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Personality
  • ingrained enduring pattern of behavng and relating to self, others, and enviroment including preceptions, attitudes, and emotions
  • traits are inflexable and maladaptive and can cause significant interference of functioning or cause emotional distress
  • very difficult to change due to lack of self awareness, or even pride in their coping and blame of others
Enduring patterns of behavior impact
  • cognition: perceptions of self and others
  • Affect: emotional response
  • interpersonal functioning
  • impulse control
Onset and cilnical course
  • 40%-50% of people with primary diagnosis of major mental illness also have a coexisting personality disorder that significantly complicates treatment
Conceptual model
  • personality disorder diagnosis should not be made on a child or adolescent
  • developmental model: function at a much lower level, un able to grow out of older coping strategies
People with personality disorders have higer rates of:
  • death
  • suicide
  • suicide attempts
  • accidents
  • ED visits
  • seperation
  • divorce
  • child custody issues
  • criminal behavior
  • alcoholism
  • drug abuse
Who diagnoses clients?
  • Cultural factors: culturals that value deference may not see a dependent personality disorder, workaholic culture may not see OCD
  • Gender sterotypes: men (antisocial, schizoid), women (borderline, hystrionic)
Symptom categories
  • symptoms direct treatment, not diagnosis
  • cognitive perceptual disturbances
  • psychotic symptoms
  • affective symptoms and mood dysregulation
  • aggression and behavioral dysfunction
  • anxiety
Treatment of cognitive perceptual disturbances
  • antipsychotics
  • social skills training
  • case management
Treatment of affective symptoms and mood dysregulation
  • lithium
  • mood stabilizer: tegretol
  • traditional or atypical antipsychotics
  • SSRIs
  • cognitive therapy yo reshape thinking patterns (cognitive restructuring, positive self talk, decatastrophizing)
  • DBT (mindfulness): borderline, but effective with others
Treatment of aggression and behavioral dysfunction
  • Impulsivity: lithium, anticonvulsants, low dose antipsychotics
  • Predatory: antipsychotics, lithium
  • organic-like: cholinergic agents (donexepil), Imipramine (tofranil)
  • Ictal: antoconvulsants (tegretol, dilantin, benzos)
  • limit setting (behavior modification)
Paranoid Personality Disorder
  • Cluster A
  • clinical picture: pervasive mistrust, suspiciousness, use of projection, conflict with authority
  • Nursing interventions: formal business like approach, involvement in plan of care, idea validation before action
Schizoid Personality disorder
  • Cluster A
  • Clinical picture: socal detatchment without distress, restricted emotions, intellectual
  • Nursing Interventions: improve functioning in the community
Schizotypal personality disorder
  • Cluster A
  • Clinical picture: socal and interpersonal deficits (they do cause distress), behavioral eccentricities, cognitive or perceptuaal distortions, odd appearance, inability to respond to normal social cues
  • Nursing interventions: self-care, social skills, community functioning
Antisocial personality disorder
  • Cluster B
  • 50% of inmates have dx
  • deceit, manipulation
  • false emotions, no empathy
  • narrowed view of the world
  • poor judgement, no insight
  • egocentric, but actual self is shallow and empty
  • relationships as serving own needs, distrust of others
  • Nursing interventions: therapeutic relationship, responsible behavior (limit setting), problem solving control of emotions, enhancing role performance
Borderline personality disorder
  • cluster B
  • unstable interpersonal relationships, self image, and affect
  • marked impulsivity
  • dysphoric mood
  • polarized extreme thinking (splitting) dissociation
  • impaired judgement (safety not a concern)
  • threats of self harm
  • social isolation
No harm contracts
  • used to be standard treatment, but outcomes do not show that they make a difference
  • use a calm but firm approach showing empathy while cetting clear boundaries
Hystrionic Personality Disorder
  • cluster B
  • clinical picture: excessive emotionality and attention seeking, insincerity, center of attention, exaggeration of relationships
  • Nursing interventions: feedback about social interactions, social skills training through role playing, exploration of strengths/assets
Narcissitic personality disorder
  • cluster B
  • clinical picture: grandiosity, need for admiration, lack of empathy, vulnerable self esteem, ambitous
  • nursing interventions: self awareness skills to avoid anger and frustration, matter of fact approach, limit setting
Avoidant personality disorder
  • cluster C
  • clinical picture: social discomfort, low self esteem, hypersensitivity to negative evaluation
  • nursing intervention: self affirmations, positive self talk, support and reassurance, reframing and decatastrophizing, social skills training
Dependent personality disorder
  • Cluster C
  • Clinical picture: need to be taken care of, submissive, clining
  • Nursing interventions: expression of feelings, autonomy and self reliance, cognitive restructuring, problem solving
obsessive compulsive personality disorder
  • cluster C
  • clinical picture: perfectionism, serious, orderliness a priority, problems with decision making and judgements, low self esteem, harsh self evaluations
  • Nursing interventions: different perspective view, cognitive restructuring, risk taking
Self awareness issues
  • avoid client attempts to manipulate
  • use clear communication
  • set limts and boundaries
  • deal with frustration: clients change slowly yet "look" like they are capable of better behavior
  • work effectively as part of a team, consistency is essential
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