Personality Disorders
Name the 10 different types of personality disorders and what category they fall under
Cluster A - Paranoid, Schizotypal, Schizoid
Cluster B - Narcissistic, Histrionic, Antisocial, Borderline
Cluster C - Avoidant, Dependent, Obsessive-Compulsive
What is anxiety in response too? and what are the feelings anxiety is characterized by?
Finish the sentence
Anxiety is _____
Fear is _____
Stress.... Apprehension, uneasiness, uncertainty, and dread
Unspecific
Specific
Give a brief description of Bipolar type 1, Bipolar type 2, and Cyclothymic
BP 1 - Full blown mania, Hx of 1 or more episodes of mania, usually a Hx of depression
BP 2 - Doesn't have mania but hypomania, at least 1 hypomanic episode, alternating w periods of depression
Cyclothymic - No manic or depressive episode, episodes of hypomania altering w periods of dysthymia. Described as chronic, sometimes "mild"
What are some treatments for depression?
Electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, Light therapy, exercise, st johns wort, CBT
Describe what defense mechanisms do?
Decrease anxiety, unconscious and automatic, adaptive and maladaptive
Give a brief description of the PDs in Cluster A
Paranoid - Holds grudges, suspicious, sees hidden messages in normal comments, reads into things
Schizoid - Indifferent to praise, restricted emotions, "cold" and unable to establish relationships, lack need for connection
Schizotypal - Magical thinking, odd, weird, bizarre appearance, lack friends, "Loner"
Name the 4 levels of Anxiety and which ones are able to problem solve, learn teach and which ones are not which causes them to have high concern r/t safety
Name 3 appropriate nursing interventions
Mild - alert and aware (YES)
moderate - difficulty concentrating, narrowed perception... step by step approach (YES)
Severe - distorted perception, hyperventilation, sever emotional distress (NO)
Panic - unable to function, personality disorganized (NO)
Promote nutrition, sleep, and hydration (fluids)
What is Mixed episodes and Rapid cycling?
Mixed Episodes - When mania and depression occur at the same time which leads to extreme anxiety, agitation and irritability
Rapid Cycling - 4 or more mood episodes in a year
What are some treatments for phobic disorders?
Specific phobia - CBT and exposure therapy
Social Phobia - SSRIs, BB, Assertiveness training
Psycho education
What are some healthy defenses? Give a brief description of each
Altruism - meeting the needs of others
Humor - HAHAHA
Sublimation - Substitute
Suppression - Conscious denial of a disturbing situation
Give a brief description of PDs in Cluster B
Antisocial - Manipulative, entitlement, aggressive, irritable, disregard to others, % in jail
Borderline - Instability in relationships, self-image, identity, behavior and affects
Histrionic - attention seeking behavior, and excessive emotions
Narcissistic - Need for admiration, lack of empathy, grandiosity
Give a brief description of panic disorder, OCD and separation anxiety disorder (SAD)
Bonus: Name the emergency med for panic disorder
SAD - May begin in childhood or adulthood, stomach aches, HA, trouble sleeping, separation/attachment issues, 8-18 months, adult form impairs functioning
OCD - Uncontrollable intrusive thoughts behaviors pt feels need to perform repeatedly
Panic - Fear, apprehension, terror, CP, dizziness, derealization, panic attacks that recur at unpredictable times w intense fear
EMERGENCY MEDS: Benzos, or other fast acting med if Hx of drug abuse
Energetic, talkative, confident, agitation, irritability, decreased need for sleep, pressured speech, creative
NO hallucinations or delusions
Name some medications and their classification?
Antidepressants: SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, sertraline) SNRIs (duloxetine, venlafaxine) TCAs (
NonBenzo: buspirone (not addictive, takes time to buildup, long term GAD)
Benzos: lorazepam, diazepam, alprazolam, chlordiazepoxide
Antihistamines: diphenhydramine, hydroxyzine, hydroxyzine hydrochloride
Beta Blockers: propanolol
Alpha 2 Agonist: clonidine
Atypical Antidepressant (Non SSRIs):NDRI (bupropion), SNRI (duloxetine, venlafaxine), NaSSA (mirtrazapine), SARI (trazodone)
MOAIs - tranylcypromine sulfate, phenelzine, isocarboxazid, selegiline
Mood Stabilizers/Anticonvulsants: Lithium, Valproate/Depakote, carbamazepine, lamotrigine
What are some intermediate defense mechanisms? Give a brief description
Repression - Unconsciously pushing back or forgetting stressful events
Displacement - Transfer emotions from one to another
Reaction formation - Opposite reaction
Somatization - anxiety expressed by physical symptoms
Undoing - Gift giving
Rationalization - justifying actions or feelings
Give a brief description of PDs in Cluster C
Avoidant - High anxiety, low self esteem, sensitive to criticism, fear rejection and AVOID social situations
Dependent - Tolerates poor treatment, clingy, submissive, passive, needs to be taken care of
OCD - Orderliness, control, perfectionist, rigid and stubborn, preoccupied w rules and details
Describe the phobia disorders
Agoraphobia - fear of being outside OR not having escape
Social Phobia/ Social anxiety disorder - highly sensitive to critsim, fear of embarrassment and humiliation, provoked by exposure to social situations
Specific phobia - usually starts in childhood, persistent and strong irrational fear of object, activity, situation, disproportionate to actual danger, high anxiety
Generalized Anxiety Disorder (GAD) - "worry disease", person finds it difficult to control the worry, cannot relax, keeps them from doing everyday task, restlessness, fatigue, sleep disturbance, muscle tension, poor concentration, irritability
What are some symptoms of Mania?
May include hallucinations and delusions, day to day life is significantly impaired, sexually inappropriate, increased engird, talkativeness, decreased need for sleep, appetite, concentration.
Starts off happy, positive --> agitation, irritability, and psychosis
Last longer and more intense
Describe serotonin syndrome and discontinuation syndrome
SS - Shivering, Hyperventilation, Increased temp, vitals unstable, encephalopathy, restlessness, sweating (SHIVERS), combing SSRIs with other drugs
DS - nausea, chills, muscle aches, dizziness, anxiety, irritability, insomnia, fatigue, when pt stops med abruptly
What are some immature defense mechanisms? Give a brief description
Passive aggression - indirectly expresses emotion
Acting out behaviors - addresses emotional conflicts or stressors by action
Dissociation - a disruption in the usually integrated functions of consciousness
Devaluation - attributing neg qualities to self or others
Regression - returning to an earlier developmental level
Splitting - All good or all bad, inability to integrate positive and neg qualities to self or others
Projection - unconsciously attributes unacceptable personal qualities to other people, objects, situations
Denial - involves escaping unpleasant realities by ignoring existence
Name 5 of the 9 criteria needed to diagnose borderline PD
Paranoid ideations, chronic emptiness, seek to avoid abandonment, extreme or uncontrollable anger, mood - affective instability, relationships (Idealization and devaluation), Splitting,, recurrent suicidal/self mutilating behavior, impulsivity
Describe Somatic symptom, Illness anxiety disorder, Malingering, Factitious disorder, Conversion disorder
SS - physical symptoms unrelated to medical cause
Illness anxiety disorder - excessive worry about health, being ill and/or becoming ill, lack symptoms, "doctor hopping"
Conversion disorder - Physical symptoms, Unintentional, due to emotional stressor
Factitious disorder - fabricate symptoms to gain attention, may inflict injury on self
Malingering - NOT A MED DIAGNOSIS, intentional for monetary gain or external incentives ex: avoid work, avoid jail time, obtain drugs or money
Hopelessness, guilt, increase suicide risk
What diet restriction do its on MOAIs have to abide by and can you name a few they CAN'T eat?
Tyramine free diet
aged cheese, sausage, wine, avocados, bands, cured meats
Name interventions for anxiety
Provide relaxation/tension reducing methods, promote/teach adaptive coping/ self-care strategies, lifestyle management, CBT, integrative and complementary therapies such as meditation