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26 terms

PNC 102 - Mental Health - Personality Disorder

STUDY
PLAY
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