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57 Cards in this Set
- Front
- Back
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What is personality disorder?
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-Is pervasive and inflexible
-Is stable over time -Leads to distress and impairment -Onset: adolescence or early adult |
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More Traits of PD
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-Defense mechanism to the point of not helping person
-Ability to get under skin -Incidence difficult to determine -Pervasive and maladaptive They believe their difficulties are the fault of everyone else |
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Axis II Review
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-Personality Disorders
-Significant Personality Traits -Significant Defense Mechanims -Mental Retardation |
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Biological Correlates
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Genetics
Neurtotransmitters Hormonal |
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Parnoid PD
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PERVASIVE DISTRUST AND SUSPICIOUSNESS
-Defensive, abrasive, sarcastic and hostile -Avoidant, jealous, difficulty w/change Attempts to appear unemotional Common DM: Projection - what they feel about themselves they will point out in others |
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Sociocultural
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Cultural norms/values
Crime and violence Family structure/dynamics |
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Cluster B
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Antisocial
Borderline Histronic Narcissitic |
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Therapeutic Management:
Paranoid |
Communication: Supportive, honest
Therapies: supportive they rarely seek treatment Pharmacological: occasionally need anti-psychotic meds for aggression |
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Psychosocial Theories
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Difficulty with separation-individuation and autonomy
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Schizoid PD
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DETACHMENT AND RESTRICTED EMOTIONAL EXPRESSIONS
-Constricted, indifferent, remote -Lack a desire for intimacy, unable to build therapeutic realtionship b/c don't desire -React passively to adverse circumstances Common DM: Intellectualization |
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Cluster C
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Avoidant
Dependent Obssessive-Compulsive |
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Ego Competencies Vs. Incompetencies
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Reality Testing
Stimulus filter/barrier Thought processes Mood |
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Therapeutic Management:
Schizoid PD |
Communication: goal is to engage
Therapies: short-term, solution focused, brief Pharmacological: short term for symptoms of Axis I |
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Ego Competencies Vs. Incompetencies Cont.'
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Judgement
Impulse Control Self Perception Relatedness |
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System Assessment:
Health History & PE |
Priority quick Assess:
Focus on: |
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Schizotypal PD
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INTERPERSONAL DEFICITS AND ACUTE DISCOMFORT W/CLOSE RELATIONSHIPS
-Perceptual disturbances, eccentricities -Constricted and distrusted Common DM: Undoing |
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Therapeutic Management: General Factors - Patterns
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Enduring
Pervasive Inflexible |
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Nursing Diagnosis Common w/ Personalty Disorder
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At risk for injury....
At risk for violence... Anxiety... Alterations in self-care Ineffective coping |
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Therapeutic Management:
Schizotypal |
Communication:
Therapies: supportive, structures therapies that encourage social interactions Pharmacologic: Acute stress induced Psychosis may require short term use of meds |
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Therapeutic Management All Personality Disorders
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Boundaries
Consistency Persistence |
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Therapeutic Management: General Factors - Clustering
All are associated w/anxiety |
Cluster A - odd or ecentric
Cluster B - dramatic, emotional and/or erratic Cluster C- anxious and/or fearful |
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Cluster A
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Paranoid
Schizoid Schizotypal |
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Antisocial
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DISREGARD FOR AND VIOLATION OF RIGHTS OF OTHERS
-Deceitful, manipulative, callous Irresponsible, impulsive and aggressive -Must be -Common DM: Acting out |
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Epidemiology - Antisocial
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-3% of men, 1% of women
- high rates associated with forensic settings -First degree relatives - high risk |
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Therapeutic Management: Antisocial PD
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-Don't seek treatment
Therapeuties: tokens system, limit settings -Considered one of the hardest to treat Pharmacologies-Acute Axis I, or extreme aggression |
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Borderline PD
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INSTABILITY OF INTERPERSONAL REALTIONSHIPS, SELF-IMAGE AND AFFECT
-Marked impulsivity -Manipulative and volatile -Common DM: Regression, look younger than they are, due to mannerisms, clothing |
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Associate Features: Borderline
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-Patterns of undermining themselves, fear of being abandoned, but alienate people
-Self-inflicted abuse is an anxiety release -Premature death from suicide -Recurrent job loss, broken relationship |
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Epidemiology: Borderline
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-Family history of physical/sexual abuse 75%
-Can think of it as a form of PTSD -75% with BPD are females -Stigma attached to men having it -5x more common in 1st degree relative |
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Course of Borderline PD
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-Early adulthood-chronic instability, serious dyscontrol
-Young adult-greatest time of risk for impairment and suicide -30-40's stabilizes for most |
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Therapeutic Management: Borderline
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Therapies: behavioural based, boundaries and limits
-Health care providers must work as a team to avoid splitting behaviours (split staff against each other) Pharmacological: Depacot, mood stabilizers for DD, SSRI's for mood stability |
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Histrionic PD
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EXCESSIVE EMOTIONALITY AND ATTENTION SEEKING
-Need to be center of attention -Dramatic, manipulative, superficial -High degree of suggestibility (don't react0 -Common DM - Dissociation |
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Therapeutic Management: Histrionic PD
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-No known effective therapy
-Therapeutic techniques: modeling, concrete/detailed interaction -Quicker than others seeks treatment, often exaggerating symptoms -Emotionally needy-reluctant to stop therapy sessions |
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Narcissistic PD
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GRANDIOSOTY AND NEED FOR ADMIRATION; LACK OF EMPATHY
-Acts self-assured, nonchalant -Arrogant, exploits others, lies-do only best -Common DM- Rationalization (helps them to have excuse for what they do) |
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Therapeutic Management:
Narcassistic PD |
-Communication-nonchalant (if you confront they will blow)
-Therapies-Brief,supportive OR long-term intensive -Often terminate the therapeutic relationship prematurely |
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Avoidant PD
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SOCIAL INHIBITION, FEELINGS OF INADEQUACY AND HYPERSENSITIVITY
-Ambivalent -Preoccupied, guarded, emptiness Common DM-Fantasy |
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Therapeutic Management: Avoidant PD
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Communication: Empathetic understanding, reassurance, friendly
Therapies: Assertiveness training, social exposure with relaxative training Pharmocological: Co-Morbid anxiety disorders |
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Dependant PD
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-Excessive need to be taken of leading to submissive and clinging behavior, fear of separation
-Timid, kind, passive, gullible Common DM: Introjection |
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Associated features: Dependent PD
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-Refer to themselves as "stupid"
-Take criticism as proof they have no worth -Avoids positions of responsibilty -Go to extensive lengths or nurturing -Worry about abandonment -Quickly replace lost significant other |
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Therapeutic management: Dependent PD
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-Communications: Limits, feedback
-Therapies:Insight oriented therapies, anxiety management, assertiveness & social skills, combination therapies -Prognosis: Good |
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Obessive Compulsive PD
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-PREOCCUPATION WITH ORDERLINESS, PERFECTIONISM AND MENTAL AND INTERPERSONAL CONTROL AT THE EXPENSE OF FLEXIBILITY AND EFFICIENCY
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Obessive Compulsive PD Cont'
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-Tense, disciplines, industrious
-VS.OCD who have obsessive intrusive thoughts. This is about being perfectt, if certain things are not perfect they are not perfect -Common DM-Reaction formation |
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Therapeutic Management:OCPD
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-Treatment is difficult secondary to intellectualizing
-Therapies- Combination therapy -Pharmacological-SSRI's have been beneficial for some |
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Therapeutic Management:OCPD cont'
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-goal is to keep underlying anger in check
-do not be too empathetic -assess for suicidal or homicidal thougths |
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General Health History and PE: System Assessment
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-Priority Quick Assess:
1.Suicidal/homicidal thought 2.Loss 3.Current meds or psych dx 4.Mid or late life personality change |
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Health History Cont'
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Then Focus on:
Physiclal, emotional, cognitive and social |
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Nursing Diagnosis Common/w PD
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-At risk for:
injury violence anxiety alterations in self-concept ineffective coping |
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Therapeutic Management: All PDs
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-BOUNDARIES
-CONSISTENCY -PERSISTENCE |
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Therapeutic Management:
The Dependent Client |
-convey optimism regarding abilites
-limits on neg remarks and behaviors -explore underlying feelings -Options and choices, but limited so not overwhelming -Encourage self-care -Positive feedback |
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Therapeutic Management:
The Manipulative Client |
-Joint plan development, include them in POC
-Identify strengths -Stress reduction -Problem solving -Role Playing |
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Therapeutic Management:
The Manipulative Client Cont' |
Limits:
Clear Realistic Enforcable Have consequences DO NOT NEGOTIATE Avoid Power Struggles |
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Therapeutic Management:
The Angry Client |
- This client may be sarcastic
-Listen, "I" statements -Calm, unhurried, don't touch -Communicate expectations -Talk out feelings -Assist with external controls -Problem-solving |
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Therapeutic Management:
The Impulsive Client |
-Identify needs/feelings
-Discuss current/previous -Explore impact -Recognize cues -Anger management -Assertive skills -Role play |
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Individual Therapies
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-CBT
-Supportive -Occupational -Art & Music -Stress reducers -Recreational (OCPD patients don't like this, cause it has to be perfect) |
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Group Therapies
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-Get Support
-Learning about themselves and problem -See the universality of their condition -Allows them to give back, by sharing |
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Therapeutic Management:
Milleu |
-Usually used in crisis, acute periods
-Provides safety -Struture-limit setting, options, consistency |
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Goals and ECO's
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-Absence of SI
-No thoughts of harm -No self-mutilation -Recognize distorted thoughts -Identify impulsive patterns -Identify isolative patterns |
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Goals and ECO's Cont'
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-Maintain increased level of functioning
-Tolerate interactions Identify new problem solving techniques -Identify new positive role models -Reward self-physically and emotionally |
