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Ch 16 PD

hello carpal tunnel!

what is personality? ingrained eduring pattern of behaving and relating to self,others,enviroment including perceptions,attitudes,emotion
are you conciously aware of your personality? NO!
personality d/o dx when traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause them emotional distress
what are cluster A personality d/o? individuals whose behaviors appears odd and eccentric- paranoid, schizotypal, and schizoid
what are cluster B personality d/o person is dramatic,emotional, or erractic- anticoscial,borderline,histrionic,and narcisistic PD
what are cluster C PD? person is anxious or fearful-avoidant,dependent,and obsessive compulsive PD
onset/clinical course PD relatively common. higher in lower classes, 45% that have major mental illness also have a PD
people with PD are often described as what? "treatment resistant" they lack perception that behavior is a problem.
etiology-biologic-temperament biologic processes of sensation,association,and motivation that underlie the intergration of skills and habits based on emotions *genetic ^ if 1st degree relative has PD
4 temperament traits harm avoidance,novelty seeking,reward dependence,and persistence
harm avoidance high-fear of uncertainty,social inhibition, shy,pessimistic worry low-carefree,energetic,outgoing,optimistic
novelty seeking high-quick tempered, curious, easily bored, impulsive low-slow tempered,stoic, elfective, frugal, reserved
reward dependence high- tenderhearted, sensitive,sociable, low-practical, tough minded,cold, socially insensitive
persistence high- hard working,over achievers low-inactive, unstable,erratic
etiology-psychodynamic-character concepts about the self and the external world
3 major character traits self directedness, cooperativeness,and self transcendance
self directedness person is responsible,reliable,resourceful, goal oriented, confident. low=blame,helpless, irresponsible,unreliable
cooperativeness person sees themselves as an integral part of human society ^= empathic,tolerant, compassionate. low=conceided, unhelpful, revengeful
self transcendence person considers themselves to be an integral part of the universe, they are spiritual&humble, low= practical, self conscious, materialistic, controlling
cultural considerations personality viewed with consideration of ethnic,cultural,social background. guarded or defensive=lang barrier, diff views of avoidance or dependent behavior, and value of work&productivity
what sex is antisocial and schizoid PD dx more in? MEN!
what sex is borderline and histrionic PD dx more in? WOMEN!!
psychopharmacology PD symptom focused 4 s/ that underlie PD= cognitive-perceptual distortions,affectives/ and mood dysregulation, agression and behavioral dysfunction, and anxiety
pyschopharm& cluster A correspond to the categories of affective dysregulation,detachment, and cognitive disturbances
psychopharm & cluster B correspond to the target symptoms of impulsiveness and aggression
psychopharm & cluster C correspond to the catagories of anxiety and depression symptoms
cognitive perceptual disturbances tx include magical thinking,odd beliefs, illusions,suspciousness, ideas of ref, low grade psy symptoms. tx with low dose antipsy
agression tx lithium, anticonvulsant mood stabilizer, benzo. low dose antipsy may be useful in modifying predatory aggression
mood dysregulation tx emotional labilty- lithium,tegretol, haldol atypical depression-MAOI,SSRI,antipsy emotional detachment- SSRI, atypical antipsy
anxiety tx chronic cognitive-SSRI MAOI benzo chronic somatic- MAOI SSRI severe- MAOI low dose antipsy
individual and group psychotherapy cognitive behavioral therapy(restructing tech=thought stopping,+ self talk,decastastrophizing dilectical behavior therapy-for pts with borderline PD
A-paranoid PD pervasive, mistrust and suspiciousness, guarded,restricted affect, more common in men
appearance paranoid PD aloof, w/d,guarded or hypervigilant,may look behind doors and furniture, alert to any impending danger,sit near exits and against a wall to prevent being snuck up on, labile mood, uses projection,conflict with authority
interventions paranoid PD serious, business like approach, teach pt to validate ideas before taking action(most effective), involve patient in tx planning, must remember these pts take everything seriously,refrain from chit chat or jokes
A-schizoid PD social detachment,restricted affect,involved with things more than people, intellectual,avoid tx as much as they avoid r/ts, aloof, indifferent,appear emotionally cold and uncaring, rarely experience enjoyment
schizoid PD cont spend long hours solving puzzles and math problems, no aspirations,rarely engage in activities involving judgemnet and decision making,do not see situation as a problem,decline social interaction,rarely date,marry and have little to no sexual contact
interventions schizoid PD improve functioning in the community, assist pt to find a case manager
A-schizotypical PD acute discomfort in r/ts, coginitive or perceptual distortions, eccentric behavior,odd appearance, inablity to respond to normal social cues, clothes often unfitting unmatched stained dirty, speech coherent but may be loose digressive or vague
schizotypical PD cont uses words incorrectly, restricted range of emotions,flat affect, flight of ideas, magical thinkers, off beliefs,great anxiety @ people, only has 1 significatn r/t which is w/ relative, mistrust/bizzare thinking=no job
interventions schizotyical PD dev self care skills,improve community functioning(role play),social skills training(face-face uncomfy so write letters or use telephone for business)
B- antisocial PD its genetic,from abuse or neglect,they have disregard for rights of others,rules,laws, 70% of inmates have this d/o,deceitful and manipulate,more common in MEN,
DSM4 criteria antisocial PD violation of the rights of others, lack of remorse,shallow emotions,lying,rationalization,poor judgement, impulsive,irritable/aggressive, lack of insight, poor work hx, irresponsible,exploitation in r/ts
assessment findings antisocial PD deceitful/manipulative, false emotions/no empathy, narrowed view of the world,poor judgement/no insight, egocentric but is actually self shallow and empty, has r/ts to serve own needs, impulsive,"dog eat dog world", can be charming
nx dx r/t antisocial PD ineffective coping, ineffective role performance, risk for other directed violence
interventions for antisocial PD limit setting, confrontation, teach pt to solve problems effectively and manage emotions of anger or frustration. therapeutic r/t, take a time out to control emotions, enhance role performance
B- borderline PD unstable r/ts self image and affect, impulsivity, self mutilation, 5x more common in 1st degree relatives with dx, most commonly found d/o in clinical setting, suicidal
DSM4 criteria for borderline PD fear of abandoment,unstable and intense r/t, unstable self image, impulsive/reckless, self mutilating/suicidal, feelings of emptiness and boredom,, irritable, polarized thinking about self or others(splitting),impaired judgement,command hallucinations
working with borderline PD pts can be frustrating, they ay cling and ask for help one min then angry and reject help the next, may attempt to manipulate staff and then sabotage tx plan they agreed to, labile mood so nurses feel like they are "back to square 1" with them
assessment borderline PD unstable interpersonal r/t, self image and affect, impulsive, wide range of behavior and appearance,dysphoric mood, social isolation,polarized thinking(splitting), dissociation(self harm occurs then)impaired judgment safety=no concern, threats selfharm
physiologic and self care borderline PD hates being alone, suicidal, self harmer,engage in binge eating,purging, drugs, unprotected sex, reckless behavior such as DWI, difficulty sleeping
nx dx borderline PD risk for suicide, risk for self mutilation, risk for other directed violence, ineffective coping, social isolation
intervention borderline PD promote safety(no self harm contract),help pt control and cope with emotions(journals), cognitive restructuring tech, structure time, teach social skills. thought stopping, positive self talk, decatastrophizing, assertiveness tech("i")
B-Histrionic PD excessive emotion, attn seeking,insincere, center of attn,exaggerate r/ts, common in women, seek tx for depression and diff r/ts.speech is colorful and dress is normal or overdress,rapid shifts in moods,self absorbed
histrionic PD cont fish for compliments if dont get them fake being ill or pass out, unflattering statement can lead to crying or tantrum,flamboyant public behavior,people who have r.ts with them say they felt used,manipulated or exploited
interventions histrionic PD teach social skills through role playing,provide factual feedback about behavior,exploration of strengths, assets
B-narcissistic PD grandiose, lack of empathy,need for admiration. common in men.arrogant or haughty attitude, superior view,fragile and vulnerable self esteem, ambitious, trouble working with others, expect special tx and when dont get it=angry
interventions narcissistic PD matter of fact approach,gain cooperation with needed tx, teach pt any self needed self care skills,self awareness, skills to avoid anger and frustration,limit setting
C-avoidant PD social inhibitions,feelings of inadequacy,hypersensitive to (-) evaluation.anxious, fidgit in chair, no eye contact,reluctant to ask ?s, low self esteem,shy fearful socially awkward, fear rejection,criticism,need excessive reassurance
interventions avoidant PD support, reassurance,self affirmation,cognitive restructuring tech, (+) self talk, reframing/decatrastrophizing, social skills training, promote self esteem
C-dependent PD submissive and clinging behavior, excessive need to be taken care of,submissive,fears of seperation,women most common in youngest child,seek tc for anxious depressed somatic s/sx, pessimistic, unhappy, fail on own, no confidence to make decisions
dependent PD cont cant function if not in r/t,cant start projects,do almost anything to keep a r/t even put up with abuse,will not disagree if conseq is losing r/t, finds another r/t asap if other fails. "any r/t is better than none at all"
interventions dependent PD foster pts self reliance and autonomy,teach problem solving and decision making skills,express feelings,cognitive restructuring
C-obsessive compulsive PD preoccupation with orderliness,perfection,and control.formal,serious, orderliness is a priority, problems with decision making,judgements, low self esteem, harsh self evaluations.stubborn and will not surrender control, restricted affect,
obsessive compulsive PD cont believe they are right others wrong, check and recheck details,prefer written rules for every activity, insight limited, little social life, frugal, prefers to work alone
interventions obsessive compulsive PD encourage negotiation w/others,assis pt to make timely decisions and complete work, cognitive restructuring,risk taking
related d/o: Depressive PD pattern of depressive cognitions and behaviors, less severe that major depression,pessimistic, (-) thinking, low self esteem, sad gloomy affect, no pleasure or joy in anything,cannot relax and no sense of humor,overtly quiet and passive,unworthy of attn
interventions depressive PD assess self harm risk, provide factual feedback,promote self esteem,^ involvement in activities, SAFETY!!!!!
related d/o:passive aggressive PD negative attitudes and passive resistance to deamnds for adequate performance in social and occupational situations,blaming of others, women,mood flucuates rapidly,affect angry or sad,low self confidence,resent and opose demands to function as expected
interventions passive aggressive PD help pt identify feelings and express them firectly,assist pt to examineown feelings and behavior realistically.
Mental health promo PD unmet needs=self care, sexual expression,budgeting,psychotic s/sx, distress. kids with ^ protective factors less like to dev antisocial behaviors
Self awareness issues PD avoid pt attempts to manipulate,use clear communication,set limits and boundries, deal with frustration, work as part of a team
elder considerations PD clusters A & C are more prevalent in older age and are closely correlated with depression
Created by: 536862996