Personality Disorders
What are the traits of Borderline Personality Disorder?
-Anger/Hostility -Mistrust
-Risk-Taking -Labile moods
-Lack of Guilt
-Impulsive
-Negative behavior
What are the 5 types of losses?
-Physiological loss
-Safety Loss
-Loss of security, sense of belonging
-Loss of self-esteem
-Loss related to self-actualization
Delirium
Syndrome involving disturbance of consciousness with change in cognition
-reversible
-usually from an identifiable disturbance or disease / drug intoxication or withdrawal
-can be treated with treatment for underlying cause
Types of Autism Disorders
–Autism (classic autism)
–Rett’s disorder
–Childhood disintegrative disorder
–Asperger’s disorder
Positive and Negative effects of psychosis
–Positive (hard)
•Delusions, hallucinations; grossly disorganized thinking, speech, behavior
–Negative (soft)
•Flat affect, lack of volition, social withdrawal, or discomfort
What is Avoidant Personality Disorder?
(Cluster C)
Having social discomfort, low self-esteem, hypersensitivity to negative evaluation.
Kubler-Ross's Five Stages
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
Dementia
-Irreversible, Multiple cognitive deficits; primarily memory plus any of the following:–Aphasia (echolalia, palilalia) –Apraxia –Agnosia –Disturbance in executive function -Stages: Mild, Moderate, Severe
Medications: cholinesterase inhibitors.
•Etiology: variable causes; decreased metabolic activity found postmortem
Symptomatic treatment: antidepressants, antipsychotics, mood stabilizers
•Research to identify risk factors for dementia (elevated levels of plasma homocysteine)
Autism
–Present by early childhood (18 months to 3 years); boys five times more than girls
-Little eye contact. - few facial expressions -limited gestures to communicate. -lack of spontaneous enjoyment. -inability to engage in play. -stereotyped motor behaviors
–Genetic link; controversy with MMR vaccine
–Goals: reduce behavioral symptoms, promote learning and development
–Special education, language therapy; medications for target symptoms
Schizophrenia
•Distorted and bizarre thoughts, perceptions, emotions, movements, behavior
•The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women.
psychotic and mood symptoms
Genetics or –Neuroanatomic and neurochemical factors (less brain tissue and cerebrospinal fluid; dopamine excess and serotonin modulation of dopamine or excess)
What is Narcissistic Personality Disorder?
(Cluster B)
Grandiosity, need for admiration, lack of empathy, arrogant or haughty attitude, superior view, vulnerable, ambitious.
What is disenfranchised grief?
Grief over loss that is not or cannot be openly acknowledged, mourned publicly, or supported socially
–A relationship has no legitimacy.
–The loss itself is not recognized.
The griever is not recognized
Korsakoff's syndrome
disturbance in memory due to long-term use of alcohol
Intellectual disability
•Below-average intellectual functioning
IQ less than 70 accompanied by significant limitations in
-communication skills. -self-care. -home living. -social interpersonal skills. -work. -leisure. -health & safety
Conventional antipsychotics/Atypical antipsychotics
Conventional: dopamine antagonists
–Targeting positive symptoms
–No observable effect on negative symptoms
Atypical antipsychotics dopamine, serotonin antagonists
–Diminish positive symptoms
–Lessen negative symptoms
What is Histrionic Personality Disorder?
(Cluster B)
Excessive emotionality and attention-seeking, insincerity, center of attention, exaggeration of relationships
What is complicated grief?
Person devoid of emotion; grieving for prolonged periods; expressions of grief seem disproportionate to event
Nursing interventions for Delirium
–Promoting patient safety
–Managing patient’s confusion: orienting cues; speaking in low, clear voice; avoiding sensory overload
–Promoting sleep, proper nutrition
ADHD
•Inattentiveness, overactivity, impulsiveness; persistent pattern of inattention and/or hyperactivity and impulsivity
-Diagnosed usually when a child starts school
-Fidgeting, noisy, disruptive, unable to complete tasks, failure to follow directions, blurting out answers, lost or forgotten homework
Six antipsychotics available in depot injection forms:
–Fluphenazine in decanoate and enanthate
–Haloperidol in decanoate
–Risperidone
–Paliperidone
–Olanzapine
–Aripiprazole
•Effects vary in length of time; eliminate need for daily oral antipsychotic medication
What is Dependent Personality Disorder?
(Cluster C)
Need to be taken care of; submissive; clinging
Grief & Mourning
-Subjective emotions and affect; normal response to loss
-Grieving/bereavement: process by which person experiences grief; content, process
-Mourning: outward expression of grief, including rituals
Nursing interventions for Dementia
–Safety
–Sleep, proper nutrition, hygiene, activity
–Environmental, routine structure
–Emotional support (supportive touch)
–Interaction, involvement (reminiscence therapy, distraction, time away, going along)
ADHD Stratagies and Medications
Home and School stratagies. -Behavior -Environmental -Parental education (rewards/consequences, daily report cards/point systems)
methylphenidate (Ritalin) amphetamine compound (adderal) *monitor for appetite suppression or growth delays* S/E in children:decreased appetite, nausea, vomiting, tiredness, and upset stomach S/E in adults: insomnia, dry mouth, urinary retention, decreased appetite, nausea, vomiting, dizziness, and sexual side effects
Second choice: antidepressants
Nonstimulant: atomoxetine (SNRI)
Antihypertensives: clonidine (Kapvay), guanfacine (Intuniv)
Nursing interventions fo schizophrenia
–Safety of patient, others
–Therapeutic relationship; therapeutic communication
–Interventions for delusional thoughts (focus on reality; no confrontation or reinforcement)
–Interventions for hallucinations
–Management of socially inappropriate behavior