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121 Cards in this Set
- Front
- Back
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Personality:
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An ingrained, enduring patten of behaving and relating to self, others, and the environment; behaviors and characteristics are consistent across a broad range of situations and do not change easily
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Personality disorders:
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when personality traits become inflexible and maladaptive and signifcantly interfere with how a person functions in society or cause the person emotional distress; usually not diagnosed until adulthood....change is possible, slow, longterm
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Cluster A
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people whose behvaior is odd or eccentric (paranoid, schizoid, schizotypal)
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Cluster B
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People who appear dramatic, emotional, or erratic (antisocial, borderline, histrionic, narcissistic)
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Cluster C
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people who are anxious, or fearful (avoidant, dependent, obsessive-compulsive)
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Disorders considered for inclusion
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Depressive or passive aggressive
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Personality disorders occur in
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10-13% of the population
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What percentage of the population of people with major mental disorders have a personality disorder
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40-45%
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Clients with perosnality disorders have
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higher death rates (suicide), inc rates of divorce, inc rates of criminal behavior
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What is the genetic component of personality disorder?
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Temperament
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What are the psychosocial factors of personality disorder?
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Character, self-directed ness, cooperativeness, self-transcendence
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Guarded or defensive behavior may be displayed as a result of
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language barriers or previous negative experiences and should not be confused with paranoid personality
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What are the psychosocial factors of personality disorder?
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Character, self-directed ness, cooperativeness, self-transcendence
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People w religious or spiritual beliefs
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could be misinterpreted as having schizotypal personality disorder
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Guarded or defensive behavior may be displayed as a result of
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language barriers or previous negative experiences and should not be confused with paranoid personality
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What can be goals of individual and group therapy for personality disorder?
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Improvement in relationships, improved basic living skills, relief of anxiety
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Four symptom categories for pharmacolgic trtment
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cognitive-perceptual distortions (including psychotic sx), affective sx & mood dysregulation, aggression and behavioral dysfunction, anxiety
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People w religious or spiritual beliefs
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could be misinterpreted as having schizotypal personality disorder
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Cognitive-perceptual disturbances
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magical thinking, odd beliefs, illusions, suspiciousness, ideas of referenece and low grade psychotic sx...treatment wioth low dose antipsychotic meds
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What can be goals of individual and group therapy for personality disorder?
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Improvement in relationships, improved basic living skills, relief of anxiety
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Mood dysregulation
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emotional instability,m emotional detachment, depression and dysphoria....treat with lithium, tegretol, depakote, neuroleptics, SSRIs, MAOIs, atypical antipsychotics
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Four symptom categories for pharmacolgic trtment
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cognitive-perceptual distortions (including psychotic sx), affective sx & mood dysregulation, aggression and behavioral dysfunction, anxiety
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Cognitive-perceptual disturbances
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magical thinking, odd beliefs, illusions, suspiciousness, ideas of referenece and low grade psychotic sx...treatment wioth low dose antipsychotic meds
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Aggression
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predatory or cruel behavior, impulsivity, poos social judgment and emotional lability ... treat with lithium, anticonvulsant mood stabilizers, benzos, and low dose neuroleptics
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Mood dysregulation
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emotional instability,m emotional detachment, depression and dysphoria....treat with lithium, tegretol, depakote, neuroleptics, SSRIs, MAOIs, atypical antipsychotics
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Anxiety
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treat with SSRIs, MAOIs, or low dose antipsychotics
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Aggression
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predatory or cruel behavior, impulsivity, poos social judgment and emotional lability ... treat with lithium, anticonvulsant mood stabilizers, benzos, and low dose neuroleptics
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Cluster A
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Schizoid personality, Schizo-typal personality, and paranoid personality
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Anxiety
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treat with SSRIs, MAOIs, or low dose antipsychotics
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What is the key for classifying types of tangible collateral?
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Primary use in the hands of the debtor, meaning this is a subjective standard - no absolutes
**e.g, golf clubs in your hands are consumer goods; in the hands of sports store, inventory |
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Schizoid personality D/O
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c/b inability to form close relationshiops, social detachment/solitary life, aloof/indifferent, restricted expression of emotion, lacks interest in others
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Nursing interventions for schizoid personality disorder
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improve functioning in the community, make referrals to social services, provide care that accommodates the desire for solitude
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Schizotypal personality d/o
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c/b exhibit abnormal/unusual thoughts, perceptions, speech, behavior patterns, suspicious, paranoid, magical thinking, odd thinking/speech, relationship deficits
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Schizotypal personality D/o: Clinical Picture
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Acute discomfort in relationships, cognitive or perceptual distortions, eccentric behavior, bizarre speech, affect flat and sometimes inappropriate. NURSING interventions: promote self care, social skills and improve functioning in the community
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Paranoid personality d/o
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c/b suspiciousness, mistrust of others, arugmentative, hostile aloofness, rigid, critical, controlling of others, grandiosity
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Paranoid personality disorder: Clinical picture
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mistrust and suspiciousness, aloof and withdrawn, guarded or hyervigilant, restricted affect, use the defense mechanism of projection. NURSING INTERVENTIONS: Approach in a formal, business-like manner, keep commitments, be straightforward, involve them in formaulating their care plains, help them learn to validate ideas b4 taking action
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Cluster C People are : Anxious (fearful group)
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avoidant personality, obsessive compulsive personality, dependent personality, passive aggressive personality
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avoidant personality disorder
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c/b social withdrawal, hypersensitive to rejection, criticism, feels inadequate, social inhibition, lacks support system
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Avoidant personality d/o: clinical picure
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Social inhibitions; feelings of inadequacy; hypersensitivity to negative evaluation; avoid situations or relationships that may result in rejection, criticism, shame, or disapproval; strongly desire closeness and intimacy but fear possible rejection and humiliation
Nursing Interventions Explore positive self-aspects and reasons for self-criticism; practice self-affirmations and positive self-talk; cognitive restructuring techniques, such as reframing and decatastrophizing; teach social skills |
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Obsessive compulsive personality d/o
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need to control others, difficulty expressing warmth/tenderness, reflects perfectionism, devoted to work, overly conscientious, inflexible, preoccupied with details, may hoard worthless objects
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Obessive compulsive personaltiy disorder clinical picture
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Preoccupation with orderliness, perfectionism, and control; formal and serious demeanor; constricted emotions; stubborn; preoccupied with details, rules, lists, and schedules; believe they are right; problems with judgment and decision making
Nursing Interventions Help accept or tolerate less-than-perfect work; use cognitive restructuring techniques; encourage to take risks; practice negotiation |
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Dependent personality disorder
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c/b lack of self confidence, fears independence/lacks autonomy, passively allows others to make decisions and assume responsibility, cannot tolerate being alone, needs others to make decisions
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Dependent personality d/o: clinical picture
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Submissive and clinging behavior; excessive need to be taken care of; pessimistic and self-critical; other people hurt their feelings easily; report feeling unhappy or depressed; difficulty making decisions; seek advice and repeated reassurances
Nursing Interventions Help identify strengths and needs; use cognitive restructuring; assist in daily functioning; teach problem solving and decision making; refrain from giving advice |
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Cluster B: Erratic dramatic group
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antisocial, borderline, narcissistic, histrionic
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antisocial personality d/o
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pervasive pattern of disregard for and violation of rights of others, deceit and manipulation
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Nursing diagnosis for antisocial
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ineffective individual coping, ineffective role performance, risk for other-directed violence
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Borderline personaltiy d/o clinical picture
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pervasive pattern of unstable interpersonal relationships, self-image, affect and marked impulsivity
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Borderline Personality Disorder
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C/B unstable interpersonal relationships
Impulsive/unpredictable behaviors Chronic feelings of emptiness Extreme shifts in mood/depression Easily bored/argumentative Self-destructive behaviors Splitting, manipulative Inability to tolerate anxiety |
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Nursing diagnosis for borderline
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risk for suicide, risk for self-mutilation, risk for other-directed violence, ineffective coping, social isolation
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Histrionic Personality D/O
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C/B Overly dramatic, intensively expressive
Enjoys being the center of attention Poor interpersonal relationships Romantic fantasies and control of partners Easily bored Displays dependency |
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Histrionic Personality Disorder: clinical picture
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Excessive emotionality and attention seeking; colorful and theatrical speech; overly concerned with impressing others; emotionally expressive, gregarious, and effusive; emotions are insincere and shallow; self-absorbed; uncomfortable when they are not the center of attention and go to great lengths to gain that status
Nursing Interventions Give feedback about social interactions; teach social skills through role playing |
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Narcissistic Personality D/O
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C/B increased sense of self –importance
Pre-occupied with fantasies /unlimited success/constant need for attention & admiration Grandiosity/inflates accomplishments Lacks empathy/sensitivity to others needs |
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Narcissistic Personality Disorder: clinical picture
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Grandiose; lack of empathy; need for admiration; arrogant or haughty attitude; disparage, belittle, or discount the feelings of others; view their problems as the fault of others; hypersensitive to criticism and need constant attention and admiration
Nursing Interventions Use self-awareness skills to avoid anger and frustration; use matter-of-fact manner; set limits on rude or verbally abusive behavior |
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Pathologic anxiety
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autonomy, intensity, duration, behavior
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Definition of anxiety
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diffuse, unpleasant vague sense of apprehension, often accopanied by autonomic sx
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Eiology
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central noradrenergic systems (locus coeruleus is the major source of adrenergic innervation, gaba neurons from the limbic system, serotoninergic systems & neuropeptides
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Medical conditions associated with anxiety
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endocrine, drug intoxication, drug withdrawal, hypoxia, metabolic, neurological
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Major anxiety disorders
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panic disorder, generalized anxiety disorder, post traumatic stress disorder, social phobia, specific phobia, OCD, substance induced anxiety disorder
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Panic attack
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discrete episodes of intense anxiety, sudden onset, peak within 10 min, associated with at least 4 of the 13 other somatic or cognitive sx of autonomic arousal
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Psychological panic attack sx
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derealization, depersonalization, fear of losing control or going crazy, fear of dying
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Panic disorder
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a syndrome characterized by recurrent unexpected panic attacks *at least 4 in 1 month, attacks are followed for 1 month with concern ab another attack
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Agoraphobia
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complication of panic d/o, 'fear of the market', restricts daily activities (can become homebound)
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first line therapy of panic disorder
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SSRI (TCA and MAOI are also used)
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Benzos are used for anxiety
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in the short term before the antidepressant has had time to work
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_____Helps pts overcome a learned pattern of catastrophically misinterpreting the physical sx associated with panic attacks
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cognitive behavioral therapy
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Generalized anxiety d/o
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suffer from severe worry or anxiety that is out of proportion to situational factors, must last most days for at least 6 months, worriers, nervous
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GAD sx include
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muscle tension, restlessness, insomnia, diff concentrating fatigable, irritability persistant anxiety
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GAD diagnostic creiteria
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excessive anxiety and worry that occurs more days than not for 6 mo, diff to control, 3 out of 6 sx, anxiety caused significant distress or impairment in fx
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Generalized anxiety disorder trtment
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cognitive behavioral therapy, antidepressants, benzodiazepines, buspirone
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Symptoms of PTSD usually begin within
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3 months of the trauma
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SYmptoms of PTSD must be
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> or equal to one month duration and include re-experiencing sx, avoidance sx, emotional numbing, hyperarousal sx
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Avoidance / numbing sx
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avoid thoughts, feelings, places or people that arouse memories of the event, being unable to recall important parts of the event, dec interest in activities, feeling detached or estranged from others, dec range of affect, sense of foreshortened future
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Hyperarousal sx (at least 2 of following)
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insomnia (falling or staying asleep), irritability or outbursts of anger, dec concentration, hypervigilance, inc/exaggerated startle response
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PTSD trtment,
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psychotherapies (cognitive behavior therapy) psychotherapy aimed at survivor anger, guilt and helplessness,
Pharmacological trtment (SSRI and sometimes atypical antipsychotics) |
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Low doses of beta blockers
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helpful in social phobia when have to public speak everyonce in a while
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Flooding
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exposing person to phobia stimulus
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Exposure therapy workby to
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desensitive the pt using a series of gradual self-paced exposures to the phobic stimulus; uses relaxation, hypnosis, breathing control and other cognitive approaches (benzos or betablockers are useful ACUTELY)
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Obsessions
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recurrent, intrusive, unwanted thoughts (ie fear of contamination)
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Compulsions
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behaviors or rituals aimed at reducing distress or preventing a dreaded event (I.e compulsive handwashing)
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OCD sx
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recurrent obsessions and/or compulsions are severe enough to consume more than one hour/day; person recognizes the obsession as a "product of his/her own mind" rather than imposed from the outside, and that they are unreasonable or excessive
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ego dystonic
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not enjoyable for the ego
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ego syntonic
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the ego likes it
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OCD trtment
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SSRI, clomipramine (serotonergic tricyclic antidepressant), & Psychotherapy: exposure and response prevention
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Addiction is a chronic disease c/b
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changes in the brain which result in compulsive desire to use drug
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because the brain senses extra dopamine when taking drugs
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may reduce the number of dopamine receptors of make less dopamine "down regulation)
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Addiction
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person seek out and use drugs compulsive (despite neg consequences)
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Tolerance
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needing more drug for the desired effect
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Pharmacotherapies for opioid addiction
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methadone, buprenorphine, naltrexone
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Buprenorphine is
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partial agonist at opioid receptors that carries low risk of overdose. reduce withdrawal sx associated with opioid dependence but does not produce the euphoria and sedation caused by heroin
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Suboxone
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combination of buprenorphine and opioid antagonist naloxone. produces severe withdrawal sx when individuals inject it to get high
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Pharmacological for tobacco addiction
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nicotine replacement therapy, zyban, chantix
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Alcohol addiction trtment
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naltrexone, acamprosate, disulfiram, topiramate
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naltrexone
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blocks opioid receptors involved in rewarding effects of drinking and craving for alcohol. Cuts relapse risk during first 3 mo by 36 percent
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Acamprosate (Campral®) acts
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on GABA and glutamate neurotransmitter systems reduce sx of protracted withdrawal
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Disulfiram
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interferes with degradation of alcohol...produces a very unpleasant rx that includes flushing, nausea and palpitations if pt drinks alcohol.
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Topiramate
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inc inhibitory (GABA) neurotransmission and red stimulatory (glutamate) neurotransmission.
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confabulation
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filling in of memory gaps with imaginary facts is a defense mechanism used by ppl experiencing memory deficits. common in substance induced dementias
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What personality disorders are in cluster a
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1. Paranoid personality d/o 2. Schizoid personality d/o 3. Schizotypal personality d/o
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Paranoid personality d/o
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characterized by irrational suspicions and mistrust of others
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Schizoid personality d/o
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lack of interest in social relationships, seeing no point in sharing time with others, anhedonia, introspection
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anhedonia
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is the inability to gain pleasure from enjoyable experiences.
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Schizotypal perosnality d/o
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characterized by odd behavior or thinking
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Cluster B
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Dramatic, emotional or erractic d/o. 1. Antisocial, borderline, histronic, and narcissistic
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Antisocial personality d/o
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a pervasive disregard for the law and the rights of others
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borderline personality d/o
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extreme 'black and white' thinking, instability in relationshiops, self-image, identity and behavior
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Histrionic personality d/o
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pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions
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narcissistic personality d/o
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a pervasive pattern of grandiosity need for admiration and lack of empathy
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Cluster C
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anxious or fearful d/o. 1. avoidant, dependent, obsessive compulsive
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Avoidant personality d/o
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social inhibitition, feelings of inadequacy, extreme sensivity to negative evaluation and avoidance of social interaction
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Dependent personality d/o
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pervasive psychological dependent on other people
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Obsessive compulsive personality d/o
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characterized by rigid conformity to rules, moral codes and excessive orderliness
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Depressive personality d/o
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pervasive pattern of depressive cognitions and behaviors beginning by early adulthood
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Passive aggressive personality d/o
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(negativitistic personality d/o) is a pattern of negative attitudes and passive resistance in interpersonal situations
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Generalized anxiety d/o
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common chronic d/o characterized by long lasting anxiety that is not focused on any one object or situation. Those suffering from generalized anxiety experience non-specific, persistent fear and worry and become overly concerned with everyday matters. GAD is most common to affect older adults
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Panic d/o
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a person suffers from brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes can last for several hours and can be triggered by stress, fear, or even exercise; although the specific cause is not always apparent.
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hypervigilance
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heightened awareness of body functioning, wherein any perceived physiological change is interpreted as a possible life threatening illness
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Obsessions
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distressing, persisten, and intrusive thoughts or images
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compulsions
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urges to perform specific acts or rituals
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agoraphobia
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specific anxiety ab being in a place where escape difficult or embarrassing or where help may be unavailable.
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Social phobia
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(social anxiety d/o) describes an intense fear of negative public scrutiny or of public humiliation. OFten manifests specific physical sx including blushing, sweating, and difficulty speaking. Attempt to avoid the source of their anxiety and can lead to complete social isolation.
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PTSD
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an anxiety d/o which results from traumatic experience. Can result from an from an extreme situation. Can also result from longterm exposure to stressor. Common sx include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression
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