Week 8; Care of Pt's With Chronic Mental Illness Flashcards
SUICIDE ASSESSMENT:
*CURRENT IDEATION
*HISTORY OF ATTEMPTS
*INTENT
*PLAN
*MEANS
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS
(DSM-5)
*DEFINES AND CLASSIFIES MENTAL DISORDERS IN ORDER TO IMPROVE DIAGNOSES, TREATMENT AND RESEARCH
SCHIZOPHRENIA
*THE WORD SCHIZOPHRENIA IS DERIVED FROM THE
GREEK WORDS SKHIZO (SPLIT) AND PHREN (MIND).
*EARLY 1900’S CALLED “DEMENTIA PRAECOX” –
DISAPPEARED WITH 1ST PUBLICATION OF THE
DIAGNOSTIC AND STATISTICAL MANUAL: MENTAL
DISORDERS (DSM-1) SCHIZOPHRENIA IS NOT A SPLIT PERSONALITY.
SCHIZOPHRENIA IS MOST LIKELY CAUSED BY
A COMBINATION OF FACTORS, INCLUDING
*GENETIC PREDISPOSITION
*BIOCHEMICAL DYSFUNCTION
*PHYSIOLOGICAL FACTORS
*PSYCHOSOCIAL STRESS
COMMUNITY BASED TREATMENT
*PRIMARY PREVENTION –
*USING SCREENING TOOLS, MENTAL HEALTHY FAIRS,
TRAINING, AT RISK POPULATIONS, SCREENING
COMMUNITY BASED TREATMENT
SECONDARY PREVENTION -
IDENTIFICATION AND PROMPT TREATMENT
*OUTPATIENT, DAY TREATMENT, INPATIENT TREATMENT,
CRISIS MANAGEMENT, SUICIDE PREVENTION
COMMUNITY BASED TREATMENT
TERTIARY PREVENTION –
PREVENTING COMPLICATIONS, REHABILITATION, HELPING PERSON REACH MAXIMUM LEVEL OF FUNCTIONING
*THERAPY, GROUP THERAPY, COUNSELING AND SUPPORT
GROUPS
OF ALL MENTAL ILLNESSES, SCHIZOPHRENIA CAUSES MORE
*LENGTHY HOSPITALIZATIONS
*CHAOS IN FAMILY LIFE
*EXORBITANT COSTS TO PEOPLE AND
GOVERNMENTS
*FEARS
*WITH SCHIZOPHRENIA, THERE IS A
SEVERE DETERIORATION OF SOCIAL AND
OCCUPATIONAL FUNCTIONING.
SCHIZOPHRENIA CAUSES DISTURBANCES IN
*THOUGHT PROCESSES
*PERCEPTION
*AFFECT
Phases of schizophrenia
Phase I: premorbid
Phase II: prodromal
Phase III: schizophrenia
Phase IV: residual phase
PHASE I
*PREMORBID PHASE
*SOCIAL MALADJUSTMENT
*ANTAGONISTIC THOUGHTS AND BEHAVIOR
*SHY AND WITHDRAWN
*POOR PEER RELATIONSHIPS
*DOING POORLY IN SCHOOL
*ANTISOCIAL BEHAVIOR
PHASE II
*PRODROMAL PHASE
*LASTS FROM A FEW WEEKS TO A FEW YEARS
*DETERIORATION IN ROLE FUNCTIONING AND
SOCIAL WITHDRAWAL
*SUBSTANTIAL FUNCTIONAL IMPAIRMENT
*SLEEP DISTURBANCE, ANXIETY, IRRITABILITY
*DEPRESSED MOOD, POOR CONCENTRATION,
FATIGUE
*PERCEPTUAL ABNORMALITIES, IDEAS OF
REFERENCE, AND SUSPICIOUSNESS HERALD
ONSET OF PSYCHOSIS
PHASE III
*SCHIZOPHRENIA
*IN THE ACTIVE PHASE OF THE DISORDER,
PSYCHOTIC SYMPTOMS ARE PROMINENT.
*DELUSIONS
*HALLUCINATIONS
*IMPAIRMENT IN WORK, SOCIAL
RELATIONS, AND SELF-CARE
PHASE IV
*RESIDUAL PHASE
*SYMPTOMS SIMILAR TO THOSE OF
THE PRODROMAL PHASE.
*FLAT AFFECT AND IMPAIRMENT IN
ROLE FUNCTIONING ARE
PROMINENT
Schizophrenia prognosis
*A RETURN TO FULL PREMORBID FUNCTIONING IS
NOT COMMON.
*FACTORS ASSOCIATED WITH A POSITIVE PROGNOSIS
INCLUDE
*GOOD PREMORBID FUNCTIONING
*LATER AGE AT ONSET
*FEMALE GENDER
*ABRUPT ONSET PRECIPITATED BY A STRESSFUL EVENT
*ASSOCIATED MOOD DISTURBANCE
*BRIEF DURATION OF ACTIVE-PHASE SYMPTOMS
FACTORS ASSOCIATED WITH A POSITIVE PROGNOSIS OF SCHIZOPHRENIA INCLUDE
*MINIMAL RESIDUAL SYMPTOMS
*ABSENCE OF STRUCTURAL BRAIN
ABNORMALITIES
*NORMAL NEUROLOGICAL FUNCTIONING
*FAMILY HISTORY OF MOOD DISORDER
*NO FAMILY HISTORY OF SCHIZOPHRENIA
SCHIZOPHRENIA BIOLOGICAL INFLUENCES
*GENETICS; A GROWING BODY OF KNOWLEDGE
INDICATES THAT GENETICS PLAYS
AN IMPORTANT ROLE IN THE
DEVELOPMENT OF SCHIZOPHRENIA
*BIOCHEMICAL INFLUENCES; ONE THEORY SUGGESTS THAT
SCHIZOPHRENIA MAY BE CAUSED BY AN
EXCESS OF DOPAMINE ACTIVITY IN THE
BRAIN. ABNORMALITIES IN OTHER
NEUROTRANSMITTERS HAVE ALSO BEEN
SUGGESTED.
*PHYSIOLOGICAL INFLUENCES; FACTORS THAT HAVE BEEN IMPLICATED
INCLUDE: VIRAL INFECTION, ANATOMICAL ABNORMALITIES, HISTOLOGICAL CHANGES IN BRAIN
SCHIZOPHRENIA PSYCHOLOGICAL INFLUENCES
*THESE THEORIES NO LONGER HOLD
CREDIBILITY. RESEARCHERS NOW FOCUS
THEIR STUDIES OF SCHIZOPHRENIA AS A
BRAIN DISORDER.
*PSYCHOSOCIAL THEORIES PROBABLY
DEVELOPED EARLY ON OUT OF A LACK OF
INFORMATION RELATED TO A BIOLOGICAL
CONNECTION.
SCHIZOPHRENIA ENVIRONMENTAL INFLUENCES
*SOCIOCULTURAL FACTORS: POVERTY
HAS BEEN LINKED WITH THE
DEVELOPMENT OF SCHIZOPHRENIA.
*DOWNWARD DRIFT HYPOTHESIS:
POOR SOCIAL CONDITIONS SEEN AS
CONSEQUENCE OF, RATHER THAN A
CAUSE OF, SCHIZOPHRENIA.
*STRESSFUL LIFE EVENTS MAY BE
ASSOCIATED WITH EXACERBATION OF
SCHIZOPHRENIC SYMPTOMS AND
INCREASED RATES OF RELAPSE.
*STUDIES OF GENETIC VULNERABILITY FOR
SCHIZOPHRENIA HAVE LINKED CERTAIN
GENES TO INCREASED RISK FOR PSYCHOSIS
AND PARTICULARLY FOR ADOLESCENTS WHO
USE CANNABINOIDS.
THEORETICAL INTEGRATION
*SCHIZOPHRENIA IS MOST LIKELY A
BIOLOGICALLY BASED DISEASE, THE ONSET
OF WHICH IS INFLUENCED BY FACTORS IN
THE INTERNAL OR EXTERNAL
ENVIRONMENT.
DELUSIONAL DISORDER
*THE EXISTENCE OF PROMINENT,
NONBIZARRE DELUSIONS
*EROTOMANIC TYPE
*GRANDIOSE TYPE
*JEALOUS TYPE
*PERSECUTORY TYPE
*SOMATIC TYPE
*MIXED TYPE
BRIEF PSYCHOTIC DISORDER
*SUDDEN ONSET OF SYMPTOMS
*MAY OR MAY NOT BE PRECEDED BY A
SEVERE
PSYCHOSOCIAL STRESSOR
*LASTS LESS THAN 1 MONTH
*RETURN TO FULL PREMORBID LEVEL OF
FUNCTIONING
*PSYCHOTIC DISORDER ASSOCIATED WITH
ANOTHER MEDICAL CONDITION
*PROMINENT HALLUCINATIONS AND
DELUSIONS ARE DIRECTLY ATTRIBUTABLE
TO A GENERAL MEDICAL CONDITION.
SUBSTANCE-INDUCED PSYCHOTIC DISORDER
*THE PRESENCE OF PROMINENT
HALLUCINATIONS AND DELUSIONS THAT
ARE JUDGED TO BE DIRECTLY
ATTRIBUTABLE TO SUBSTANCE
INTOXICATION OR WITHDRAWAL
THE CATATONIC FEATURES SPECIFIER
*CATATONIC FEATURES MAY BE ASSOCIATED WITH OTHER
PSYCHOTIC DISORDERS, SUCH AS BRIEF PSYCHOTIC
DISORDER, SCHIZOPHRENIFORM DISORDER,
SCHIZOPHRENIA, SCHIZOAFFECTIVE DISORDER, AND
SUBSTANCE-INDUCED PSYCHOTIC DISORDER.
SYMPTOMS OF CATATONIC DISORDER INCLUDE:
*STUPOR AND MUSCLE RIGIDITY OR EXCESSIVE,
PURPOSELESS MOTOR ACTIVITY
*WAXY FLEXIBILITY, NEGATIVISM, ECHOLALIA,
ECHOPRAXIA
SCHIZOPHRENIFORM DISORDER
*SAME SYMPTOMS AS SCHIZOPHRENIA WITH THE EXCEPTION THAT THE DURATION OF THE DISORDER HAS BEEN AT LEAST 1 MONTH BUT LESS THAN 6 MONTHS
SCHIZOAFFECTIVE DISORDER
*SCHIZOPHRENIC SYMPTOMS ACCOMPANIED BY A STRONG ELEMENT OF SYMPTOMATOLOGY ASSOCIATED WITH THE MOOD DISORDERS EITHER MANIA OR DEPRESSION
DELUSIONS:
FALSE PERSONAL BELIEFS
RELIGIOSITY:
EXCESSIVE DEMONSTRATION OF OBSESSION WITH RELIGIOUS IDEAS AND BEHAVIOR
PARANOIA:
EXTREME SUSPICIOUSNESS OF OTHERS
MAGICAL THINKING:
IDEAS THAT ONE’S THOUGHTS OR BEHAVIORS HAVE CONTROL OVER
SPECIFIC SITUATIONS
POSITIVE SYMPTOMS
- CONTENT OF THOUGHT
FORM OF THOUGHT (POSITIVE SX)
ASSOCIATIVE LOOSENESS
(ALSO CALLED LOOSE ASSOCIATION): SHIFT OF IDEAS FROM ONE UNRELATED TOPIC TO ANOTHER
FORM OF THOUGHT (POSITIVE SX)
NEOLOGISMS:
MADE-UP WORDS THAT HAVE MEANING ONLY TO THE PERSON WHO INVENTS THEM
FORM OF THOUGHT (POSITIVE SX)
CONCRETE THINKING:
LITERAL INTERPRETATIONS OF THE ENVIRONMENT
FORM OF THOUGHT (POSITIVE SX)
CLANG ASSOCIATIONS:
CHOICE OF WORDS IS GOVERNED BY SOUND (OFTEN RHYMING)
WORD SALAD:
GROUP OF WORDS PUT TOGETHER IN A RANDOM FASHION
CIRCUMSTANTIALITY:
DELAY IN REACHING THE POINT OF A COMMUNICATION BECAUSE OF UNNECESSARY AND TEDIOUS DETAILS
TANGENTIALITY:
INABILITY TO GET TO THE POINT OF COMMUNICATION DUE TO INTRODUCTION OF MANY NEW TOPICS
MUTISM:
NABILITY OR REFUSAL TO SPEAK
PERSEVERATION:
PERSISTENT REPETITION OF
THE SAME WORD OR IDEA IN RESPONSE TO
DIFFERENT QUESTIONS
PERCEPTION:
INTERPRETATION OF STIMULI THROUGH THE SENSES
HALLUCINATIONS:
FALSE SENSORY PERCEPTIONS NOT
ASSOCIATED WITH REAL EXTERNAL STIMULI
−AUDITORY
−VISUAL
−TACTILE
−GUSTATORY
−OLFACTORY
ECHOLALIA:
REPEATING WORDS THAT ARE HEARD
ILLUSIONS:
MISPERCEPTIONS OF REAL EXTERNAL STIMULI
ECHOPRAXIA:
REPEATING MOVEMENTS THAT ARE
OBSERVED
IDENTIFICATION AND IMITATION:
TAKING ON THE FORM OF BEHAVIOR ONE OBSERVES IN ANOTHER
DEPERSONALIZATION:
FEELINGS OF UNREALITY
NEGATIVE SYMPTOMS AFFECT:
THE FEELING STATE OR EMOTIONAL TONE
INAPPROPRIATE AFFECT:
EMOTIONS ARE INCONGRUENT WITH THE CIRCUMSTANCES
BLAND:
WEAK EMOTIONAL TONE
FLAT:
APPEARS TO BE VOID OF EMOTIONAL TONE
APATHY:
DISINTEREST IN THE ENVIRONMENT
VOLITION:
IMPAIRMENT IN THE ABILITY TO INITIATE GOAL-DIRECTED ACTIVITY
EMOTIONAL AMBIVALENCE:
COEXISTENCE OF OPPOSITE EMOTIONS TOWARD SAME OBJECT, PERSON, OR SITUATION
DETERIORATION IN APPEARANCE:
IMPAIRED PERSONAL GROOMING AND SELF-CARE ACTIVITIES
IMPAIRED SOCIAL INTERACTION:
LINGING AND INTRUDING ON THE PERSONAL SPACE OF OTHERS, EXHIBITING BEHAVIORS THAT ARE NOT CULTURALLY AND SOCIALLY ACCEPTABLE
SOCIAL ISOLATION:
A FOCUS INWARD ON THE SELF TO THE EXCLUSION OF THE EXTERNAL
ENVIRONMENT
ANERGIA:
DEFICIENCY OF ENERGY
WAXY FLEXIBILITY:
PASSIVE YIELDING OF ALL MOVABLE PARTS OF THE BODY TO ANY EFFORT MADE AT PLACING THEM IN CERTAIN POSITIONS
POSTURING:
VOLUNTARY ASSUMPTION OF INAPPROPRIATE OR BIZARRE POSTURES
PACING AND ROCKING:
PACING BACK AND FORTH AND ROCKING THE BODY
ANHEDONIA:
INABILITY TO EXPERIENCE PLEASURE
REGRESSION:
RETREAT TO AN EARLIER LEVEL OF DEVELOPMENT
PATIENT OUTCOMES
*DEMONSTRATES AN ABILITY TO RELATE TO
OTHERS SATISFACTORILY
*RECOGNIZES DISTORTIONS OF REALITY
*HAS NOT HARMED SELF OR OTHERS
*PERCEIVES SELF REALISTICALLY
*DEMONSTRATES ABILITY TO PERCEIVE THE
ENVIRONMENT CORRECTLY
*MAINTAINS ANXIETY AT A MANAGEABLE
LEVEL
*RELINQUISHES NEED FOR DELUSIONS AND
HALLUCINATIONS
*DEMONSTRATES ABILITY TO TRUST
OTHERS
*USES APPROPRIATE VERBAL
COMMUNICATION IN INTERACTIONS WITH
OTHERS
*PERFORMS SELF-CARE ACTIVITIES
INDEPENDENTL
NURSING INTERVENTIONS R/T HALLUCINATIONS
*OBSERVE THE CLIENT FOR SIGNS OF
HALLUCINATIONS.
*HELP CLIENT UNDERSTAND CONNECTIONS
BETWEEN ANXIETY
AND HALLUCINATIONS.
*DISTRACT THE CLIENT FROM
HALLUCINATIONS.
NURSING INTERVENTIONS R/T DISTURBED THOUGHT PROCESS
*DO NOT ARGUE OR DENY THE BELIEF.
*REINFORCE AND FOCUS ON REALITY.
NURSING INTERVENTIONS R/T RISK FOR VIOLENCE
*OBSERVE CLIENT’S BEHAVIOR.
*MAINTAIN CALM ATTITUDE.
*HAVE SUFFICIENT STAFF ON HAND.
NURSING INTERVENTIONS R/T IMPAIRED VERBAL COMMUNICATION
*FACILITATE TRUST AND UNDERSTANDING.
*ORIENT THE CLIENT TO REALITY.
PT AND FAMILY EDUCATION: NATURE OF ILLNESS
*WHAT TO EXPECT AS ILLNESS PROGRESSES
*SYMPTOMS ASSOCIATED WITH ILLNESS
*WAYS FOR FAMILY TO RESPOND TO
BEHAVIORS ASSOCIATED WITH ILLNESS
PT AND FAMILY EDUCATION: MANAGEMENT OF THE ILLNESS
*CONNECTION OF EXACERBATION OF SYMPTOMS TO TIMES OF STRESS
*APPROPRIATE MEDICATION MANAGEMENT
*SIDE EFFECTS OF MEDICATIONS
*IMPORTANCE OF NOT STOPPING MEDICATIONS
*WHEN TO CONTACT HEALTH-CARE PROVIDER
*RELAXATION TECHNIQUES
*SOCIAL SKILLS TRAINING
*DAILY LIVING SKILLS TRAINING
PT AND FAMILY EDUCATION: SUPPORT SERVICES
*FINANCIAL ASSISTANCE
*LEGAL ASSISTANCE
*CAREGIVER SUPPORT GROUPS
*RESPITE CARE
*HOME HEALTH CARE
PSYCHOLOGICAL TREATMENTS: INDIVIDUAL PSYCHOTHERAPY
LONG-TERM THERAPEUTIC APPROACH; DIFFICULT BECAUSE OF CLIENT’S IMPAIRMENT IN INTERPERSONAL FUNCTIONING
PSYCHOLOGICAL TREATMENTS: GROUP THERAPY
SOME SUCCESS IF OCCURRING OVER THE LONG-TERM COURSE
OF THE ILLNESS; LESS SUCCESSFUL IN ACUTE, SHORT-TERM TREATMENT
PSYCHOLOGICAL TREATMENTS: BEHAVIOR THERAPY
CHIEF DRAWBACK HAS BEEN INABILITY TO GENERALIZE TO COMMUNITY SETTING AFTER CLIENT HAS BEEN DISCHARGED FROM TREATMENT.
PSYCHOLOGICAL TREATMENTS: SOCIAL SKILLS TRAINING
USE OF ROLE PLAY TO TEACH CLIENT APPROPRIATE EYE
CONTACT, INTERPERSONAL SKILLS, VOICE INTONATION, POSTURE, AND SO ON; AIMED AT IMPROVING RELATIONSHIP DEVELOPMEN
PROGRAM OF ASSERTIVE COMMUNITY TREATMENT
*A PROGRAM OF CASE MANAGEMENT THAT TAKES A TEAM APPROACH IN PROVIDING COMPREHENSIVE, COMMUNITY-BASED PSYCHIATRIC TREATMENT, REHABILITATION, AND SUPPORT TO PERSONS WITH SERIOUS AND PERSISTENT MENTAL ILLNESS
PSYCHOPHARMACOLOGY
ANTIPSYCHOTICS:
USED TO DECREASE AGITATION AND PSYCHOTIC SYMPTOMS OF
SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
PSYCHOPHARMACOLOGY
TYPICAL ANTIPSYCHOTICS:
DOPAMINERGIC BLOCKERS WITH VARIOUS AFFINITY FOR
CHOLINERGIC, Α-ADRENERGIC, AND HISTAMINIC RECEPTORS
PSYCHOPHARMACOLOGY
ATYPICALS:
WEAK DOPAMINE ANTAGONISTS; POTENT 5HT ANTAGONISTS; ALSO EXHIBIT ANTAGONISM FOR CHOLINERGIC, HISTAMINIC, AND ADRENERGIC RECEPTORS
Psychopharm side effects
*ANTICHOLINERGIC EFFECTS
*NAUSEA; GASTROINTESTINAL
UPSET
*SKIN RASH
*SEDATION
*ORTHOSTATIC HYPOTENSION
*PHOTOSENSITIVITY
*HORMONAL EFFECTS
*ELECTROCARDIOGRAM CHANGES
*HYPERSALIVATION
*WEIGHT GAIN
*HYPERGLYCEMIA/DIABETES
*INCREASED RISK OF MORTALITY
IN ELDERLY CLIENTS WITH
DEMENTIA
*REDUCTION IN SEIZURE
THRESHOLD
*AGRANULOCYTOSIS
*EXTRAPYRAMIDAL SYMPTOMS
*TARDIVE DYSKINESIA
*NEUROLEPTIC MALIGNANT
SYNDROME
EXTRAPYRAMIDAL SYMPTOMS (EPS) INCLUDE
*PSEUDOPARKINSONISM
*AKINESIA
*AKATHISIA
*DYSTONIA
*OCULOGYRIC CRISIS
What is used to counteract EPS?
ANTIPARKINSONIAN AGENTS
Medication teaching for pt and family
*NOT STOP TAKING THE DRUG ABRUPTLY.
*USE SUNSCREENS AND WEAR PROTECTIVE
CLOTHING WHEN SPENDING TIME OUTDOORS.
*REPORT WEEKLY (IF RECEIVING CLOZAPINE
THERAPY) TO HAVE BLOOD LEVELS DRAWN AND TO
OBTAIN A WEEKLY SUPPLY OF THE DRUG.
*BE AWARE OF POSSIBLE RISKS OF TAKING
ANTIPSYCHOTICS DURING PREGNANCY.
*NOT DRINK ALCOHOL WHILE RECEIVING ANTIPSYCHOTIC THERAPY
*NOT CONSUME OTHER MEDICATIONS (INCLUDING OVER-THE-COUNTER DRUGS) WITHOUT THE PHYSICIAN’S KNOWLEDGE
MOOD
IS DEFINED AS A PERVASIVE AND SUSTAINED
EMOTION THAT MAY HAVE A MAJOR INFLUENCE ON A
PERSON’S PERCEPTION OF THE WORLD.
* EXAMPLES OF MOOD: DEPRESSION, JOY, ELATION,
ANGER, ANXIETY
AFFECT
IS DESCRIBED AS THE EMOTIONAL REACTION
ASSOCIATED WITH AN EXPERIENCE. MOOD IS SOMETIMES ALSO CALLED AFFECT. HOWEVER – AFFECT IS DISTINGUISHED FROM MOOD. MOOD IS SUSTAINED, PERVASIVE.
MANIA
IS AN ALTERATION IN MOOD THAT IS EXPRESSED BY FEELINGS OF ELATION, INFLATED SELF-ESTEEM, GRANDIOSITY, HYPERACTIVITY, AGITATION, AND ACCELERATED THINKING AND SPEAKING.
* MANIA CAN OCCUR AS A BIOLOGICAL (ORGANIC) OR
PSYCHOLOGICAL DISORDER, OR AS A RESPONSE TO SUBSTANCE USE OR A GENERAL MEDICAL CONDITION.
DEPRESSION
IS THE OLDEST AND ONE OF THE MOST FREQUENTLY DIAGNOSED PSYCHIATRIC ILLNESSES. TRANSIENT SYMPTOMS ARE NORMAL, HEALTHY RESPONSES TO EVERYDAY DISAPPOINTMENTS IN LIFE. DEPRESSION IS AN ALTERATION IN MOOD THAT IS EXPRESSED BY FEELINGS OF SADNESS, DESPAIR, AND PESSIMISM.
Depression risk factors
GENDER PREVALENCE: DEPRESSION IS MORE PREVALENT IN WOMEN THAN IN MEN BY ABOUT 2 TO 1.
AGE: DEPRESSION IS MORE COMMON IN YOUNG
WOMEN THAN IN YOUNG MEN. THE GENDER DIFFERENCE IS LESS PRONOUNCED BETWEEN AGES 44 AND 65, BUT AFTER AGE 65, WOMEN ARE AGAIN MORE LIKELY TO BE DEPRESSED THAN ARE MEN.
SOCIAL CLASS: THERE IS AN INVERSE RELATIONSHIP BETWEEN SOCIAL CLASS AND REPORT OF DEPRESSIVE SYMPTOMS. LOWER SOCIOECONOMIC GROUPS HAVE MORE DEPRESSION
RACE: NO CONSISTENT RELATIONSHIP BETWEEN RACE AND AFFECTIVE DISORDER HAS BEEN REPORTED. ONE RECENT SURVEY REVEALED: DEPRESSION IS MORE PREVALENT IN WHITES THAN IN BLACKS. DEPRESSION IS MORE SEVERE AND DISABLING IN BLACKS. BLACKS ARE LESS LIKELY TO RECEIVE TREATMENT THAN ARE WHITES.
MARITAL STATUS: SINGLE AND DIVORCED PEOPLE ARE MORE LIKELY TO EXPERIENCE DEPRESSION THAN ARE MARRIED PERSONS OR PERSONS WITH A CLOSE INTERPERSONAL RELATIONSHIP.
SEASONALITY: AFFECTIVE DISORDERS ARE MORE PREVALENT IN THE SPRING AND IN THE FALL
MAJOR DEPRESSIVE DISORDER
- CHARACTERIZED BY DEPRESSED MOOD
- LOSS OF INTEREST OR PLEASURE IN USUAL
ACTIVITIES - SYMPTOMS PRESENT FOR AT LEAST 2 WEEKS
- NO HISTORY OF MANIC BEHAVIOR
- CANNOT BE ATTRIBUTED TO USE OF SUBSTANCES OR
ANOTHER MEDICAL CONDITION
DYSTHYMIC DISORDER
- SAD OR “DOWN IN THE DUMPS”
- NO EVIDENCE OF PSYCHOTIC SYMPTOMS
- ESSENTIAL FEATURE IS A CHRONICALLY DEPRESSED
MOOD FOR - MOST OF THE DAY
- MORE DAYS THAN NOT
- AT LEAST 2 YEARS
PREMENSTRUAL DYSPHORIC DISORDER
- DEPRESSED MOOD
- ANXIETY
- MOOD SWINGS
- DECREASED INTEREST IN ACTIVITIES
- SYMPTOMS BEGIN DURING WEEK PRIOR TO
MENSES, START TO IMPROVE WITHIN A FEW DAYS
AFTER THE ONSET OF MENSES, AND BECOME
MINIMAL OR ABSENT IN THE WEEK POST-MENSES.
SUBSTANCE-INDUCED DEPRESSIVE DISORDER
CONSIDERED TO BE THE DIRECT RESULT OF
PHYSIOLOGICAL EFFECTS OF A SUBSTANCE
PREDISPOSING FACTORS TO DEPRESSION
- GENETICS; HEREDITARY FACTOR MAY BE INVOLVED
- BIOCHEMICAL INFLUENCES; DEFICIENCY OF NOREPINEPHRINE, SEROTONIN, AND DOPAMINE HAS BEEN IMPLICATED. EXCESSIVE CHOLINERGIC TRANSMISSION MAY ALSO BE A FACTOR.
- NEUROENDOCRINE DISTURBANCES; POSSIBLE FAILURE WITHIN THE HYPOTHALAMIC-PITUITARY-ADRENOCORTICAL AXIS. POSSIBLE DIMINISHED RELEASE OF TSH
- PHYSIOLOGICAL INFLUENCES; MEDICATION SIDE EFFECTS, NEUROLOGICAL DISORDERS, ELECTROLYTE DISTURBANCES, HORMONAL DISORDERS, NUTRITIONAL DEFICIENCIES, OTHER PHYSIOLOGICAL CONDITIONS.
- PSYCHOSOCIAL THEORIES (CONT’D)
- LEARNING THEORY; LEARNED HELPLESSNESS: THE INDIVIDUAL WHO EXPERIENCES NUMEROUS FAILURES LEARNS TO GIVE UP TRYING, LOSS
CHILDHOOD DEPRESSION
- < AGE 3: FEEDING PROBLEMS, TANTRUMS, LACK OF
PLAYFULNESS AND EMOTIONAL EXPRESSIVENESS - AGES 3 TO 5: ACCIDENT PRONENESS, PHOBIAS, EXCESSIVE SELF-REPROACH
- AGES 6 TO 8: PHYSICAL COMPLAINTS, AGGRESSIVE
BEHAVIOR, CLINGING BEHAVIOR - AGES 9 TO 12: MORBID THOUGHTS AND EXCESSIVE
WORRYING
ADOLESCENCE DEPRESSION
- ANGER, AGGRESSIVENESS
- RUNNING AWAY
- DELINQUENCY
- SOCIAL WITHDRAWAL
- SEXUAL ACTING OUT
- SUBSTANCE ABUSE
- RESTLESSNESS, APATHY
- BEST CLUE THAT DIFFERENTIATES DEPRESSION FROM NORMAL STORMY ADOLESCENT BEHAVIOR
- A VISIBLE MANIFESTATION OF BEHAVIORAL CHANGE THAT LASTS FOR SEVERAL WEEKS.
- MOST COMMON PRECIPITANT TO ADOLESCENT SUICIDE
- PERCEPTION OF ABANDONMENT BY PARENTS OR CLOSE PEER RELATIONSHIP
- TREATMENT WITH SUPPORTIVE PSYCHOSOCIAL INTERVENTION, ANTIDEPRESSANT MEDICATION
NOTE: ALL ANTIDEPRESSANTS CARRY A FOOD AND DRUG ADMINISTRATION BLACK-BOX WARNING FOR INCREASED RISK OF SUICIDALITY IN CHILDREN AND ADOLESCENTS.
POSTPARTUM DEPRESSION
- MAY LAST FOR A FEW WEEKS TO SEVERAL MONTHS
- ASSOCIATED WITH HORMONAL CHANGES, TRYPTOPHAN METABOLISM, OR
CELL ALTERATIONS - TREATMENTS
- ANTIDEPRESSANTS AND PSYCHOSOCIAL THERAPIES
- SYMPTOMS INCLUDE
- FATIGUE
- IRRITABILITY
- LOSS OF APPETITE
- SLEEP DISTURBANCES
- LOSS OF LIBIDO
- CONCERN ABOUT INABILITY TO CARE FOR INFANT
DEPRESSED MOOD
- SUBJECTIVE REPORTING OR OBJECTIVE OBSERVATION
- SUBJECTIVE: “FEELS SAD”, “HOPELESS”
- OBJECTIVE: “APPEARS TEARFUL”, FLAT AFFECT, SAD AFFECT
- DIMINISHED INTEREST OR PLEASURE (ANHEDONIA)
- WEIGHT CHANGE – INCREASE OR DECREASE
- INSOMNIA OR HYPERSOMNIA
- WITH INSOMNIA: DIFFICULTY FALLING ASLEEP, STAYING ASLEEP, OR EARLY MORNING AWAKENING
- PSYCHOMOTOR AGITATION OR RETARDATION
- WORTHLESSNESS OR EXCESSIVE/INAPPROPRIATE GUILT
- INABILITY TO CONCENTRATE
- RECURRENT THOUGHT OF DEATH OR SUICIDAL IDEATION
- CAN CAUSE IMPAIRMENT IN SOCIAL, OCCUPATION OR OTHER AREAS OF FUNCTIONING
TRANSIENT DEPRESSION
- SYMPTOMS AT THIS LEVEL OF THE CONTINUUM ARE NOT NECESSARILY DYSFUNCTIONAL.
- AFFECTIVE: THE “BLUES”
- BEHAVIORAL: SOME CRYING
- COGNITIVE: SOME DIFFICULTY GETTING MIND OFF OF
ONE’S DISAPPOINTMENT - PHYSIOLOGICAL: FEELING TIRED AND LISTLESS
SEVERE DEPRESSION
- INCLUDES SYMPTOMS OF MAJOR DEPRESSIVE DISORDER AND BIPOLAR DEPRESSION
- AFFECTIVE: FEELINGS OF TOTAL DESPAIR, WORTHLESSNESS, FLAT AFFECT
- BEHAVIORAL: PSYCHOMOTOR RETARDATION, CURLED-UP POSITION, ABSENCE OF COMMUNICATION
- COGNITIVE: PREVALENT DELUSIONAL THINKING, WITH
DELUSIONS OF PERSECUTION AND SOMATIC DELUSIONS; CONFUSION; SUICIDAL THOUGHTS - PHYSIOLOGICAL: A GENERAL SLOW-DOWN OF THE ENTIRE BODY
RISK FOR SUICIDE RELATED TO
- DEPRESSED MOOD
- FEELINGS OF WORTHLESSNESS
- ANGER TURNED INWARD ON THE SELF
- MISINTERPRETATIONS OF REALITY
DEPRESSION OUTCOMES
- HAS EXPERIENCED NO PHYSICAL HARM TO SELF
- DISCUSSES THE LOSS WITH STAFF AND FAMILY MEMBERS
- NO LONGER IDEALIZES OR OBSESSES ABOUT THE LOST
ENTITY - SETS REALISTIC GOALS FOR SELF
- ATTEMPTS NEW ACTIVITIES WITHOUT FEAR OF FAILURE
- IS ABLE TO IDENTIFY ASPECTS OF SELF-CONTROL OVER
LIFE SITUATION
CLIENT/FAMILY EDUCATION
- NATURE OF THE ILLNESS
- STAGES OF GRIEF AND SYMPTOMS ASSOCIATED WITH
EACH STAGE - WHAT IS DEPRESSION?
- WHY DO PEOPLE GET DEPRESSED?
- MANAGEMENT OF THE ILLNESS
- MEDICATION MANAGEMENT
- ASSERTIVE TECHNIQUES
- STRESS-MANAGEMENT TECHNIQUES
- WAYS TO INCREASE SELF-ESTEEM
- ELECTROCONVULSIVE THERAPY
- WHAT ARE THE SYMPTOMS OF DEPRESSION?
- SUPPORT SERVICES; SUICIDE HOTLINE, SUPPORT GROUPS, LEGAL/FINANCIAL ASSISTANCE
DEPRESSION TREATMENT MODALITIES
- INDIVIDUAL PSYCHOTHERAPY
- GROUP THERAPY
- FAMILY THERAPY
- COGNITIVE THERAPY
- ELECTROCONVULSIVE THERAPY
- LIGHT THERAPY
ELECTROCONVULSIVE THERAPY
- MECHANISM OF ACTION: THOUGHT TO INCREASE
LEVELS OF BIOGENIC AMINES - SIDE EFFECTS: TEMPORARY MEMORY LOSS AND
CONFUSION - RISKS: MORTALITY; PERMANENT MEMORY LOSS;
BRAIN DAMAGE - MEDICATIONS: PRETREATMENT MEDICATION; MUSCLE
RELAXANT; SHORT-ACTING ANESTHETIC
PSYCHOPHARMACOLOGY INCLUDES:
- TRICYCLICS
- SELECTIVE SEROTONIN REUPTAKE INHIBITORS
- MONOAMINE OXIDASE INHIBITORS (MAOIS)
- SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS
CLIENT/FAMILY EDUCATION RELATED TO
ANTIDEPRESSANTS
- CONTINUE TO TAKE MEDICATION FOR 4 WEEKS.
- DO NOT DISCONTINUE MEDICATION ABRUPTLY.
- REPORT SORE THROAT, FEVER, MALAISE, YELLOW SKIN,
BLEEDING, BRUISING, PERSISTENT VOMITING OR
HEADACHES, RAPID HEART RATE, SEIZURES, STIFF NECK
AND CHEST PAIN TO PHYSICIAN. - AVOID FOODS AND MEDICATIONS HIGH IN TYRAMINE WHEN TAKING MAO INHIBITORS (MAOI’S). THESE INCLUDE BUT NOT LIMITED TO:
- AGED CHEESE
- WINE; BEER
- CHOCOLATE; COLAS
- COFFEE; TEA
- SOUR CREAM; YOGURT
- SMOKED AND PROCESSED MEATS
- BEEF OR CHICKEN LIVER
- CANNED FIGS
- CAVIAR, PICKLED HERRING,
- SOY SAUCE
- COLD TABLETS
EPIDEMIOLOGY OF DEPRESSION
- BIPOLAR DISORDER AFFECTS APPROXIMATELY 5.7 MILLION AMERICAN ADULTS.
- GENDER INCIDENCE IS ROUGHLY EQUAL: RATIO OF WOMEN TO MEN IS ABOUT 1.2 TO 1.
- AVERAGE AGE AT ONSET IS THE EARLY 20S.
- MORE COMMON IN SINGLE THAN IN MARRIED PERSONS
- OCCURS MORE OFTEN IN THE HIGHER
SOCIOECONOMIC CLASSES - SIXTH LEADING CAUSE OF DISABILITY IN THE MIDDLE AGE GROUP
BIPOLAR DISORDER
IS CHARACTERIZED BY MOOD SWINGS FROM PROFOUND DEPRESSION TO EXTREME
EUPHORIA (MANIA), WITH INTERVENING PERIODS OF
NORMALCY. DELUSIONS OR HALLUCINATIONS MAY OR MAY NOT BE PART OF CLINICAL PICTURE.
* ONSET OF SYMPTOMS MAY REFLECT SEASONAL PATTERN.
* A SOMEWHAT MILDER FORM OF MANIA IS CALLED
HYPOMANIA.
BIPOLAR I DISORDER
- CLIENT IS EXPERIENCING, OR HAS EXPERIENCED, A
FULL SYNDROME OF MANIC OR MIXED SYMPTOMS. - MAY ALSO HAVE EXPERIENCED EPISODES OF
DEPRESSION
BIPOLAR II DISORDER
- CHARACTERIZED BY BOUTS OF MAJOR
DEPRESSION WITH EPISODIC OCCURRENCE
OF HYPOMANIA - HAS NEVER MET CRITERIA FOR FULL MANIC
EPISODE
CYCLOTHYMIC DISORDER
- CHRONIC MOOD DISTURBANCE
- AT LEAST 2-YEAR DURATION
- NUMEROUS EPISODES OF HYPOMANIA AND
DEPRESSED MOOD OF INSUFFICIENT SEVERITY TO
MEET THE CRITERIA FOR EITHER BIPOLAR I OR II
DISORDER
SUBSTANCE-INDUCED BIPOLAR DISORDER
- DIRECT RESULT OF THE PHYSIOLOGICAL EFFECTS OF A SUBSTANCE (E.G., INGESTION OF OR WITHDRAWAL FROM A DRUG OF ABUSE OR A MEDICATION OR OTHER TREATMENT
BIPOLAR DISORDER ASSOCIATED WITH ANOTHER MEDICAL CONDITION
- RESULT OF DIRECT PHYSIOLOGICAL EFFECTS OF ANOTHER MEDICAL CONDITION
SYMPTOMS MAY BE CATEGORIZED BY DEGREE OF
SEVERITY.
* STAGE I
HYPOMANIA: SYMPTOMS NOT
SUFFICIENTLY SEVERE TO CAUSE MARKED
IMPAIRMENT IN SOCIAL OR OCCUPATIONAL
FUNCTIONING OR TO REQUIRE HOSPITALIZATION
* CHEERFUL MOOD
* RAPID FLOW OF IDEAS; HEIGHTENED PERCEPTION
* INCREASED MOTOR ACTIVITY
* INCREASED CREATIVITY
STAGE II:
ACUTE MANIA: MARKED IMPAIRMENT IN
FUNCTIONING; USUALLY REQUIRES HOSPITALIZATION
* ELATION AND EUPHORIA; A CONTINUOUS “HIGH”
* FLIGHT OF IDEAS; ACCELERATED, PRESSURED SPEECH
* HALLUCINATIONS AND DELUSIONS
* EXCESSIVE MOTOR ACTIVITY
* SOCIAL AND SEXUAL INHIBITION
* LITTLE NEED FOR SLEEP
* EXCESSIVE SHOPPING, RUNNING UP CREDIT CARDS
STAGE III. DELIRIOUS MANIA:
- THE CONDITION IS RARE SINCE THE ADVENT OF
ANTIPSYCHOTIC MEDICATION. - LABILE MOOD; PANIC ANXIETY
- CLOUDING OF CONSCIOUSNESS; DISORIENTATION
- FRENZIED PSYCHOMOTOR ACTIVITY, BIZARRE
BEHAVIOR OR DRESS - EXHAUSTION AND POSSIBLY DEATH WITHOUT
INTERVENTION - LITTLE TO NO SLEEP
- RISK FOR VIOLENCE
MANIC PT PRIORITIES
PRIORITIZATION OF INTERVENTIONS SHOULD
ALWAYS BE SAFETY, NUTRITION, AND SLEEP WITH
MANIC PATIENTS.
CRITERIA FOR MEASURING OUTCOMES FOR BPD
- EXHIBITS NO EVIDENCE OF PHYSICAL INJURY
- HAS NOT HARMED SELF OR OTHERS
- IS NO LONGER EXHIBITING SIGNS OF PHYSICAL
AGITATION - EATS A WELL-BALANCED DIET WITH SNACKS TO PREVENT WEIGHT LOSS AND MAINTAIN NUTRITIONAL STATUS
- VERBALIZES AN ACCURATE INTERPRETATION OF THE
ENVIRONMENT - VERBALIZES THAT HALLUCINATORY ACTIVITY HAS CEASED AND DEMONSTRATES NO OUTWARD BEHAVIOR
INDICATING HALLUCINATIONS - ACCEPTS RESPONSIBILITY FOR OWN BEHAVIORS (MAY
TAKE AWHILE) - DOES NOT MANIPULATE OTHERS FOR GRATIFICATION OF OWN NEEDS (MAY TAKE AWHILE)
- INTERACTS APPROPRIATELY WITH OTHERS (MAY TAKE
AWHILE) - IS ABLE TO FALL ASLEEP WITHIN 30 MINUTES OF RETIRING
- IS ABLE TO SLEEP 6 TO 8 HOURS PER NIGHT
RISK FOR VIOLENCE: SELF-DIRECTED OR OTHER-
DIRECTED NURSING INTERVENTIONS
- REMOVE ALL DANGEROUS OBJECTS FROM
THE ENVIRONMENT. - MAINTAIN A CALM ATTITUDE .
- IF RESTRAINT IS DEEMED NECESSARY, ENSURE
THAT SUFFICIENT STAFF IS AVAILABLE TO
ASSIST.
IMBALANCED NUTRITION: LESS THAN BODY
REQUIREMENTS/INSOMNIA NURSING INTERVENTIONS
- PROVIDE CLIENT WITH HIGH-PROTEIN, HIGH-
CALORIE FOODS. - MAINTAIN AN ACCURATE RECORD OF INTAKE,
OUTPUT, AND CALORIE COUNT. - MONITOR SLEEP PATTERNS.
IMPAIRED SOCIAL INTERACTION NURSING INTERVENTIONS
- SET LIMITS ON MANIPULATIVE BEHAVIORS.
- DO NOT ARGUE, BARGAIN, OR TRY TO
REASON WITH THE CLIENT. - PROVIDE POSITIVE REINFORCEMENT.
CLIENT/FAMILY EDUCATION FOR BPD
- NATURE OF THE ILLNESS
- CAUSES OF BIPOLAR DISORDER
- CYCLIC NATURE OF THE ILLNESS
- SYMPTOMS OF DEPRESSION
- SYMPTOMS OF MANIA
- MANAGEMENT OF THE ILLNESS
- MEDICATION MANAGEMENT
- ASSERTIVE TECHNIQUES
- ANGER MANAGEMENT
TREATMENT MODALITIES FOR BIPOLAR
DISORDER
*INDIVIDUAL PSYCHOTHERAPY
*GROUP THERAPY
*FAMILY THERAPY
*COGNITIVE THERAPY
PSYCHOPHARMACOLOGY
- FOR MANIA
- LITHIUM CARBONATE – STILL USED BUT NOT AS
MUCH - ANTICONVULSANTS
- VERAPAMIL
- ANTIPSYCHOTICS
- FOR DEPRESSIVE PHASE
- USE ANTIDEPRESSANTS WITH CARE (MAY TRIGGER
MANIA).
LITHIUM TEACHING
- TAKE THE MEDICATION REGULARLY.
- DO NOT SKIMP ON DIETARY SODIUM.
- DRINK SIX TO EIGHT GLASSES OF WATER EACH DAY.
- NOTIFY PHYSICIAN IF VOMITING OR DIARRHEA
OCCUR. - HAVE SERUM LITHIUM LEVEL CHECKED EVERY 1 TO 2
MONTHS, OR AS ADVISED BY PHYSICIAN. - NOTIFY PHYSICIAN IF ANY OF THE FOLLOWING
SYMPTOMS OCCUR: PERSISTENT NAUSEA AND VOMITING, SEVERE DIARRHEA, ATAXIA, BLURRED VISION, TINNITUS, EXCESSIVE OUTPUT OF URINE, INCREASING TREMORS, MENTAL CONFUSION
ANTICONVULSANT TEACHING
- REFRAIN FROM DISCONTINUING THE DRUG
ABRUPTLY. - REPORT THE FOLLOWING SYMPTOMS TO THE
PHYSICIAN IMMEDIATELY: SKIN RASH, UNUSUAL
BLEEDING, SPONTANEOUS BRUISING, SORE THROAT,
FEVER, MALAISE, DARK URINE, AND YELLOW SKIN OR
EYES. - AVOID USING ALCOHOL AND OVER-THE-COUNTER
MEDICATIONS WITHOUT APPROVAL FROM
PHYSICIA
ANTIPSYCHOTICS TEACHING
- DO NOT DISCONTINUE DRUG ABRUPTLY.
- USE SUNBLOCK WHEN OUTDOORS.
- RISE SLOWLY FROM A SITTING OR LYING POSITION.
- AVOID ALCOHOL AND OVER-THE-COUNTER
MEDICATIONS. - CONTINUE TO TAKE THE MEDICATION, EVEN IF
FEELING WELL AND AS THOUGH IT IS NOT NEEDED;
SYMPTOMS MAY RETURN IF MEDICATION IS
DISCONTINUED. - SORE THROAT; FEVER; MALAISE
- UNUSUAL BLEEDING; EASY BRUISING; SKIN RASH
- PERSISTENT NAUSEA AND VOMITING
- SEVERE HEADACHE; RAPID HEART RATE
- DIFFICULTY URINATING OR EXCESSIVE URINATION
- MUSCLE TWITCHING, TREMORS
- DARKLY COLORED URINE; PALE STOOLS
- YELLOW SKIN OR EYES, EXCESSIVE THIRST OR
HUNGER - MUSCULAR INCOORDINATION OR WEAKNESS
Trauma
AN EXTREMELY DISTRESSING EXPERIENCE THAT CAUSES
SEVERE EMOTIONAL SHOCK AND MAY HAVE LONG
LASTING PSYCHOLOGICAL EFFECTS.
PTSD
- A REACTION TO AN EXTREME TRAUMA
- LIKELY TO CAUSE PERVASIVE DISTRESS TO ALMOST ANYONE
- EXAMPLES INCLUDE: NATURAL OR MAN-MADE DISASTERS, COMBAT, SERIOUS ACCIDENTS, WITNESSING THE VIOLENT DEATH OF OTHERS, BEING THE VICTIM OF TORTURE, TERRORISM, RAPE, OR OTHER CRIMES
PTSD SX
- RE-EXPERIENCING THE TRAUMATIC EVENT
- A SUSTAINED HIGH LEVEL OF ANXIETY OR AROUSAL
- A GENERAL NUMBING OF RESPONSIVENESS
- INTRUSIVE RECOLLECTIONS OR NIGHTMARES
- AMNESIA TO CERTAIN ASPECTS OF THE TRAUMA
- DEPRESSION; SURVIVOR’S GUILT
- SUBSTANCE ABUSE
- ANGER AND AGGRESSION
- RELATIONSHIP PROBLEMS
- SYMPTOMS MAY BEGIN WITHIN THE FIRST 3 MONTHS
AFTER THE TRAUMA, OR THERE MAY BE A DELAY OF
SEVERAL MONTHS OR EVEN YEARS.
INTRUSION SX
*RECURRENT
*INVOLUNTARY
*INTRUSIVE DISTRESSING MEMORIES
*RECURRENT DISTRESSING DREAMS
*DISSOCIATIVE REACTIONS (FLASHBACKS)
*INTENSE OR PROLONGED PSYCHOLOGICAL
DISTRESS
DISSOCIATIVE SYMPTOMS
- ALTERED SENSE OF REALITY OF ONE’S SURROUNDINGS OR ONESELF
- INABILITY TO REMEMBER AN IMPORTANT ASPECT OF THE TRAUMATIC EVENT
AVOIDANCE SYMPTOMS
- EFFORTS TO AVOID DISTRESSING MEMORIES, THOUGHTS, OR FEELINGS ABOUT OR CLOSELY RELATED TO THE TRAUMATIC EVENT
AROUSAL SYMPTOMS
- SLEEP DISTURBANCE
- IRRITABLE BEHAVIOR OR ANGRY OUTBURSTS WITH LITTLE OR NO PROVOCATION
- HYPERVIGILANCE
- PROBLEMS WITH CONCENTRATION
- EXAGGERATED STARTLE RESPONSE
ACUTE STRESS DISORDER (ASD)
- SIMILAR TO PTSD IN TERMS OF PRECIPITATING TRAUMATIC EVENTS AND SYMPTOMATOLOGY
- SYMPTOMS ARE TIME LIMITED: UP TO 1 MONTH
FOLLOWING THE TRAUMA. - IF THE SYMPTOMS LAST LONGER THAN 1 MONTH, THE
DIAGNOSIS IS PTSD.
TRAUMA-RELATED DISORDERS; PREDISPOSING FACTORS
- PSYCHOSOCIAL THEORY
- SEEKS TO EXPLAIN WHY SOME INDIVIDUALS
EXPOSED TO MASSIVE TRAUMA DEVELOP PTSD
WHILE OTHERS DO NOT - VARIABLES INCLUDE CHARACTERISTICS THAT
RELATE TO: THE TRAUMATIC EXPERIENCE, THE INDIVIDUAL, THE RECOVERY ENVIRONMENT
POST-TRAUMA SYNDROME RELATED TO
DISTRESSING EVENT CONSIDERED TO BE OUTSIDE
THE RANGE OF USUAL HUMAN EXPERIENCE
EVIDENCED BY:
- FLASHBACKS
- INTRUSIVE RECOLLECTIONS
- NIGHTMARES
- PSYCHOLOGICAL NUMBNESS RELATED TO THE
EVENT, DISSOCIATION, OR AMNESIA.
RECOVERY ENVIRONMENT FOR PTSD
- QUALITY OF ENVIRONMENT THAT HE INDIVIDUAL ATTEMPTS TO WORK
THROUGH THE TRAUMATIC EXPERIENCE IS CORRELATED WITH THE OUTCOME - AVAILABILITY OF SOCIAL SUPPORTS
- COHESIVENESS AND PROTECTIVENESS OF FAMILY AND FRIENDS
- ATTITUDES OF SOCIETY REGARDING THE EXPERIENCE
- CULTURAL INFLUENCES
- IN RESEARCH WITH VIETNAM VETERANS, IT WAS SHOWN THAT THE BEST
PREDICTORS OF PTSD WERE THE SEVERITY OF THE STRESSOR AND DEGREE OF
PSYCHOSOCIAL ISOLATION IN THE RECOVERY ENVIRONMENT. - THE WORSE THE STRESSOR AND THE MORE ISOLATED = POOR PROGNOSIS
OUTCOME CRITERIA
THE CLIENT
* CAN ACKNOWLEDGE THE TRAUMA AND THE IMPACT
ON HIS OR HER LIFE
* CAN DEMONSTRATE ADAPTIVE COPING STRATEGIES
* HAS MADE REALISTIC GOALS FOR THE FUTURE
* HAS WORKED THROUGH FEELINGS OF SURVIVOR’S
GUILT
* ATTENDS SUPPORT GROUP OF INDIVIDUALS
RECOVERING FROM SIMILAR TRAUMATIC
EXPERIENCES
* VERBALIZES DESIRE TO PUT TRAUMA IN THE PAST
AND PROGRESS WITH HIS OR HER LIFE
NURSING CARE OF THE CLIENT WITH A TRAUMA-RELATED DISORDER IS AIMED AT
- REASSURANCE OF SAFETY
- DECREASE IN MALADAPTIVE SYMPTOMS
- DEMONSTRATION OF MORE ADAPTIVE COPING
STRATEGIES - ADAPTIVE PROGRESSION THROUGH THE GRIEVING
PROCESS - EDUCATION
ADJUSTMENT DISORDERS
- CHARACTERIZED BY A MALADAPTIVE REACTION TO AN
IDENTIFIABLE STRESSOR OR STRESSORS THAT RESULTS IN THE DEVELOPMENT OF CLINICALLY SIGNIFICANT
EMOTIONAL OR BEHAVIORAL SYMPTOMS - SYMPTOMS OCCUR WITHIN 3 MONTHS OF THE STRESSOR AND LAST NO LONGER THAN 6 MONTHS.
- EXCEPTION: THE “RELATED TO BEREAVEMENT” SUBTYPE
ADJUSTMENT DISORDER TYPES
- WITH DEPRESSED MOOD
- WITH ANXIETY
- WITH MIXED ANXIETY AND DEPRESSED MOOD
- WITH DISTURBANCE OF CONDUCT
- WITH MIXED DISTURBANCE OF EMOTIONS AND
CONDUCT - RELATED TO BEREAVEMENT
- UNSPECIFIED
ADJUSTMENT DISORDER INTERVENTIONS
*ADAPTIVE PROGRESSION THROUGH THE GRIEF
PROCESS
*HELPING THE CLIENT ACHIEVE ACCEPTANCE OF A
CHANGE IN HEALTH STATUS
*ASSISTING WITH STRATEGIES TO MAINTAIN
ANXIETY AT A MANAGEABLE LEVEL
TREATMENT MODALITIES FOR TRAUMA-RELATED DISORDERS
- COGNITIVE THERAPY
- PROLONGED EXPOSURE THERAPY
- GROUP/FAMILY THERAPY
- EYE MOVEMENT DESENSITIZATION AND
REPROCESSING - PSYCHOPHARMACOLOGY
TREATMENT MODALITIES FOR ADJUSTMENT DISORDERS
- INDIVIDUAL PSYCHOTHERAPY
- FAMILY THERAPY
- BEHAVIOR THERAPY
- SELF-HELP GROUPS
- CRISIS INTERVENTION
- PSYCHOPHARMACOLOGY
SOMATIC SYMPTOM DISORDERS
ARE CHARACTERIZED BY PHYSICAL SYMPTOMS
SUGGESTING MEDICAL DISEASE BUT
WITHOUT DEMONSTRABLE ORGANIC
PATHOLOGY OR A KNOWN
PATHOPHYSIOLOGICAL MECHANISM TO
ACCOUNT FOR THEM.
SOMATIC SYMPTOM DISORDERS ETIOLOGY
*MORE COMMON IN WOMEN THAN IN MEN
*LESS EDUCATED PERSONS
*RURAL AREAS
DISSOCIATIVE DISORDER RISK FACTORS
*DISSOCIATIVE DISORDERS (DIDS) ARE STATISTICALLY
QUITE RARE.
*DID IS MORE PREVALENT IN WOMEN THAN IN MEN.
*BRIEF EPISODES OF DEPERSONALIZATION
SYMPTOMS APPEAR TO BE COMMON IN YOUNG
ADULTS, PARTICULARLY IN TIMES OF SEVERE STRESS.
SOMATIC SYMPTOM DISORDER
- A SYNDROME OF MULTIPLE SOMATIC SYMPTOMS
THAT CANNOT BE EXPLAINED MEDICALLY AND IS
ASSOCIATED WITH PSYCHOSOCIAL DISTRESS AND
LONG-TERM SEEKING OF ASSISTANCE FROM HEALTH
-CARE PROFESSIONALS - THE DISORDER IS CHRONIC, AND ANXIETY,
DEPRESSION, AND SUICIDAL IDEATION ARE
FREQUENTLY MANIFESTED.
CONVERSION DISORDER
- A LOSS OF OR CHANGE IN BODY FUNCTION THAT
CANNOT BE EXPLAINED BY ANY KNOWN MEDICAL
DISORDER OR PATHOPHYSIOLOGICAL MECHANISM. - THE MOST OBVIOUS AND “CLASSIC” CONVERSION
SYMPTOMS ARE THOSE THAT SUGGEST
NEUROLOGICAL DISEASE. - SOME INSTANCES OF CONVERSION DISORDER MAY BE
PRECIPITATED BY PSYCHOLOGICAL STRESS.
FACTITIOUS DISORDER
- CONSCIOUS, INTENTIONAL FEIGNING OF PHYSICAL
AND/OR PSYCHOLOGICAL SYMPTOMS - INDIVIDUAL PRETENDS TO BE ILL TO RECEIVE
EMOTIONAL CARE AND SUPPORT COMMONLY
ASSOCIATED WITH THE ROLE OF “PATIENT.” - THE DISORDER MAY ALSO BE IDENTIFIED AS
MUNCHAUSEN SYNDROME. - THE DISORDER MAY BE IMPOSED ON ANOTHER
PERSON UNDER THE CARE OF THE PERPETRATOR
(FORMERLY CALLED FACTITIOUS DISORDER BY
PROXY). ALSO REFERRED TO AS MUNCHAUSEN BY
PROXY.
LOCALIZED AMNESIA
THE INABILITY TO RECALL ALL INCIDENTS ASSOCIATED WITH THE TRAUMATIC EVENT
SELECTIVE AMNESIA
THE INABILITY TO RECALL ONLY CERTAIN INCIDENTS ASSOCIATED WITH A TRAUMATIC EVENT FOR A SPECIFIC PERIOD FOLLOWING THE EVENT
GENERALIZED AMNESIA
THE INABILITY TO RECALL ANYTHING THAT HAS HAPPENED DURING THE INDIVIDUAL’S ENTIRE LIFETIME, INCLUDING PERSONAL IDENTITY
DISSOCIATIVE FUGUE
A SPECIFIC SUBTYPE OF DISSOCIATIVE AMNESIA IS
WITH DISSOCIATIVE FUGUE, IN WHICH THERE IS
A SUDDEN, UNEXPECTED TRAVEL AWAY FROM
HOME WITH THE INABILITY TO RECALL SOME OR
ALL OF ONE’S PAST.
DISSOCIATIVE IDENTITY DISORDER
- PREVIOUSLY CALLED MULTIPLE PERSONALITY DISORDER
- CHARACTERIZED BY THE EXISTENCE OF TWO OR
MORE PERSONALITIES WITHIN A SINGLE INDIVIDUAL - TRANSITION FROM ONE PERSONALITY TO ANOTHER
USUALLY SUDDEN, OFTEN DRAMATIC, AND USUALLY
PRECIPITATED
BY STRESS
DEPERSONALIZATION
IS DEFINED AS A DISTURBANCE IN THE PERCEPTION OF ONESELF.
DEREALIZATION
IS DESCRIBED AS AN ALTERATION IN THE PERCEPTION OF THE EXTERNAL ENVIRONMENT.
DEPERSONALIZATION-DEREALIZATION DISORDER
- CHARACTERIZED BY A TEMPORARY CHANGE IN THE
QUALITY OF SELF-AWARENESS, WHICH OFTEN
TAKES THE FORM OF - FEELINGS OF UNREALITY
- CHANGES IN BODY IMAGE
- FEELINGS OF DETACHMENT FROM THE
ENVIRONMENT - A SENSE OF OBSERVING ONESELF FROM OUTSIDE
THE BODY
SYMPTOMS OF THIS DISORDER ARE OFTEN
ACCOMPANIED BY:
- ANXIETY AND DEPRESSION
- FEAR OF GOING INSANE
- OBSESSIVE THOUGHTS
- SOMATIC COMPLAINTS
- DISTURBANCE IN THE SUBJECTIVE SENSE OF
TIME
NURSING CARE OF THE INDIVIDUAL WITH A SOMATIC
SYMPTOM DISORDER IS AIMED AT:
RELIEF OF DISCOMFORT FROM THE PHYSICAL SYMPTOMS.
* ASSISTANCE IS PROVIDED TO THE CLIENT IN AN EFFORT TO DETERMINE STRATEGIES FOR COPING WITH STRESS BY MEANS OTHER THAN PREOCCUPATION WITH PHYSICAL SYMPTOMS.
NURSING CARE FOR THE CLIENT WITH A DISSOCIATIVE
DISORDER IS AIMED AT:
RESTORING NORMAL THOUGHT PROCESSES.
* ASSISTANCE IS PROVIDED TO THE CLIENT IN AN EFFORT TO DETERMINE STRATEGIES FOR COPING WITH STRESS BY MEANS OTHER THAN DISSOCIATION FROM
THE ENVIRONMENT.
THERAPIES FOR SOMATIC DISORDERS
*INDIVIDUAL PSYCHOTHERAPY
*HYPNOSIS
*SUPPORTIVE CARE
*COGNITIVE THERAPY
*GROUP THERAPY
*INTEGRATION THERAPY (DID) – GOAL OF
THERAPY
*PSYCHOPHARMACOLOGY
HOARDING DISORDER
- THE PERSISTENT DIFFICULTY DISCARDING POSSESSIONS REGARDLESS
OF THEIR VALUE. - ADDITIONALLY, THERE CAN BE A NEED FOR EXCESSIVE ACQUIRING OF
ITEMS (BY PURCHASING OR OTHER MEANS). - MORE MEN THAN WOMEN ARE DIAGNOSED WITH THIS DISORDER.
CLIENT/FAMILY EDUCATION R/T PERSONALITY DISORDERS
- NATURE OF THE ILLNESS
- WHAT IS ANXIETY?
- WHAT IS OCD?
- WHAT IS BODY DYSMORPHIC DISORDER?
- SYMPTOMS OF ANXIETY, OCD, AND RELATED DISORDERS
- MANAGEMENT OF THE ILLNESS
- MEDICATION MANAGEMENT
- POSSIBLE ADVERSE EFFECT
- LENGTH OF TIME TO TAKE EFFECT
- WHAT TO EXPECT FROM THE MEDICATION
- MANAGEMENT OF THE ILLNESS (CONT’D)
- STRESS MANAGEMENT
- TEACH WAYS TO INTERRUPT ESCALATING
ANXIETY. - TEACH RELAXATION TECHNIQUES.
TREATMENT MODALITIES FOR PERSONALITY DISORDERS
- INDIVIDUAL PSYCHOTHERAPY
- COGNITIVE THERAPY
- BEHAVIOR THERAPY
- SYSTEMATIC DESENSITIZATION
- MEDICATIONS
PERSONALITY
- THE TOTALITY OF EMOTIONAL AND BEHAVIORAL
CHARACTERISTICS THAT ARE PARTICULAR TO A
SPECIFIC PERSON AND THAT REMAIN SOMEWHAT
STABLE AND PREDICTABLE OVER TIME. - PERSONALITY TRAITS - CHARACTERISTICS WITH WHICH AN INDIVIDUAL IS BORN OR DEVELOPS EARLY IN LIFE.
Personality disorder
OCCURS WHEN THESE TRAITS BECOME RIGID AND
INFLEXIBLE AND CONTRIBUTE TO MALADAPTIVE
PATTERNS OF BEHAVIOR OR IMPAIRMENT IN
FUNCTIONING.
TEN SPECIFIC TYPES OF PERSONALITY DISORDERS
ARE IDENTIFIED IN THE DSM-5. THEY FALL INTO THREE
CLUSTERS:
- BEHAVIORS DESCRIBED AS ODD OR ECCENTRIC
- BEHAVIORS DESCRIBED AS DRAMATIC,
EMOTIONAL, OR ERRATIC - BEHAVIORS DESCRIBED AS ANXIOUS OR
FEARFUL
CLUSTER 1
BEHAVIORS DESCRIBED AS ODD OR ECCENTRIC:
a. PARANOID PERSONALITY DISORDER
b. SCHIZOID PERSONALITY DISORDER
c. SCHIZOTYPAL PERSONALITY DISORDER
CLUSTER 2
BEHAVIORS DESCRIBED AS DRAMATIC, EMOTIONAL,
OR ERRATIC:
a. ANTISOCIAL PERSONALITY DISORDER
b. BORDERLINE PERSONALITY DISORDER
c. HISTRIONIC PERSONALITY DISORDER
d. NARCISSISTIC PERSONALITY DISORDER
CLUSTER 3
BEHAVIORS DESCRIBED AS ANXIOUS OR FEARFUL:
a. AVOIDANT PERSONALITY DISORDER
b. DEPENDENT PERSONALITY DISORDER
c. OBSESSIVE-COMPULSIVE PERSONALITY
PARANOID PERSONALITY DISORDER
- CHARACTERIZED BY A PERVASIVE, PERSISTENT, AND
INAPPROPRIATE MISTRUST OF OTHERS - INDIVIDUALS WITH THIS DISORDER ARE SUSPICIOUS
OF OTHERS’ MOTIVES AND ASSUME THAT OTHERS
INTEND TO EXPLOIT, HARM, OR DECEIVE THEM. - THE DISORDER IS MORE COMMON IN MEN THAN IN
WOMEN. - CONSTANTLY ON GUARD
- HYPERVIGILANT
- READY FOR ANY REAL OR IMAGINED THREAT
- TRUSTS NO ONE
- CONSTANTLY TESTS THE HONESTY OF OTHERS
SCHIZOID PERSONALITY DISORDER
- CHARACTERIZED PRIMARILY BY A PROFOUND DEFECT
IN THE ABILITY TO FORM PERSONAL RELATIONSHIPS - FAILURE TO RESPOND TO OTHERS IN A MEANINGFUL
EMOTIONAL WAY - ALOOF AND INDIFFERENT TO OTHERS
- EMOTIONALLY COLD
- NO CLOSE FRIENDS; PREFERS TO BE ALONE
- APPEARS SHY, ANXIOUS, OR UNEASY IN THE
PRESENCE OF OTHERS - INAPPROPRIATELY SERIOUS ABOUT EVERYTHING
AND DIFFICULTY ACTING IN A LIGHT-HEARTED
MANNER
SCHIZOID CHARACTARISTICS
MAGICAL THINKING, IDEAS OF REFERENCE (BELIEF THAT IRRELEVANT, UNRELATED THINGS ARE REFERRING TO THEM DIRECTLY, “SPECIAL MESSAGES”), ILLUSIONS, DEPERSONALIZATION, SUPERSTITIOUSNESS, WITHDRAWAL INTO SELF
ANTISOCIAL PERSONALITY DISORDER
- A PATTERN OF BEHAVIOR THAT IS
- SOCIALLY IRRESPONSIBLE
- EXPLOITATIVE
- WITHOUT REMORSE
- BEHAVIOR REFLECTS A DISREGARD FOR THE RIGHTS
OF OTHERS. - FAILS TO SUSTAIN CONSISTENT EMPLOYMENT
- FAILS TO CONFORM TO THE LAW
- EXPLOITS AND MANIPULATES OTHERS FOR
PERSONAL GAIN - FAILS TO DEVELOP STABLE RELATIONSHIPS
BORDERLINE PERSONALITY DISORDER
- CHARACTERIZED BY A PATTERN OF INTENSE AND
CHAOTIC RELATIONSHIPS WITH AFFECTIVE
INSTABILITY - FLUCTUATING AND EXTREME ATTITUDES REGARDING
OTHER PEOPLE - HIGHLY IMPULSIVE
- EMOTIONALLY UNSTABLE
- DIRECTLY AND INDIRECTLY SELF-DESTRUCTIVE
- LACKS A CLEAR SENSE OF IDENTITY
- AFFECTS ABOUT 1 TO 2 PERCENT OF THE
POPULATION - MORE COMMON IN WOMEN THAN IN MEN
HISTRIONIC PERSONALITY DISORDER
BEHAVIOR IS:
- EXCITABLE
- EMOTIONAL
- COLORFUL
- DRAMATIC
- EXTROVERTED
HISTRIONIC PERSONALITY DISORDER S/S
- SELF-DRAMATIZING
- ATTENTION-SEEKING
- OVERLY GREGARIOUS
- SEDUCTIVE
- MANIPULATIVE
- EXHIBITIONISTIC
NARCISSISTIC PERSONALITY DISORDER
- CHARACTERIZED BY AN EXAGGERATED SENSE OF
SELF-WORTH - LACK OF EMPATHY
- BELIEF IN AN INALIENABLE RIGHT TO RECEIVE SPECIAL
CONSIDERATION
AVOIDANT PERSONALITY DISORDER IS CHARACTERIZED BY:
- EXTREME SENSITIVITY TO REJECTION
- SOCIAL WITHDRAWAL
- PREVALENCE IS ABOUT 1 PERCENT AND IS EQUALLY
COMMON IN MEN AND WOMEN. - AWKWARD AND UNCOMFORTABLE IN SOCIAL
SITUATIONS - DESIRE CLOSE RELATIONSHIPS BUT AVOID THEM
BECAUSE OF FEAR OF BEING REJECTED - PERCEIVED AS TIMID, WITHDRAWN, OR COLD
AND STRANGE - OFTEN LONELY AND FEEL UNWANTED
- VIEW OTHERS AS CRITICAL AND BETRAYING
DEPENDENT PERSONALITY DISORDER
- CHARACTERIZED BY A PATTERN OF RELYING ON
OTHERS FOR EMOTIONAL SUPPORT - RELATIVELY COMMON WITHIN THE POPULATION
- MORE COMMON IN WOMEN THAN IN MEN
- MORE COMMON IN THE YOUNGEST CHILDREN OF A
FAMILY THAN IN THE OLDER ONES - NOTABLE LACK OF SELF-CONFIDENCE THAT IS OFTEN
APPARENT IN: POSTURE, VOICE, MANNERISMS - OVERLY GENEROUS AND THOUGHTFUL, WHILE
UNDERPLAYING OWN ATTRACTIVENESS AND
ACHIEVEMENT - LOW SELF-WORTH AND EASILY HURT BY CRITICISM
AND DISAPPROVAL - AVOID POSITIONS OF RESPONSIBILITY AND BECOME
ANXIOUS WHEN FORCED INTO THEM - PASSIVE AND SUBMISSIVE ROLES IN RELATIONSHIPS
OBSESSIVE-COMPULSIVE PERSONALITY
DISORDER
- CHARACTERIZED BY INFLEXIBILITY ABOUT THE WAY
IN WHICH THINGS MUST BE DONE - DEVOTION TO PRODUCTIVITY AT THE EXCLUSION OF
PERSONAL PLEASURE - ESPECIALLY CONCERNED WITH MATTERS OF
ORGANIZATION
AND EFFICIENCY - TEND TO BE RIGID AND UNBENDING
- SOCIALLY POLITE AND FORMAL
- RANK-CONSCIOUS
INGRATIATING WITH AUTHORITY FIGURES
AUTOCRATIC AND CONDEMNATORY WITH
SUBORDINATES
TREATMENT FOR PERSONALITY DISORDERS
- MEDICATIONS CAN HELP WITH SOME SYMPTOMS BUT NOT DESIRED
TREATMENT - COUNSELING AND THERAPY
- COGNITIVE BEHAVIORAL THERAPY
- TREATMENT FOCUSED ON SYMPTOMS SUCH AS ANXIETY, SELF HARM,
RELATIONSHIP ISSUES - LONG TERM MANAGEMENT
BORDERLINE PERSONALITY DISORDER NAME BC:
DESIGNATED AS “BORDERLINE” BECAUSE OF
THE TENDENCY OF THESE CLIENTS TO FALL ON
THE BORDER BETWEEN NEUROSES AND
PSYCHOSES.
BORDERLINE PERSONALITY DISORDER
- HISTORICALLY THIS GROUP DID NOT CLASSICALLY CONFORM TO THE
STANDARD CATEGORIES OF NEUROSIS OR PSYCHOSIS - THE DESIGNATION BORDERLINE WAS INTRODUCED TO IDENTIFY
THESE CLIENTS WHO SEEMED TO FALL ON THE BORDER - ALWAYS SEEM TO BE IN A STATE OF CRISES AND HAVE FREQUENT
MOOD SWINGS - THERE MAY BE COMORBIDITY OF BIPOLAR
BPD TRAITS
COMMON BEHAVIORS
* CHRONIC DEPRESSION
* INABILITY TO BE ALONE
* CLINGING AND DISTANCING BEHAVIORS
* SPLITTING
* MANIPULATION
* SELF-DESTRUCTIVE BEHAVIORS
* IMPULSIVITY
PREDISPOSING FACTORS TO BPD
- BIOCHEMICAL – HAVE HIGH INCIDENCE OF MAJOR DEPRESSIVE EPISODES AND ANTIDEPRESSANTS HAVE DEMONSTRATED BENEFITS IN SOME CASES
- THIS FACT AND SUPPORTING INFORMATION FROM BRAIN IMAGING HAVE LED TO HYPOTHESIS THAT THERE IS A SEROTONIN AND OR NOREPINEPHRINE DYSREGULATION
*GENETIC – AN INCREASED PREVALENCE OF MAJOR DEPRESSION AND SUBSTANCE ABUSE DISORDERS IN FIRST-DEGREE RELATIVES OF INDIVIDUALS WITH BPD SUGGEST THERE MAY BE GENETIC VULNERABILITIES - PATIENTS WITH BPD ARE 5X MORE LIKELY TO HAVE A FIRST-DEGREE RELATIVE WITH BPD
- PSYCHOSOCIAL INFLUENCES
- CHILDHOOD TRAUMA, NEGLECT, ABUSE, SERIOUS PARENTAL
PSYCHOPATHOLOGY - 70% OF BPD CLIENTS REPORT A HISTORY OF PHYSICAL AND/OR SEXUAL ABUSE
- DEVELOPMENTAL FACTORS
- OBJECT RELATIONS THEORY – ONE EXAMPLE: WHEN A CHILD SHOWS INDEPENDENCE MOTHER OR PRIMARY CAREGIVER FEELS SECURE AS LONG AS CHILD IS DEPENDENT. INDEPENDENCE IS THREATENING AND
MOTHER WITHDRAWS EMOTIONAL SUPPORT AND REWARDS “CLINGING”
PERSONALITY DISORDER INTERVENTIONS
- ENCOURAGE CLIENT TO EXAMINE BEHAVIORS AND TO RECOGNIZE THAT THEY ARE OCCURRING
- HELP CLIENT REALIZE THAT NURSE IS AVAILABLE BUT NOT REINFORCE DEPENDENCY
- ROTATE STAFF WHO WORK WITH CLIENT FROM DAY TO DAY BUT DIRECT TO ONE DURING A SHIFT
- RECOGNIZE WHEN CLIENT IS PLAYING OR “SPLITTING” STAFF
- GOOD COMMUNICATION BETWEEN STAFF – KEEP OTHERS INFORMED
- DO NOT LISTEN TO CLIENT TRY TO DEGRADE STAFF
- EXPLORE FEELINGS THAT RELATE TO FEARS OF ABANDONMENT
- HELP THEM TO SEE AND UNDERSTAND CLINGING AND DISTANCING BEHAVIORS
- ASSIST CLIENT TO WORK TOWARD ACHIEVEMENT OF OBJECT CONSTANCY BY CREATING TRUSTING RELATIONSHIP
- OBSERVE BEHAVIOR FREQUENTLY, KEEP SAFE ENVIRONMENT
- GIVE POSITIVE FEEDBACK BUT SET LIMITS ON ACTING OUT BEHAVIOR
INTERPERSONAL EFFECTIVENESS:
ASKING FOR WHAT YOU WANT AND SAYING NO WHEN YOU NEED TO (WHILE STILL MAINTAINING SELF-RESPECT AND HEALTHY RELATIONSHIPS)
NURSES SHOULD WORK TO DECREASE NEGATIVE ATTITUDES AND STIGMATIZATION OF BPD BY:
- UNDERSTAND THE DISORDER INCLUDING THE DYNAMICS OF CHILDHOOD TRAUMA
- APPROACH WITH COMPASSION AN CONVEY HOPEFULNESS THAT
THIS IS A TREATABLE RATHER THAN UNTREATABLE DISORDER - SELF–REFLECTION
- DEVELOP CLEAR MODEL OF COMMUNICATION AND INTERVENTION AMONG TEAM MEMBERS
