluctuate between idealisation and devaluation)
Identify signs and symptoms of borderline personality disorder
- low self esteem
- mood instability
- self harming/suicidal tendencies - maladaptive coping mechanism to stress
- impulsivity
- argumentative
- unstable interpersonal relationships
- insecurity - due to fear of abandonment
- dependence - due to fear of abandonment
- auditory hallucinations in times of stress “you are worthless” “kill yourself”
Biological causes of borderline personality disorder
- genetic heritability
- family history of substance misuse and other affective disorders
- inability to cope with stress
Brain
* abnormal emotional centre
* control mechanisms over the emotional brain are impaired
* * dopamine and serotonin dysfunction
alongside environmental factors
Psychological causes of borderline personality disorder
Ability to cope with stress
Environmental causes of borderline personality disorder
- Childhood trauma
- SEXUAL ABUSE
- low socioeconomic status
- bullying
- family instability (separation, death, strange dynamics)
Timeline of borderline personality disorder
Childhood - dysfunctional behaviours emerge
Early adulthood - severe mood an impulse control issues = unpredictability and risk of suicide
Adulthood - behaviour patterns stabilises by 40 and sometimes no longer meet criteria
Suicide and self-harm
Common feature of BPD
* oftenan attempt to communicate distress or cope with crisis
* 10% die by suicide
Signs of impending suicide or self harm
* discharge (coming up, recently happened)
* variations to normal self harm patterns
* metal decline
* increased substance misuse
* recent adverse life changes
* past suicide attempts (and lethality)
Identify and explain non pharmacological treatments for borderline personality disorder
Dialectical behavioural therapy
* teaches consumer how to sit through distress and employ self soothing
* teaches delaying techniques eg. wait an hour to cut
* teaches interpersonal skills (active listening, communicating, healthy relationships)
* diffuses black and white thinking of people
* may help consumer identify enablers in their life
* helps in minimising self harm
Cognitive behavioural therapy
* identifies faulty thinking
* supports reconstructing ways of thinking and forming postive coping strategies
* for anger and impulse management, and maintaining self esteem
* diffuses black and white thinking of people
Acceptance commitment therapy
* allows consumer to accept their potential and feel empowered
* mindfulness
* helpful in minimising the negative impacts of painful experiences
Pharmacological interventions as an adjunct therapy
Antipsychotics
* manages agitation and anger
* therefore improves general interpersonal functioning
Antidepressants
* hostility and emotional variances of BPD
* does not effectively treat self harming behaviours
Mood stabilisers
* controls mood instability
* therefore interpersonal functioning
Identify nursing intervention and rationale for people experiencing borderline personality disorder
Inpatient treatment is only effective for unavoidable crisis management
Understand and maintain boundaries
* protects consumer and physician
Exercuse firm limit setting (appointment times, treatment)
* mitigates abandonment issues
Collaborate with consumer to follow management plan - consistency, trust, patient centred
Build rapport and trust - builds comfort, allows consumer to open up about urges
MSE and risk assessment
medication management
Encourage self soothing mechanisms in times of distress- supports recovery via productive coping
* using ice instead of cutting
* journal writing
* exercising
* relaxation techniques
Close visual obs (15/60) if necesary - this could be comforting or distressing
Mental health management plans
Developed by the consumer and their community case manager
* diagnosis
* goals (short and long term)
* coping strategies
* emergency contacts
* roles and responsiblities of the care providers, family, and support systems
* risk factors to their care
Transferrance and countertransferrance
Transferance - when a patient imposes feelings or emotions onto the nurse because they remind them of someone
* can be positive or negative
Countertransferace - when a nurse imposes feelnigs or emotions onto the patient because they remind them of another patient
* most usually negative
Be aware so as to not
* impact care
* impact consumer
* divide staff
