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Personality Disorders Characteristics of each personality disorder Nursing Interventions Issues rela

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Lifelong, inflexible, dysfunctional patterns or relating and behaving ... Arrogant or naughty. 13. Criteria for histrionic personality disorder ... – PowerPoint PPT presentation

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Title: Personality Disorders Characteristics of each personality disorder Nursing Interventions Issues rela


1
Personality DisordersCharacteristics of each
personality disorderNursing InterventionsIssues
related to the nursing care ethical cultural
consideration
2
Introduction
  • Lifelong, inflexible, dysfunctional patterns or
    relating and behaving - distress to others, not
    to themselves unless from others reactions or
    behaviors toward them.
  • Listed on DSM axis II with others
  • Most commonly treated borderline personality
    disorder
  • Interventions focus primarily on N-P R
  • Etiology combination of psychosocial
    biological variables

3
Criteria for a personality disorder
  • Disturbances in 2 or more of the following
  • Cognition (thinking about self, people, events)
  • Affectivity (range, intensity, lability,
    appropriateness of emotional response)
  • Interpersonal functioning
  • Impulse control

4
Clusters
  • A. Odd or eccentric behaviors
  • Paranoid, schizoid, schizotypal personality
    disorder
  • B. Dramatic, emotional or erratic behaviors
  • Antisocial, borderline, histrionic, narcissistic
    personality disorder
  • C. Anxious or fearful behaviors
  • Avoidant, dependent obsessive-compulsive disorder

5
Odd- eccentric cluster of PD
6
Criteria for paranoid personality disorder
  • Suspicious of others
  • Doubt trustworthiness or loyalty of friends
    others
  • Fear of confiding in others
  • Suspicious, without justification, of spouses or
    sexual partners fidelity
  • Interpret remarks as demeaning or threatening
  • Hold grudges toward others
  • Become angry threatening when they perceive
    they are attacked by others

7
Criteria for schizoid personality disorder
  • Lacks desire for close relationships or friends
  • Chooses solitary activities a lifelong loner
  • Little interest in sexual experiences
  • Avoids activities
  • Appears cold detached
  • Lacks close friends
  • Appears indifference to praise or criticism

8
Criteria for schizotypal personality disorder
  • Ideas of reference
  • Magical thinking or odd beliefs
  • Unusual perceptual experience, including bodily
    illusion
  • Odd thinking vague, stereotypical, overlaborate
    speech
  • Suspicious
  • blunted or inappropriate affect
  • Odd or eccentric appearance or behavior
  • Few close relationships
  • Excessive social anxiety

9
Dramatic-erratic cluster of PD
10
Criteria for antisocial personality disorder
  • Deceitfulness as seen in lying or conning others
  • Engages in illegal activities
  • Aggressive behavior violence
  • Lack of guilt or remorse
  • Irresponsible in work with finances
  • Impulsiveness
  • Reckless disregard of safety for self or others
  • Insensitivity

11
Criteria for borderline personality disorder
  • Frantic avoidance of abandonment real or
    imagined
  • Unstable intense IPR Identity disturbances
  • Impulsivity Affective instability
  • Recurrent suicidal behavior or self-mutilating
    behavior to express feelings of
    anger/frustration
  • Rapid mood shifts
  • Chronic feelings of emptiness
  • Transient dissociative paranoid symptoms

12
Criteria for narcissistic personality disorder
  • Grandiose self-importance
  • Fantasies of unlimited power, success, or
    brilliance
  • Believes he/she is special or unique Needs to be
    admired
  • Sense of entitlement (i.e., deserves to be
    favored or given special treatment)
  • Takes advantage of others for own benefit
  • Lacks empathy
  • Envious of others or others are envious of
    him/her
  • Arrogant or naughty

13
Criteria for histrionic personality disorder
  • Needs to be center of attention
  • Displays sexually seductive or provocative
    behaviors
  • Shallow, rapidly shifting emotions
  • Uses physical appearance to draw attention
  • Uses speech to impress others but is lacking in
    depth
  • Dramatic expression of emotion
  • Easily influenced by others
  • Exaggerates degree of intimacy with others

14
Anxious-fearful cluster of PD
15
Criteria for dependent personality disorder
  • Unable to make daily decisions without much
    advice reassurance
  • Needs others to be responsible for important
    areas of life
  • Seldom disagrees with others because of fear of
    loss of support or approval
  • Problem with initiating projects or doing things
    on own because of little self-confidence
  • Performs unpleasant tasks to obtain support from
    others
  • Anxious or helpless when alone because of fear of
    being unable to care for self
  • Urgently seeks another relationship for support
    care after a close R ends
  • Preoccupied with fear of being alone to care for
    self

16
Criteria for avoidance personality disorder
  • Avoids occupations involving interpersonal
    contact because of fears of disapproval or
    rejection
  • Uninvolved with others unless certain of being
    liked
  • Fears intimate Rs due to fear of shame or
    ridicule
  • Preoccupied with being criticized or rejected in
    social situations
  • Inhibited feels inadequate in new interpersonal
    situations
  • Believes self to be socially inept, unappealing,
    or inferior to others
  • Very reluctant to take risks or engage in new
    activities due to possibility of being embarrassed

17
Criteria for obsessive-compulsive personality
disorder
  • Preoccupied with details, rules, lists,
    organization
  • Perfectionism that interferes with task
    completion
  • Too busy working to have friends or leisure
    activities
  • Over conscientious inflexible
  • Unable to discard worthless or worn-out objects
  • Others must do things his/her way in work or task
    related activity
  • Reluctant to spend and hoards money
  • Rigid and stubborn

18
Related Nursing Diagnoses
  • Anxiety
  • High risk for self-mutilation
  • Hopelessness
  • Impaired communication
  • Ineffective individual coping
  • Self-esteem disturbance
  • Social isolation

19
Nursing Care
  • Nurse-Patient relationship trust, empathy,
    authenticity
  • Focus on specific behaviors, distress to self or
    others or both awareness of dysfunctional
    self-defeating patterns
  • Case management stress reduction crisis
    intervention
  • Assertive training Social skill training
  • Psychobiological therapy (with caution)
  • Milieu therapy setting limits

20
Conclusion
  • Personality traits - individualization
  • Disorder rigid, dysfunctional, distress
  • Distress come from others reaction to or
    behaviors toward that person - evoke
    interpersonal conflict
  • Usually have more than one DSM diagnosis
  • Long-term hospitalization is unnecessary
  • Limit setting multidisciplinary work
  • Px - have a fairly good prognosis only with
    therapy

21
Substance-related disorders
  • Personal and societal toll
  • Terminology criteria for diagnoses
  • Care plan and interventions

22
Introduction
  • Epidemiology - 1 health problem in the US -
    effects on cost, quality of life, society
  • Types - Alcohol, tobacco, other drugs ie opium,
    heroin, codeine, synthetic narcotics.
  • Cigarettes and alcohol gateway drugs
  • History medical use, social use, illegal use
  • Central nervous system (CNS) was affected
  • Substance dependency Client experiences
    tolerance and withdrawal symptoms

23
Substance
  • Prescribed medications i.e. Ritalin, OxyContin
  • Over-the-counter cough, cold, sleep, and diet
    medication
  • Narcotics ie. Heroin, morphine, demerol,
    methadone
  • Inhalants
  • Hallucinogen ie. Marijuana, LSD, PCP
  • Stimulants ie. cocaine, amphetamines

24
Other Substance Trends
  • Club drugs ie MDMA (ecstasy), GHB, Rohypnol,
    ketamine, methamphetamine, LSD
  • CNS depressants ie. Valium, phenobarbital
  • Steroids
  • 1960 hallucinogens, amphetamines
  • 1970 heroin, marijuana, sedatives
  • 1980 cocaine injection, smoking

25
Terminology
  • Dependence physical psychological
  • Codependence -
  • Tolerance
  • Cross-tolerance
  • Withdrawal abstinence syndrome
  • Dual diagnosis -
  • CAGE cutdown, annoy, guilty, eye opener
  • Blackout -

26
A continuum of substance use
27
Etiology
  • Biological theories genetic predisposition
  • Psychological theories psychoanalytic theories,
    interpersonal theories
  • Family theories family system theory
  • Learning theories positive effect of mood
    alternations, media reinforcement, peer pressures
  • Psychosocial and behavioral factors increase the
    clients vulnerability to drug or alcohol abuse.

28
Age Substance Use
College 2001
90
29
Perinatal concerns
  • 25-30 of women expose their children to nicotine
    in utero
  • 3 out of every 5 women of childbearing age drink
    alcohol
  • 10 of women of childrearing age use an illicit
    drug
  • Substances teratogens - malformations in the
    fetus, intrauterine growth retardation, subtle
    mental and behavioral deficits.

30
Fetal Alcohol Syndrome (FAS)
  • Low birth weight
  • Certain facial characteristics ie. microcephaly,
    microthalmia, short palpebral fissures, poorly
    developed philtrum, thin upper lip, short nose,
    small chin, flattening of the maxillary area
  • Neurological abnormalities ie developmental
    and/or intellectual delays it is a preventable
    cause of mental retardation
  • Fetal Alcohol Effect (FAE)- Less severe cases

31
Other problems of FAS FAE
  • Other organs heart, hearing, visual, dental,
    genital anomalies
  • Hyperactivity, poor coordination, short attention
    spans, dependency, social withdrawal,
    impulsivity
  • Co-morbidity
  • Depression, anger, suicidal ideation, antisocial
    behaviors
  • Preventable health problem for children

32
Adolescent Substance Abuse
  • Health social problem
  • School drop-out
  • Victim of abuse child/parental, sexual
  • Experienced trouble with law
  • Suicide attempts
  • Feelings of inferiority, history of mental
    problems

33
Signs of Adolescent Drug Use
  • Sudden behavioral changes
  • Sweating, especially at night
  • Needle marks
  • Inebriation (intoxicated, drunk)
  • Change in nutritional intake
  • Nasal congestion
  • Rhinorrhea with cocaine use
  • School problems

34
Warning Ss of Teen Sub. Abuse
35
Prevention of Adolescent substance Use
  • Positive role modeling
  • Reinforce positive behaviors
  • Support cope with social pressure
  • Establish normative expectations
  • Help to anticipate pressures
  • Involve in life skills training programs
  • Open communication

36
Alcohol Abuse
  • Body damage - brain cell - neurological S/S
    Liver, G-I, muscle, heart, sexual function
  • Blackouts
  • Wernickes syndrome - intact intellectual
    function but poor memory, ataxia, confusion, vit
    B deficiency
  • Korsakoffs syndrome disorientation
  • Alcohol withdrawal syndrome (AWS) -
  • Alcohol withdrawal delirium - Delirium tremens
    (DT) confusion, disorientation, hallucination,
    tachycardia, tremor,

37
Wernickes encephalopathy
  • Clouding of consciousness with an abrupt onset of
    confusion and mental status changes along with
    drowsiness.
  • Ocular motor abnormalities.
  • Ataxia of gait from weakness in limbs or
    coordination of muscles or poor balance

38
Korsakoff syndrome
  • Difficulty in acquiring new information or
    learning new skills
  • Lack of insight into their deficit
  • Amnesia
  • Impaired short term memory
  • Tendency for confabulation
  • Apathy
  • Inattention
  • Impaired fine motor skills
  • Impaired sense of smell
  • Talkative an repetitive behaviors

39
Treatment of WKS
  • IV or IM thiamine
  • Medications
  • Cholinersterase inhibitors
  • Atypical antipsychotics
  • SSRI
  • Alcohol cessation
  • Dietary consumption

40
Clinical Description
  • Denial
  • Dependence compulsive use
  • Abuse dysfunction in work,
  • Intoxication
  • Withdrawal
  • Delirium
  • Psychotic disorders

41
Alcohol-related Disorders
42
Alcohol
  • Detoxification 3Ss-
  • Secure environment
  • Sedation
  • Supplements

43
CNS depressant - Narcotics
  • Opioids endorphin agonist, euphoria
  • Increasing pain threshold, reducing anxiety and
    fear
  • Decreased pulmonary ventilation/esp. elders
  • Respiratory depression in neonates/preg
  • Withdrawal is rarely fatal, but painful ie
    yawning, tearing, rhinorrhea, sweating, flushing,
    tachycardia, tremor, restlessness, irritability,
    muscle spasm, fever, nausea, diarrhea, vomiting,
    repetitive sneezing, abdominal cramps, backache

44
CNS depressant - Barbiturates
  • Medical relieve anxiety, produce sleep,
    anesthesia, epilepsy, soften withdrawal from
    heroin
  • Narrow therapeutic index
  • Classification- ultrashort (30-3h), short
    (3-4h), intermediate (6-8h), long (10-12h)
  • Intoxication unsteady gait, slurred speech,
    sustained nystagmus, confusion, irritability,
    insomnia
  • Tolerance

45
Stimulant - Cocaine
  • Medical relief for altitude sickness,
    anesthetics,
  • Block norepinephrine dopamine reuptake
  • CNS PNS effects euphoria, alertness,
    anorexia, sexual stimulation
  • Derivatives crack, rock
  • Physical dependence is less severe
  • Psychological dependence is intense
  • Highs ( reinforcement) lows ( - reinforcement)
  • Cocaine-induced depression, suicide
  • Death caused by meta. resp. acidosis, and
    hyperthermia, prolonged seizure, tachyarrhythmias

46
Stimulant - Amphetamine
  • Speed, ice, crank, poor persons cocaine
  • Medical ADD, narcolepsy, obesity
  • CNS effects wakefulness, alertness, heightened
    concentration, energy, euphoria, insomnia,
    amnesia, restlessness, agitation,
  • PNS effects- palpitations, tachycardia,
    hypertension
  • Amphetamine-induced psychosis
  • Facilitate excretion by acidification of urine

47
Hallucinogen
  • Natural synthetic
  • Heighten awareness of reality or cause a
    terrifying psychosis-like reaction, distortions
    in body image, sense of depersonalization, loss
    of the sense of reality, panic, anxiety,
    confusion, paranoid reaction
  • Altered perception - unable to perform simple
    tasks or lead to violent behaviors

48
Dual Diagnosis
  • Comorbidity 2 or more disorders in the same
    person
  • Dual diagnosis- 2 initial unrelated disorders
    that interact and cause increased manifestations
    of the other disorder
  • Personality disorders higher incidence 47 of
    antisocial 2/3 of borderline 4.5-15
    above the norm in Schizophrenia

49
Etiology of Dual Diagnosis
  • Substance use - calmer, feel better, less
    anxious, decrease the intensity of
    hallucinations.
  • Compare with using antipsychotics less
    uncomfortable side effects
  • Increase social acceptance, feeling of autonomy
    or power - self-esteem

50
Tx for Dual Dx
  • Multifaceted multidisciplinary case
    management, ind/gr therapy, skill training,
    vocational counseling,
  • N-Pt Relationship knowledgeable, skilled,
    nonjudgmental, empathic
  • Monitoring S/s of withdrawal
  • Milieu therapy set limits
  • Psychopharmacology - compliance

51
Impaired Professionals
  • Incidence 5 - chemical abuser
  • 8-10 (or higher) -chemically dependent
  • Common profile
  • Family hx of sub abuse, depression, sexual abuse
  • Academically and professionally successful
  • Divorced
  • Received professional treatment for sub abuse
  • Regularly attends recovery self-help groups
  • Report to supervisor immediately

52
Common Nursing Diagnoses
  • Anxiety
  • Ineffective individual coping/ self-care
  • Altered health maintenance/ nutrition/
    sensory-perception/ family process,
  • Risk for injury/infection
  • Impaired communication/ social interaction
  • Violence, potential for

53
Substance Abuse Problems Needing Collaboration
  • 53 of drug abusers have at least 1 serious
    psychiatric problem
  • 37 of alcohol abusers have at least 1 serious
    psychiatric problem

54
Pharmacological Treatment
  • Alcoholism
  • Naltrexone (Trexan, ReVia)
  • Disulfiram (Antabuse)
  • Opiod addict
  • Methadone (Dolophine)
  • L-alpha Acetylmethadol (LAAM)
  • Naltrexone (Trexan, ReVia)
  • Clonidine

55
Pharmacological Treatment (II)
  • Stimulant dependence
  • Dopaminergic drugs ie. Amantadine (Symmetrel),
    bromocriptine (Parlodel)
  • Anticonvulsants ie carbamazepine (Tegretol)
  • TCA ie desipramine (Norpramine)
  • Hallucinogen dependence
  • Diazepam (Valium)

56
Supplementary treatment
  • Sedatives
  • Benzodiazepine ie Librium, Valium
  • Phenobarbital
  • Thiamine (Vit B1)
  • Folic Acid
  • Magnesium sulfate
  • Anticonvulsant
  • Multivitamins

57
N-Pt Relationship
  • Trust - communication
  • Support minimizes anxiety
  • Consistency objective nonjudgmental
  • Continually assess
  • Presence of predictable defense style
  • Psychophysiological responses
  • Referral local resources/ community agencies

58
Milieu Therapy
  • Drug-free safety, structure, norms, limit
    setting
  • Motivation
  • Dependency vs. face the consequences
  • 3Cs family members
  • did not cause the disease,
  • cannot control it,
  • cannot cure it
  • Belongingness significant relationship, social
    skills,

59
Interdisciplinary Interventions
  • Breaking through defenses - denial
  • Understanding and accepting the disorder
  • Identification with peers
  • Development of hope
  • Re-socialization
  • Developing self-esteem and self-worth

60
Persons with HIV Disease
  • Sexual risk-taking behavior 60alcohol,
    substance use
  • Injectable drug abuse
  • Alcohol immunosuppressive effects damage to
    live - susceptibility to the HIV6060
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