Exam 2 MH

What is a personality disorder?

- Happen when someone's personality becomes pathological (dangerous)

- Someone can get hurt, they can hurt themselves, or they can hurt other people

- Can co-occur with other mental health disorders (substance abuse, depression, bipolar)

Do people with personality disorders believe they have a problem?

No, believe "it's just who I am" (egosyntonic)

What are cluster A personality disorders?

Odd or eccentric traits

What is the list of cluster A personality disorders?

- Paranoid

- Schizoid

- Schizotypal

What is paranoid personality disorder?

Distrust and suspiciousness towards others (think there is an ulterior motive)

What are interventions for paranoid personality disorder?

- 1:1 patient teaching: more comfortable and prevents feeling ganged up on

- Clear and simple communication (direct)

you’re in a group setting and they only trust you, how do you want to get out of that scenario - they are very overwhelmed

ask if they want to step out and do a 1:1 teaching together

What is schizoid personality disorder?

- Detached (average emo)

- Doesn't want to form close relationships

- Keep to themselves (isolated)

- Don't perform well under stress, will cause them to become psychotic

What are interventions for schizoid personality disorder?

Don't force them to socialize - they will get stressed and upset with you - they won’t thrive in a social setting bc they prefer to be alone

What are occupation opportunities for schizoid personality disorder?

Online/remote jobs: tech and data analysis

What is schizotypal personality disorder?

- Odd beliefs: witchcraft, wizardry, supernatural (superstitious)

- Magical thinking: thinking about a possible occurrence can make it happen

- Will probably join or lead a cult

main character vibes

What are interventions for schizotypal personality disorder?

Clarify and ask to interpret their words/metaphors

ex: “i envision my future in flames”

you say: “what do you mean by that, can you tell me more?” (you want to know if they are hopeless or if they plan to set stuff on fire, etc)

What are cluster B personality disorders?

Dramatic, erratic, and emotional (very manipulative)

What is the list of cluster B personality disorders?

- Antisocial

- Borderline

- Histrionic

- Narcissistic

What is antisocial personality disorder?

- Lacks empathy and accountability: don't care what happens to you (no remorse)

- Sense of entitlement: don't believe in societal norms or rules

- Charming

- Impulsive: do anything to get what they want to do

What are interventions for antisocial personality disorder?

Confrontation: be firm and set limit

ex: writing slurs in the bathroom wall or smoking a cig in the bathroom

you: confront them and be stern “no, you need to stop, you are breaking the rules” DONT BEAT AROUND THE BUSH - they won’t listen to you

What is borderline personality disorder?

- Black and white thinking: no flexibility (all or nothing) ("it's the end of the world") - will want to kill themselves over a minor inconvenience

- Intense mood swings: "it's gonna be a good day" to "it's the worst day ever"

- Fear of abandonment: clingy - results in a lot of manipulation: instead of talking and communicating they say "if you leave me i will kms"

- Impulsive

- Engages in splitting: thinking one thing about you but the next moment it's the opposite (defense mechanism)

- ex: pt will be like hi what’s your name and you talk to them and they’re like omg you’re such a nice nurse, then later in the shift they ask to make a phone call and you say it’s not call hours yet and they say omg you’re the worst nurse ever i hate you so much

- staff splitting: you tell them they can’t call so then they go ask the CNA if they can make a phone call and they let them

- intervention to avoid staff splitting: communicate- hey these are the rules of the unit plz let pt know that rules need to be enforced (be super clear and make sure that everyone is following the rules)

What are interventions for borderline personality disorder?

Safety: instability, impulsivity, and black and white thinking can make the patient be very suicidal or inflict self harm (banging head, slitting wrists, throwing themselves at the floor)

What is histrionic personality disorder?

Seductive and flirty for attention from someone

What are interventions for histrionic personality disorder?

Limit setting: make sure they don't make someone uncomfortable ("they don't want your advances, you need to back off")

What is narcissistic personality disorder?

- Grandiose sense of importance

- Huge ego/conceited

- Do not take criticism very well

- Do not care about other people, only about themselves

What are interventions for narcissistic personality disorder?

Establish a sense of fairness (give others a chance)

humble them

What are cluster C personality disorders?

Anxious or fearful traits; insecure and inadequate

What is the list of cluster C personality disorders?

- Avoidant

- Dependent

- Obsessive compulsive

What is avoidant personality disorder?

- Afraid of commitment: emotionally unavailable for relationships

- Feels they're inferior or "not good enough"

What is dependent personality disorder?

- Really relies on others

- No breaks after a breakup

What is obsessive compulsive personality disorder?

- Absolute perfectionist

- Very critical of themselves

- No room for flexibility

- Will freak out if it doesn't go their way

difference between this and regular OCD:

- they are very hard on themselves and if something goes wrong then they freak out

What are general interventions for all cluster personality disorders?

- Don't argue with them (don't start anything with them)

- Don't be too friendly (will take advantage of you)

- Be direct

What are the type of somatic disorders?

- somatic symptoms disorder

- illness anxiety disorder

- conversion disorder

- factitious disorder

What is somatic symptoms disorder?

Genuinely feeling distressing symptoms (discomfort, nausea, palpitation) without significant physical findings

Why do healthcare workers get frustrated with somatic symptoms disorder patients?

Continue to go to the hospital when they feel something despite being medically cleared

What is an intervention for somatic symptom disorder?

Psychological consult: checking in on their mental state

What is illness anxiety disorder?

- Misinterpretation of physical symptoms

- Will think symptoms will lead to a deadly disease

*think of a hypochondriac

What is conversion disorder?

Emotional conflicts (trauma) channel towards physical symptoms

What are psychical symptoms in conversion disorder?

- Loss of senses: seeing, hearing, tasting

- No voice

- Paralysis

What is the main intervention for conversion disorder?

Rule out organic pathology (make sure they don't have something genuinely wrong with them)

What is factitious disorder?

- Artificially, deliberately, and dramatically inflicting injury and illness towards self or others

- Extremely manipulative act (for secondary gain)

What are types of factitious disorder?

- Munchausen: inflicted on yourself

- Munchausen by proxy: inflicted by other person

What is dissociation, what can too much cause, and what is needed in order to dissociate in the first place?

- Involves separating ideas and memories from events and experiences (detachment)

- Too much dissociating can cause amnesia and reduced consciousness

- Need some kind of trauma involved in your life

What are the types of dissociative disorders?

- dissociative amnesia

->dissociative fuge

- dissociative identity disorder

- depersonalization-derealization disorder

What is dissociative amnesia?

Extreme trauma to the point where they cannot recall things

What is an intervention for dissociative amnesia?

Rule out substance abuse or other medical conditions

What is dissociaitve fugue?

Sudden, unexpected travel away from community (new identity can even be made)

What is dissociative identity disorder?

- Presence of two or more distinct personality states called "alters"

- Each alter has its own personality and way of perceiving things

they get amnesia and forget what happens when they switch alters

switching alters is a way of coping w things that trigger trauma

*need to have trauma

How do you address someone with DID?

address them and their other alters "hey guys, do you guys like this, etc" not "do you like this" acknowledge the other alters

treat it as if it's the host when they switch alters -> just carry on w convo and act like nothing happened

What is depersonalization in depersonalization-derealization disorder?

Individual doesn't feel like a physical person (body part doesn't feel like their own)

What is an example of depersonalization in depersonalization-derealization disorder?

"I know my hand is moving, but this is not really my hand it's someone else's hand"

What is derealization in depersonalization-derealization disorder?

Individual doesn't feel like the world around them doesn't exist (around the person)

What is psychosis?

Disorganization of personality, deterioration in social functioning, and loss of contact with or distortion of reality

What are the types of psychosis?

- Substance induced psychosis

- Schizoaffective disorder

- Schizophrenia

What is substance induced psychosis?

- can be caused by meds

- can be a really bad trip from weed, etc.

- goes away after drug goes down

- see/hearing things while on whatever drug

ex: you go to a diff plug and the weed is different and you have a bad trip

What is schizoaffective disorder, and how long must it occur for?

- Schizophrenia traits with mood disorders (bipolar or depression on top of hallucinations or delusions)

- PYSCHOSIS AND MOOD DISORDER

- Must occur for at least two weeks in the absence of a major mood episode

What is schizophrenia, and how long must it occur for?

- Two or more positive or negative symptoms must be present

- Symptoms negatively affect daily functioning and interpersonal relationships (debilitating)

- Symptoms are continuous and persist for at least six months

What are positive symptoms?

"Extra" things we don't see in a normal person

ex: you dont hear voices or see things that aren't there EXTRA existence

What are examples of positive symptoms?

- Abnormal motor behavior: catatonia

- Disorganized thinking: how they approach a sentence

- Delusions: false fixed beliefs

- Hallucinations: auditory/visual

What is catatonia?

Bizarre posture or decreased responsiveness to things around them

ex: vegetative state, not responding, staring blankly either at you or out into the distance

What are the types of false fixed beliefs (delusions)?

- Persecutory: someone is out to kill/get them (cameras are watching them and it’s the FBI)

- Ideas of reference: sense/see/hear everyone/everything is talking about them/to them (news talking directly to them, billboard announcing abt them)

- Delusions of grandeur: think they are an almighty figure (president/king)

What are delusion interventions, especially for persecutory delusions?

- Don't deny belief: acknowledge it and redirect

- redirect: let them know that they are at the hospital and that they are a patient

- Redirect them to reality especially towards persecutory delusions: open medications in front of them to show them its not tampered with, open their meals in front of them

How can disorganized thinking be assessed?

Talking to the patient (mental status exam)

What are types of disorganized thinking?

- Loose association

- Tangential

- Circumstantial

- Word Salad

- Neologisms

- Clang associations

- Echolalia

- Echopraxia

What is loose association?

Speech in which ideas shift from one unrelated subject to another (no correlation)

ex: start talking abt plants and plants they take care of then they switch to video games and the newest one out - they combine it

What is tangential?

The speaker introduces many unrelated topics until the original topic of discussion is lost (inability to get to the point of a story)

ex: drawing to mac n cheese recipe on tiktok then assignment done over weekend for school (THEY NEVER GO BACK TO ORIGINAL TOPIC)

What is circumstantial?

The delay of an individual to reach the point of a communication, owing to unnecessary and tedious details (go back to the original conversation)

ex: mac n cheese then youtube video abt downfall of a really niche video game then they go back to the mac n cheese recepie (idea A to B then back to A)

What is word salad?

Group of words that are put together in a random fashion without any logical connection (mixing words)

ex: book leather carpet fortnite v bucks card

What is neologisms?

New words that an individual invents

ex: skibbidy (words not in dictionary)

What is clang associations?

A pattern of speech in which the choice of words is governed by sounds (rhyming/rapping)

What is echolalia?

Repetition of words or phrases spoken by another person

ex: imitating a noise that they make like yelping the way someone else did while tripping

What is echopraxia?

Involuntary imitation of movements made by another person

ex: walking and swinging their arms like another pt

What are hallucinations?

Sensing things that are not there

How do you assess for hallucinations?

- "Are you seeing or hearing anything that's not there?" (ALWAYS START W THIS)

- If no, you can stop there

- If yes, ask to describe extent of hallucination (especially if auditory to assess safety): "What are the voices telling you" or "what are you seeing"

- Once described, validate their feelings but let them know you don't hear anything "that sounds really scary, that must be really hard for you but I personally do not hear anything, you are safe"

What are negative symptoms?

"Lack of" normal behaviors (the As)

missing something that should be presented in a not schizophrenic person

What are examples of negative symptoms?

- Affect lacking

- Avolition

- Alogia

- Anergia

- Anhedonia

What is affect lacking?

Blunted/flat affect

ex: no facial expression

"what you see on the face"

What is avolition?

No motivation to complete purposeful activities (ADLs)

What is alogia?

Decreased verbal communication (can be selectively mute)

ex: pt will not respond when talking w them but they will talk to someone else and not you

What is anergia?

Decreased energy

What is anhedonia?

Decreased pleasure in doing things

What are typical antipsychotics?

Treats only positive symptoms, more potent side effects (1st generation - old school)

What are atypical antipsychotics?

treat positive and negative symptoms, less potent side effects (2nd/3rd generation - more modern )

What are antipsychotic side effects?

Extrapyramidal side effects (EPS): tardive dyskinesia (TD), pseudoparkinsonism, akathisia, and dystonia

What is tardive dyskinesia in EPS?

- Wink at you

- Stick their tongue out

- Pucker their lips

- Sway their hips

What is pseudoparkinsonism in EPS?

- Shuffling gait

- Rolling thumb and index finger (asking for money) - pill rolling

- Tremors

drug induced parkinsons

What is akathisia in EPS?

- Restless

- Jittery

- Hyper

What is dystonia in EPS?

- Tilt their head up/twisting neck up

- Roll their eyes back

- Lock the jaw

- Voice box closes (can be fatal) - they sound like they’re possessed (groaning/screeching) - laryngeal spasms

MEDICAL EMERGENCYYY!!!

What is given when a patient experiences dystonia?

IM Cogentin - anticholinergic

main go to!

What medication address extrapyramidal side effects (EPS)?

Anticholinergics (ABCs)

What is the anticholinergic medication list?

- Trihexyphenidyl (Artane)

- Diphenhydramine (Benadryl)

- Benztropine (Cogentin)

What are the anticholinergic side effects?

- Can't see (blurry vision)

- Can't spit (dry mouth)

- Can't shit (constipation)

- Can't piss (low urine output)

What are the 1st generation antipsychotics?

- Haloperidol (Haldol)

- Chlorpromazine (Thorazine)

- Fluphenazine (Prolixin)

- Loxapine (Loxitane)

- Perphenazine (Trilafon)

- Pimozide (Orap)

- Prochlorperazine (Compazine)

- Thioridazine (Mellaril)

- Thiothixene (Navane)

- Trifluoperazine (Stelazine)

Halo is a 1st gen student whos a germaphobe - he always uses clorox and hates the flu and pimples

His perfect day consists of having a lox bagel w/o his twin brothers thiodaz & thioxene who he refers to as "pro triflers"

What are the 2nd generation antipsychotics?

- Ziprasidone (Geodon): cardiac side effects (qt prolongation & dysrhythmia) - routine EKGs

- Risperidone (Risperdal)

- Paliperidone (Invega)

- Lurasidone (Latuda)

- Olanzapine (Zyprexa)

- Quetiapine (Seroquel): orthostatic hypotension is BIG (FALLS!!!!)

- Clozapine (Clozaril): agranulocytosis (decreased white blood cell count - look out for infection! they are prone to infection!)

this is the 2nd time this guy named pali w/ weird heart(cardiac side effects) zippers said hola & tried to rizz me up

he almost lured me in bc I thought he was cute but I almost fell(orthostatic hypotension) when I came close cuz he was so ugly I literally felt like I got an eye infection(agranulocytosis-prone to infection) from looking at him

What are the 3rd generation antipsychotics?

Aripiprazole (Abilify) - tamest side effects bc not at potent

What are special routes of antipsychotic administration?

- Orally disintegrated tablets (under the tongue and dissolves to prevent cheeking)

- Depot formulation: requires loading dose and monthly injections (long acting IM injection)

Why would patients receive antipsychotics through IM?

- Noncompliant

- Do not want to take PO

- easier for out patient

What is a complication of antipsychotics?

Neuroleptic malignant syndrome

What are manifestations of neuroleptic malignant syndrome?

- Fever

- Altered level of consciousness

- Muscle rigidity

- Fluctuating blood pressure

What is administered for neuroleptic malignant syndrome?

Dantrolene (muscle relaxant)

*main intervention: just stop the med in general

What labs are assessed when administering antipsychotics?

- Lipid panel: HDL, LDL, and cholesterol

- Hemoglobin A1C

taken bc pts are eating more carbs and sugar

pts are not exercising

both of these = metabolic syndrome (weight gain)

**taking antipsychotics = risk for metabolic syndrome

**1st gen is most potent for metabolic syndrome 3rd gen is least

What is the relationship between withdrawal and intoxication?

Seesaw relationship (will be the opposite)

alch: is a downer & when withdrawing symptoms are like uppers

meth: is a stimulant & when withdrawing symptoms are like downers (meth crash)

What is addiction?

Excessive or compulsive use even when they know it's bad (not limited to substances)

What is intoxication?

Excessive use of substance