Title: Personality Disorders Characteristics of each personality disorder Nursing Interventions Issues rela
1Personality DisordersCharacteristics of each
personality disorderNursing InterventionsIssues
related to the nursing care ethical cultural
consideration
2Introduction
- 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
3Criteria 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
4Clusters
- 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
5Odd- eccentric cluster of PD
6Criteria 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
7Criteria 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
8Criteria 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
10Criteria 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
11Criteria 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
12Criteria 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
13Criteria 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
14Anxious-fearful cluster of PD
15Criteria 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
16Criteria 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
17Criteria 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
18Related Nursing Diagnoses
- Anxiety
- High risk for self-mutilation
- Hopelessness
- Impaired communication
- Ineffective individual coping
- Self-esteem disturbance
- Social isolation
19Nursing 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
20Conclusion
- 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
21Substance-related disorders
- Personal and societal toll
- Terminology criteria for diagnoses
- Care plan and interventions
22Introduction
- 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
23Substance
- 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
24Other 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
25Terminology
- Dependence physical psychological
- Codependence -
- Tolerance
- Cross-tolerance
- Withdrawal abstinence syndrome
- Dual diagnosis -
- CAGE cutdown, annoy, guilty, eye opener
- Blackout -
26A continuum of substance use
27Etiology
- 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.
28Age Substance Use
College 2001
90
29Perinatal 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.
30Fetal 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
31Other 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
32Adolescent 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
33Signs 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
34Warning Ss of Teen Sub. Abuse
35Prevention 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
36Alcohol 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,
37Wernickes 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
38Korsakoff 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
39Treatment of WKS
- IV or IM thiamine
- Medications
- Cholinersterase inhibitors
- Atypical antipsychotics
- SSRI
- Alcohol cessation
- Dietary consumption
40Clinical Description
- Denial
- Dependence compulsive use
- Abuse dysfunction in work,
- Intoxication
- Withdrawal
- Delirium
- Psychotic disorders
41Alcohol-related Disorders
42Alcohol
- Detoxification 3Ss-
- Secure environment
- Sedation
- Supplements
43CNS 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
44CNS 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
45Stimulant - 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
46Stimulant - 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
47Hallucinogen
- 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
48Dual 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
49Etiology 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
50Tx 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
51Impaired 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
52Common 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
53Substance 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
54Pharmacological Treatment
- Alcoholism
- Naltrexone (Trexan, ReVia)
- Disulfiram (Antabuse)
- Opiod addict
- Methadone (Dolophine)
- L-alpha Acetylmethadol (LAAM)
- Naltrexone (Trexan, ReVia)
- Clonidine
55Pharmacological Treatment (II)
- Stimulant dependence
- Dopaminergic drugs ie. Amantadine (Symmetrel),
bromocriptine (Parlodel) - Anticonvulsants ie carbamazepine (Tegretol)
- TCA ie desipramine (Norpramine)
- Hallucinogen dependence
- Diazepam (Valium)
56Supplementary treatment
- Sedatives
- Benzodiazepine ie Librium, Valium
- Phenobarbital
- Thiamine (Vit B1)
- Folic Acid
- Magnesium sulfate
- Anticonvulsant
- Multivitamins
57N-Pt Relationship
- Trust - communication
- Support minimizes anxiety
- Consistency objective nonjudgmental
- Continually assess
- Presence of predictable defense style
- Psychophysiological responses
- Referral local resources/ community agencies
58Milieu 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,
59Interdisciplinary Interventions
- Breaking through defenses - denial
- Understanding and accepting the disorder
- Identification with peers
- Development of hope
- Re-socialization
- Developing self-esteem and self-worth
60Persons with HIV Disease
- Sexual risk-taking behavior 60alcohol,
substance use - Injectable drug abuse
- Alcohol immunosuppressive effects damage to
live - susceptibility to the HIV6060