PNC 102 - Mental Health - Personality Disorder

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What are the three clusters by which personality Disorders are classified into?

1) Odd and eccentric (PSS)
- Parnoid
- Schizoid
- Schizotypal

2) Dramatic- Emotional (ANHN)
- Antisocial
- Borderline
- Histrionic
- Narcissistic

3) Anxious-Fearful (ADO)
- Avoidant
- Dependent
- OCD

PERSONALITY DISORDERS

Enduring pattern of inner experiences and behavior that has the following characteristics

- Deviates markedly from expectations of person¡¦s culture
- Is pervasive and inflexible
- Begins in adolescence or young adulthood
- Stable over time
- Leads to distress or impairment of functioning

CHALLENGES FOR NURSES

- Can be manipulative, socially inappropriate, and difficult
- Not within clients ability to change completely
- Require patience and skill
- Nurses must adapt the nurse-client relationship to the special concerns of the client

PARANOID PERSONALITY DISORDER

- Pattern of distrust and suspiciousness
- Assume others will hurt or deceive them
- Imagine hidden messages in comments and actions of others
- Find it difficult to forgive and hold grudges

*Hallmark is difficulty with relationships*
Causes hostile and defensive nature

COLLABORATIVE CARE for Paranoid PD

- Difficult to treat because resistant to change
- Cognitive-behavioral therapy most effective

- Often lack insight
- No medication effective

- Identify realistic short-term outcomes related to small changes in thinking and behavior
-Long-term goal is increased flexibility and trust

- Use matter-of-fact, businesslike approach and Respond best to reassurance about safety

SCHIZOID PERSONALITY DISORDER

- Pervasive pattern of detachment from social relationships and restricted range of emotional expression

- Prefer to be alone
- Little interest in sexual or intimate relationships
- Lack friends, indifferent to opinion of others
Impairment in occupational functioning

COLLABORATIVE CARE for Schizoid PD

- Goal is enough interpersonal contact to keep them oriented to reality

- Treatment outcomes focus on finding individual activities that provide satisfaction

SCHIZOTYPAL PERSONALITY DISORDER

a personality disorder characterized by detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, [Superstitious or preoccupied with paranormal] and behaviors (eccentric)

*Ideas of reference

COLLABORATIVE CARE of Schizotypal

- Reinforce reality
- Do not argue about delusional thoughts
- Brief, concrete conversations
- Matter-of-fact businesslike approach

- Social skills training valuable

ANTISOCIAL PERSONALITY DISORDER

Pervasive pattern or disregarding and violating other's rights

- Lie repeatedly, impulsive, aggressive, irritable
Disregard safety of others and self

- Irresponsible, little remorse shown
- Affects men more than women

Criteria for Dx of antisocial

- Must be at least 18 years old

- Must have Conduct Disorder by age 15
Cruelty to animals, deceitfulness or theft, destruction of property, serious violation of rules

- Break the law, deceitful, and manipulative

COLLABORATIVE CARE for Antisocial pt

**First short-term goal is no harm to others
 Manage manipulative and physically violent issues first
 Other issues include anger management, coping skills, increasing self-awareness, seeing from another's point of view

- Nurses should tell the truth clearly and concisely
- Share perceptions about emotional consequences of client's behavior
- Follow facility rules consistently
Group interventions helpful

BORDERLINE PERSONALITY DISORDER

Caused by interaction of biological and social learning influences

Behavior includes the following:
Emotional vulnerability
Self-invalidation
Unrelenting crises
Inhibited grieving
Active passivity
Apparent competence

Describe types of Borderline Personality

Biosocial
 Results from vulnerable individual interacting with invalidating environment

Biological
 Impaired regulation of neural circuits regulating emotions

CLINICAL FEATURES of Borderline Personality

- Impulsive
- Instability in relationships (Pattern of intense and unstable relationships), self-image (may hurt self/ Depersonalization), and emotions

- Intense fear of abandonment
- Very sensitive to environmental circumstances
- Intense fear and anger when faced with separations
- Intolerant of being alone
- May injure themselves to prevent abandonment

COLLABORATIVE CARE for Borderline Personality

- Often associated with depression requiring antidepressants

*Priority is no self-harm*
- Long-term treatment

_ Dialectical behavior therapy

HISTRIONIC PERSONALITY DISORDER

- Excessive emotionality
- Attention seeking behavior Need to be center of attention
- Appear inappropriately sexually provocative
- Expression shallow and changeable
- Speech lacks detail and excessively impressionistic

- Strong opinions, emotions exaggerated
- Very suggestible and easily influenced
- Overly trusting, difficulty achieving close relationships

COLLABORATIVE CARE of Histrionic Personality

- Don't seek mental health care (When they do it's because of rejection, disapproval, or period of unsatisfying relationships)

**Treatment goal - focus on themselves for problem solving

NARCISSISTIC PERSONALITY DISORDER

characterized by a grandiose sense of self-importance, a preoccupation with fantasies of success or power, and a need for constant attention or admiration

- Exploit others, little empathy for other's feelings
- Arrogant, conceited behavior and attitudes
- Quick to criticize

COLLABORATIVE CARE NARCISSISTIC PERSONALITY DISORDER

- Only seen when admitted for another disorder
- Difficult to work with

**Direct communication with clear expectations for client behavior
*Set clear, consistent limits
***Treatment goals - developing coping skills and independent problem solving skills

AVOIDANT PERSONALITY DISORDER

a personality disorder characterized by inhibition in social situations; feelings of inadequacy; oversensitivity to criticism

- Fear disapproval or rejection
- Avoid work or school activities involving contact with others
- Avoid making new friends
- Would like to have social relationships but hesitate to join social activities
- Preoccupied with thoughts of being criticized or rejected

COLLABORATIVE CARE of Avoidant Personality

Treatment goals
Improve self-esteem
Develop trusting relationships
Develop adaptive coping skills
Improve social skills

Antianxiety and antidepressants may be helpful

DEPENDENT PERSONALITY DISORDER

- Need to be taken care of
- Submissive, clinging behavior
- Fear separation and abandonment
- Difficult to make decisions without help and advice from others

- Allow others to take responsibility for major areas of their lives
- Avoid jobs requiring initiative or decision making
Social behavior warm and giving

COLLABORATIVE CARE for Dependent Personality

- One of most common disorders seen in mental health clinics

- Challenge for nurse is to support client's own decision making without giving advice

- Reinforce need for long-term psychotherapy

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

- Preoccupation with orderliness, perfectionism, and control (mental & personal)
- Inflexible, closed, and lack efficiency
- Painstaking attention to rules, trivial details, lists, and schedules
- Extraordinary attention to detail and repeated - checking for mistakes

- Pack rats, hoarding behavior
- Reluctant to delegate to others
- Miserly

COLLABORATIVE CARE of OCD

- Requires long-term therapy
- Antianxiety medications may be helpful
- Focus on assessing how the client is affected by the disorder

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