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57 Cards in this Set

  • Front
  • Back
What is personality disorder?
-Is pervasive and inflexible
-Is stable over time
-Leads to distress and impairment
-Onset: adolescence or early adult
More Traits of PD
-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
Axis II Review
-Personality Disorders
-Significant Personality Traits
-Significant Defense Mechanims
-Mental Retardation
Biological Correlates
Genetics
Neurtotransmitters
Hormonal
Parnoid PD
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
Sociocultural
Cultural norms/values
Crime and violence
Family structure/dynamics
Cluster B
Antisocial
Borderline
Histronic
Narcissitic
Therapeutic Management:
Paranoid
Communication: Supportive, honest
Therapies: supportive they rarely seek treatment
Pharmacological: occasionally need anti-psychotic meds for aggression
Psychosocial Theories
Difficulty with separation-individuation and autonomy
Schizoid PD
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
Cluster C
Avoidant
Dependent
Obssessive-Compulsive
Ego Competencies Vs. Incompetencies
Reality Testing
Stimulus filter/barrier
Thought processes
Mood
Therapeutic Management:
Schizoid PD
Communication: goal is to engage
Therapies: short-term, solution focused, brief
Pharmacological: short term for symptoms of Axis I
Ego Competencies Vs. Incompetencies Cont.'
Judgement
Impulse Control
Self Perception
Relatedness
System Assessment:
Health History & PE
Priority quick Assess:

Focus on:
Schizotypal PD
INTERPERSONAL DEFICITS AND ACUTE DISCOMFORT W/CLOSE RELATIONSHIPS
-Perceptual disturbances, eccentricities
-Constricted and distrusted
Common DM: Undoing
Therapeutic Management: General Factors - Patterns
Enduring
Pervasive
Inflexible
Nursing Diagnosis Common w/ Personalty Disorder
At risk for injury....
At risk for violence...
Anxiety...
Alterations in self-care
Ineffective coping
Therapeutic Management:
Schizotypal
Communication:
Therapies: supportive, structures therapies that encourage social interactions
Pharmacologic: Acute stress induced Psychosis may require short term use of meds
Therapeutic Management All Personality Disorders
Boundaries
Consistency
Persistence
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
Cluster A
Paranoid
Schizoid
Schizotypal
Antisocial
DISREGARD FOR AND VIOLATION OF RIGHTS OF OTHERS
-Deceitful, manipulative, callous
Irresponsible, impulsive and aggressive
-Must be
-Common DM: Acting out
Epidemiology - Antisocial
-3% of men, 1% of women
- high rates associated with forensic settings
-First degree relatives - high risk
Therapeutic Management: Antisocial PD
-Don't seek treatment
Therapeuties: tokens system, limit settings
-Considered one of the hardest to treat
Pharmacologies-Acute Axis I, or extreme aggression
Borderline PD
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
Associate Features: Borderline
-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
Epidemiology: Borderline
-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
Course of Borderline PD
-Early adulthood-chronic instability, serious dyscontrol
-Young adult-greatest time of risk for impairment and suicide
-30-40's stabilizes for most
Therapeutic Management: Borderline
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
Histrionic PD
EXCESSIVE EMOTIONALITY AND ATTENTION SEEKING
-Need to be center of attention
-Dramatic, manipulative, superficial
-High degree of suggestibility (don't react0
-Common DM - Dissociation
Therapeutic Management: Histrionic PD
-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
Narcissistic PD
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)
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
Avoidant PD
SOCIAL INHIBITION, FEELINGS OF INADEQUACY AND HYPERSENSITIVITY
-Ambivalent
-Preoccupied, guarded, emptiness
Common DM-Fantasy
Therapeutic Management: Avoidant PD
Communication: Empathetic understanding, reassurance, friendly
Therapies: Assertiveness training, social exposure with relaxative training
Pharmocological: Co-Morbid anxiety disorders
Dependant PD
-Excessive need to be taken of leading to submissive and clinging behavior, fear of separation
-Timid, kind, passive, gullible
Common DM: Introjection
Associated features: Dependent PD
-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
Therapeutic management: Dependent PD
-Communications: Limits, feedback
-Therapies:Insight oriented therapies, anxiety management, assertiveness & social skills, combination therapies
-Prognosis: Good
Obessive Compulsive PD
-PREOCCUPATION WITH ORDERLINESS, PERFECTIONISM AND MENTAL AND INTERPERSONAL CONTROL AT THE EXPENSE OF FLEXIBILITY AND EFFICIENCY
Obessive Compulsive PD Cont'
-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
Therapeutic Management:OCPD
-Treatment is difficult secondary to intellectualizing
-Therapies- Combination therapy
-Pharmacological-SSRI's have been beneficial for some
Therapeutic Management:OCPD cont'
-goal is to keep underlying anger in check
-do not be too empathetic
-assess for suicidal or homicidal thougths
General Health History and PE: System Assessment
-Priority Quick Assess:
1.Suicidal/homicidal thought
2.Loss
3.Current meds or psych dx
4.Mid or late life personality change
Health History Cont'
Then Focus on:
Physiclal, emotional, cognitive and social
Nursing Diagnosis Common/w PD
-At risk for:
injury
violence
anxiety
alterations in self-concept
ineffective coping
Therapeutic Management: All PDs
-BOUNDARIES
-CONSISTENCY
-PERSISTENCE
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
Therapeutic Management:
The Manipulative Client
-Joint plan development, include them in POC
-Identify strengths
-Stress reduction
-Problem solving
-Role Playing
Therapeutic Management:
The Manipulative Client Cont'
Limits:
Clear
Realistic
Enforcable
Have consequences
DO NOT NEGOTIATE
Avoid Power Struggles
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
Therapeutic Management:
The Impulsive Client
-Identify needs/feelings
-Discuss current/previous
-Explore impact
-Recognize cues
-Anger management
-Assertive skills
-Role play
Individual Therapies
-CBT
-Supportive
-Occupational
-Art & Music
-Stress reducers
-Recreational (OCPD patients don't like this, cause it has to be perfect)
Group Therapies
-Get Support
-Learning about themselves and problem
-See the universality of their condition
-Allows them to give back, by sharing
Therapeutic Management:
Milleu
-Usually used in crisis, acute periods
-Provides safety
-Struture-limit setting, options, consistency
Goals and ECO's
-Absence of SI
-No thoughts of harm
-No self-mutilation
-Recognize distorted thoughts
-Identify impulsive patterns
-Identify isolative patterns
Goals and ECO's Cont'
-Maintain increased level of functioning
-Tolerate interactions
Identify new problem solving techniques
-Identify new positive role models
-Reward self-physically and emotionally