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| what is personality? | ingrained eduring pattern of behaving and relating to self,others,enviroment including perceptions,attitudes,emotion
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| are you conciously aware of your personality? | NO!
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| 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
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| what are cluster A personality d/o? | individuals whose behaviors appears odd and eccentric- paranoid, schizotypal, and schizoid
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| what are cluster B personality d/o | person is dramatic,emotional, or erractic- anticoscial,borderline,histrionic,and narcisistic PD
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| what are cluster C PD? | person is anxious or fearful-avoidant,dependent,and obsessive compulsive PD
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| onset/clinical course PD | relatively common. higher in lower classes, 45% that have major mental illness also have a PD
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| people with PD are often described as what? | "treatment resistant" they lack perception that behavior is a problem.
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| 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
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| 4 temperament traits | harm avoidance,novelty seeking,reward dependence,and persistence
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| harm avoidance | high-fear of uncertainty,social inhibition, shy,pessimistic worry
low-carefree,energetic,outgoing,optimistic
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| novelty seeking | high-quick tempered, curious, easily bored, impulsive
low-slow tempered,stoic, elfective, frugal, reserved
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| reward dependence | high- tenderhearted, sensitive,sociable,
low-practical, tough minded,cold, socially insensitive
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| persistence | high- hard working,over achievers
low-inactive, unstable,erratic
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| etiology-psychodynamic-character | concepts about the self and the external world
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| 3 major character traits | self directedness, cooperativeness,and self transcendance
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| self directedness | person is responsible,reliable,resourceful, goal oriented, confident. low=blame,helpless, irresponsible,unreliable
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| cooperativeness | person sees themselves as an integral part of human society ^= empathic,tolerant, compassionate. low=conceided, unhelpful, revengeful
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| self transcendence | person considers themselves to be an integral part of the universe, they are spiritual&humble, low= practical, self conscious, materialistic, controlling
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| 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
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| what sex is antisocial and schizoid PD dx more in? | MEN!
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| what sex is borderline and histrionic PD dx more in? | WOMEN!!
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| psychopharmacology PD | symptom focused
4 s/ that underlie PD= cognitive-perceptual distortions,affectives/ and mood dysregulation, agression and behavioral dysfunction, and anxiety
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| pyschopharm& cluster A | correspond to the categories of affective dysregulation,detachment, and cognitive disturbances
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| psychopharm & cluster B | correspond to the target symptoms of impulsiveness and aggression
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| psychopharm & cluster C | correspond to the catagories of anxiety and depression symptoms
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| cognitive perceptual disturbances tx | include magical thinking,odd beliefs, illusions,suspciousness, ideas of ref, low grade psy symptoms. tx with low dose antipsy
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| agression tx | lithium, anticonvulsant mood stabilizer, benzo. low dose antipsy may be useful in modifying predatory aggression
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| mood dysregulation tx | emotional labilty- lithium,tegretol, haldol
atypical depression-MAOI,SSRI,antipsy
emotional detachment- SSRI, atypical antipsy
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| anxiety tx | chronic cognitive-SSRI MAOI benzo
chronic somatic- MAOI SSRI
severe- MAOI low dose antipsy
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| individual and group psychotherapy | cognitive behavioral therapy(restructing tech=thought stopping,+ self talk,decastastrophizing
dilectical behavior therapy-for pts with borderline PD
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| A-paranoid PD | pervasive, mistrust and suspiciousness, guarded,restricted affect, more common in men
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| 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
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| 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
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| 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
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| 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
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| interventions schizoid PD | improve functioning in the community, assist pt to find a case manager
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| 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
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| 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
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| 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)
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| 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,
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| 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
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| 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
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| nx dx r/t antisocial PD | ineffective coping, ineffective role performance, risk for other directed violence
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| nx dx borderline PD | risk for suicide, risk for self mutilation, risk for other directed violence, ineffective coping, social isolation
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| 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")
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| 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
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| 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
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| interventions histrionic PD | teach social skills through role playing,provide factual feedback about behavior,exploration of strengths, assets
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| 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
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| 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
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| 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
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| interventions avoidant PD | support, reassurance,self affirmation,cognitive restructuring tech, (+) self talk, reframing/decatrastrophizing, social skills training, promote self esteem
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| 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
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| 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"
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| interventions dependent PD | foster pts self reliance and autonomy,teach problem solving and decision making skills,express feelings,cognitive restructuring
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| 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,
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| 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
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| interventions obsessive compulsive PD | encourage negotiation w/others,assis pt to make timely decisions and complete work, cognitive restructuring,risk taking
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| 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
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| interventions depressive PD | assess self harm risk, provide factual feedback,promote self esteem,^ involvement in activities, SAFETY!!!!!
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| 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
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| interventions passive aggressive PD | help pt identify feelings and express them firectly,assist pt to examineown feelings and behavior realistically.
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| 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
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| 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
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| elder considerations PD | clusters A & C are more prevalent in older age and are closely correlated with depression
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