Hehi Test #3 - Personality Disorders

Front 1

What is a personality disorder?

Back 1

1. Enduring pattern of inner experiences and behavior that deviates markedly from the individual's culture
2. Is pervasive and inflexible
3. Is stable over time
4. Leads to distress and impairment

Onset is generally adolescence or early adulthood

Front 2

Biological Correlates

Back 2

1. Genetics - cluster A (schizophrenia type disorders) only
2. Neurotransmitters - change could be either the cause or the result
3. Hormonal - cortical arousal of autonomic nervous system (Anxiety/ Inhibition theory or Hypothalamus dysregulation = aggression)

Front 3

Sociocultural Correlates

Back 3

1. Cultural Norms/ Values
2. Family Structure/ Dynamics - Environment is 100% a correlate to the development of a personality disorder

Front 4

Incidence

Back 4

Difficult to determine because they often go untreated - the disorder the individual's effective way of coping

Front 5

Psychosocial Theories

Back 5

1. Difficulty with separation-individuation and autonomy developmetal tasks

Ego Development deficiencies

Front 6

Ego Competencies vs. Incompetence

Back 6

1. Reality Testing - what is real and what isn't?
2. Stimulus filter/ barrier - overstimulated all the time easily excitable
3. thought processes - urgent thought requires immediate reaction
4. Mood
5. Judgement
6.Impulse control
7. Self-perception
8. Relatedness - ADL's and how they go about it

Front 7

Cluster A Personality disorders

Back 7

odd and eccentric

1.Paranoid
2. Schizoid
3. Schizotypal

Front 8

Paranoid Personality Disorder

Back 8

Pervasive distrust and suspiciousness without justification
- Defensive, abrasive, sarcastic, hostile
- Avoidant, jealousy
- Attempts to appear unemotional
- Common defense mechanism: PROJECTION

Holds grudges, abrasive, hostile

Usually labile, but try to project that nothing bothers them

Front 9

Therapeutic Management of Paranoid Personality Disorder

Back 9

1. Communication - supportive, honest, concrete
2. Therapies: supportive, rarely present for treatment
3. Pharmacological: occasional anti-psychotics

Front 10

Schizoid Personality disorder

Back 10

Detachment and restricted emotional expressions (think breakfast club)

1. Constricted, indifferent, remote
2. Lack a desire for intimacy
3. React passively to adverse circumstances
4. Common Defense Mechanism: Intellectualization

*Difference in schizoid vs. schizotypal is that schizoid has not DESIRE for relationship.

Front 11

Therapeutic Management of Schizoid Personality disorder

Back 11

1. Communication: goal is to engage
2. therapies - short term, solution focused, brief
3. Unlikely to seek treatment
4. Pharmacological - short term for symptoms of Axis 1

Front 12

Schizotypal Personality disorder

Back 12

Interpersonal deficits and acute discomfort with close relationships

1. Perceptual disturbances, eccentricities
2. Constricted, distrustful
3. Common defense mechanisms: Undoing

See themselves as different from others - superstitious or magical thinking

Desire to have relationships with other people

Front 13

Therapeutic Management - Schizotypal Personality Disorders

Back 13

1. Communication
2. Therapies: supportive, structured therapies that encourage social interaction; social skills training
3. Pharmacological: acute psychosis may appear with stress, requiring short-term use of medications

Front 14

Cluster B personality Disorders

Back 14

"Dramatic, emotional, and/or erratic"

1. Antisocial
2. Borderline
3. Histrionic
4. Nacissistic

Front 15

Antisocial Personality Disorder

Back 15

Serial killers
*Disregard for violation of the right of others

1. Deceitful, manipulative, callous
2. Irresponsible, impulsive, aggressive
3. Must be > 18 year old with history of Conduct disorder > 15 yo
4. Common Defense Mechanism: acting out

Front 16

Therapeutic Management - Antisocial Personality Disorder

Back 16

Don't seek treatment
1. Communication
2. Therapeutic community - token systems, limit setting (do best in environments with enforced limits)
3. Considered one of the most difficult to treat
4. Pharmacological - Actute Axis 1 or extreme aggression

Front 17

Borderline Personality Disorder

Back 17

*Instability of interpersonl relationships, self-image, and affect

1. Marked impulsivity
2. Manipulative and volatile
3. Common defense mechanism: regression (revert back to an earlier time of development)

Front 18

Associated Features of Borderline Personality Disorder

Back 18

1. Patterns of undermining themselves
2. Self-inflicted abuse behaviors
3. Premature death from suicide - often accidental
4. Recurrent job loss, broken relationships

Front 19

Epidemiology - Borderline Personality Disorder

Back 19

1. Family History - physical/ sexual abuse, neglect, hostile conflict, loss or seperation
2. 2% general population, other 30-60%
3. 75% with Bipolar Disorder
4. 5 x's more common in those with first degree relatives

Front 20

Course: Borderline Personality Disorder

Back 20

Early Adulthood - chronic instability, serious dyscontrol

Young adult - greatest time of risk for impairment and suicide

30s-40s - stabilizes

Front 21

Therapeutic Management - Borderline Personality Disorder

Back 21

1. Communication
2. Therapies: behavioral base: boudaries and limits
3. Health care providers must work as team to avoid splitting behaviors
4. Pharmacological: transient symptoms of Axis I disorders; mood stabilizers

Front 22

Histrionic Personality Disorder

Back 22

Pattern of excessive emotionality and attention seeking behavior

1. Need to be center of attention
2. Dramatic, manipulative, superficial
3. High degree of suggestibility
4. Common defense mechanism: dissociation

Cannot control their dramatic reactions

Front 23

Therapeutic Management: Histrionic Personality Disorder

Back 23

1. No known effective therapy
2. therapeutic techniques - modeling, concrete/ detailed interaction
3. Quicker than other to seek treatment, often exaggerating symptoms
4. Emotionally needy - reluctant to stop therapy treatments

Front 24

Associated Features of Narcissistic Personality Disorders

Back 24

1. Grandiosity and need for admiration: lack of empathy - also need everyone else to know how important they are
2. Act self-assured, non-chalant
3. Arrogant, exploits others, lies
4. Common defense mechanism: rationalization "I am being as honest as I can."

Front 25

Therapeutic Management: Narcissistic Personality Disorder

Back 25

1. Communication: nonchalant
2. Therapies: brief & supportive or long term and intensive

Often terminate the therapeutic relationship prematurely - symptoms become less severe as the patient gets older and wiser

Front 26

Cluster C Personality disorders

Back 26

"Anxious and/ or fearful"

1. Avoidant
2. Dependent
3. Obsessive-Compulsive

Front 27

Avoidant Personality disorder

Back 27

*Social inhibition, feelings of inadequacy and hypersensitivity

1. Ambivalen
2. Preoccupied, gaurded, emptiness
3. Common defense mechanism: Fnatasy

Front 28

Therapeutic Management: Avoidant Personality Disorder

Back 28

1. Communication - empathetic, reassurance, friendly
2. Therapies: assertiveness training; social exposure and relaxation training; cognitive therapies
3. Pharmacological: co-morbid anxiety disorders

Front 29

Dependent Personality Disorder

Back 29

*Excessive need to be taken are of leading to submissive and clinging behavior, fear of seperation

1. Timid, kind, passive, gullible
2. Common Defense Mechanism: Introjection - keeping individual thoughts to themself

Front 30

Associated Features: Dependent Personality disorders

Back 30

1. Refer to themselves as "stupid"
2. Take criticism as proof they have no worth
3. Avoids positions of responsibility
4. Go to extensive lengths for nurturing
5. worry about abandonment

Front 31

Therapeutic Management: Dependent Personality disorder

Back 31

1. communication - limits feedback
2. Therapies: insight oriented therapies; assertiveness and social skills; anxiety management; combination therapies

Prognosis is good

Front 32

Obsessive-Compulsive Personality disorder

Back 32

*Preoccupation with orderliness, perfectionism, and mental and interpersonal control ath the expense of flexibility and efficiency

Tense, disciplined, industrious

common defense mechanism: reaction formation

Front 33

therapeutic Management: Obsessive-Compulsive Personality disorder

Back 33

Treatment is difficult secondary to intellecualizing

therapies: combination therapies

Pharmacological: SSRI's have been beneficial for some, TCA;s ofr some...

Front 34

Nursing Priorities

Back 34

1. Safety - suicidal/ homicidal ideation
2. Loss
3. Current medical or pther psych disorder?
4. Mid- or late life personality change?

Front 35

Therapeutic Management of ALL personality Disorders

Back 35

1. Boundaries - lack boundaries due to underdeveloped ego
2. Consistency
3. Persistence

Front 36

Therapeutic Strategies regarding the Dependent Client

Back 36

1. convey optimism regarding abilities
2. Limits on negative remarks and behaviors
3. Explore underlying feelings (inadequacy, shame, anxiety, and fear)
4. Options and choices
5. Encourage self-care and participation
5. Positive feedback and reinforcement

Front 37

The Manipulative Client

Back 37

1, Verbal characterisitics
2. Non-verbal characteristics

Don't do things TO patients, do things WITH patients

Front 38

Therapeutic Strategies - the manipulative client

Back 38

1. Joint plan development
2. Identify strengths
3. Stress reduction
4. Assertiveness
5. Problem solving
6. role playing

DO NOT NEGOTIATE

Front 39

Therapeutic Strategies - the angry client

Back 39

1. LISTEN - angry people believe that no one has
2. calm, unhurried, don't touch - don't get defensive
3. "I" statements
4. Communicate (+) expectations
5. Talk-out instead of act out
6. Assist with external controls
7. Problem-solving after situation is calm

"I need you to lower your voice"

Front 40

Therapeutic Strategies - the Impusive Client

Back 40

1. Identify needs/feelings
2. Discuss current/ previous
3. Explore impact
4. Recognize cues
5. Anger management
6. Assertive skills
7. Role play

Front 41

Goals and ECO's

Back 41

1. Absence of Suicidal ideation
2. No thoughts of self harm
3. No self mutiliation
4. Recognize distorted thoughts
5. Identify impulsice patterns
6. Identify isolative patterns
7. Maintain increased level of functioning
8. Tolerate interaction
9. Identify new problem-solving strategies
10. Reward self - physically and emotionally
11. Identify with positive models