Personality Disorders

Question 1

What are the cluster A d/o

Answer 1

(APSS) Paranoid, Schizoid, Schizotypal - Odd or eccentric

Question 2

What is Paranoid PD

Answer 2

(Cluster A) Distrust, suspicion, short temper, argumentative, jealous, unable to forgive or adjust to change. Lack of tender feelings for others

Question 3

What is Schizoid PD

Answer 3

(Cluster A) Brief psychotic episodes in response to stress, loner, passive, detached, self absorbed, lack of strong emotions, lack of trust, difficulty expressing anger

Question 4

What is Schizotypal PD

Answer 4

(Cluster A) Magical thinking, incorrect interpretation of external events and belief that all events refer to self, constricted/inappropriate affect, social anxiety (poor/moderate functioning)

Question 5

What are the cluster B d/o

Answer 5

(NAHB) Narcissistic, Antisocial, Histrionic, Borderline - Dramatic, emotional, erratic

Question 6

What is Antisocial PD

Answer 6

(Cluster B) charming at first, lack of conscience, empathy or responsibility, manipulative, involved in criminal acts or substance abuse

Question 7

What is Borderline PD

Answer 7

(Cluster B) Anger, suicidal thoughts, self mutilation, cutting intense stormy relationships, impulsive acts, people as all good or all bad, feel abandoned, difficulty identifying self

Question 8

Intervention for Borderline PD

Answer 8

Dialect behavioral therapy - dialogue to rework destructive ways to deal with crisis, teaches there are choices to decrease suicidal thoughts, learn new patterns of thinking and behaving

Question 9

What is Narcissistic PD

Answer 9

(Cluster B) Grandiose view of self, lack of empthty for others, needs admiration, preoccupation with fantasies of success, brilliance, beauty, perfect love, conceded

Question 10

What is Histrionic PD

Answer 10

(Cluster B) Fluctuations of emotions, suicidal threats when feeling abandoned, attention seeker, sexual seduction, flamboyance, somatization, dramatic speech, attentive to physical appearance, shallow, DRAMA QUEEN

Question 11

What are cluster C d/o

Answer 11

(ADOC) Avoidant, Dependent, Obsessive Compulsive

Question 12

What is Avoidant PD

Answer 12

(Cluster C) Fears criticism, disapproval or rejection, avoid social interactions, hold in thoughts and feelings, low self-esteem - intermediate functioning

Question 13

What is Dependent PD

Answer 13

(Cluster C) Submissive, clingy, can’t make decisions on own, cant follow through on tasks, cant express negative feelings

Question 14

What is Obsessive Compulsive PD

Answer 14

(Cluster C) Preoccupied with structure/organization/perfection/control, workaholics, cant relax, self critical, rule conscious, insistence that others go with their methods, cant get rid of things, cant delegate, procrastination, wont spend money

Question 15

Freud’s perspective of PD

Answer 15

Comes from unresolved conflicts

1) Oral- probs trusting others, self centered, dependent, jealous (Paranoid,borderline, histrionic)
2) Anal- probs making decisions, cannot share, full of rage (antisocial,borderline, histrionic dependent)
3) Phallic- probs with superego, guilt (antisocial/borderline, histrionic, narcissistic)
4) Latency- probs with too little (borderline) or too much (OCD) control
5) Genital- probs with sense of self (various PD)

Question 16

Separation - Individuation (Margaret Mahler)

Answer 16

Childhood process of developing sense of self separate from mother (4 stages)
Differentiation
Practicing
Rapprochement
Beginning of object constancy

Question 17

Otto Kernberg

Answer 17

2 tasks of object relations - child can distinguish between self and another, can integrate good and bad images of self and of others
Borderline PD - splitting (cant integrate good and bad of self and others), idealization of those who meet needs, devaluation of those who don’t meet needs, lack of object constancy (cant hold memory of another, love one is absent is viewed as abandonment) ALWAYS AT NURSES STATION

Question 18

Masterson - Object Relations

Answer 18

4 defenses block growth and autonomy (Projection, Denial, Clinging, Avoidance)
Borderline PD develops when person is ‘stuck’ (frustration in every day living, cant maintain relationships, anger and rage when ignored, inability to have images of another when absent, cannot mourn) CENTER OF ATTENTION

Question 19

What is splitting of staff, and how can we reduce it

Answer 19

No equality of the staff, always the ‘good nurse’ and others are ‘bad nurse’ images
Open communication in staff meetings, ongoing clinical supervision

Question 20

Splitting behaviors of patients

Answer 20

Primary defense with borderline PD, labels people as ‘all good’ or ‘all bad’, creates conflict with staff members

Question 21

Therapies for PD

Answer 21

Milieu - recreation of a community setting
Movement - learning relaxation
Music/art - helps express feelings
Occupational - helps development of life skills
Group - problem solving
Family - family dynamics
Medication- control symptoms

Question 22

Medications of PD

Answer 22

Benzos - short term
Antipsychotics to treat aggressiveness and impulsivity
Mood stabilizers to treat rage, violence, impulsivity, feelings of losing control
Antidepressants
Antianxiety agents

Question 23

Nursing Diagnosis for Cluster A

Answer 23

Anxiety
Ineffective Coping
Social Isolation
Disturbed thought process

Question 24

Nursing Diagnosis for Cluster B

Answer 24

Ineffective Coping
Disturbed personal identity
Chronic low self-esteem
Risk for self mutilation
Risk for suicide
Impaired social interaction
Risk for self.other directed violence

Question 25

Nursing Diagnosis for Cluster C

Answer 25

Anxiety
Ineffective Coping
Chronic low self-esteem
Impaired social interaction

Question 26

Interventions for manipulative, aggressive, or impulse behaviors

Answer 26

Calm nonjudgmental approach
Communication with tx team to prevent splitting
Teach alternative ways to manage feelings
Frequent short interactions
Encourage journaling
Encourage group participation
Close watch for escalation in anger
Redirection
Time out
Seclusion/restraint per protocol - LAST RESORT

Question 27

Discharge Criteria for PD

Answer 27

Consider risk factor of safety for client and others
Have follow-up plan
Provide psycho-education