Module Three Exam (Updated)

Addiction

- A compulsion that if the need is unfulfilled or unmanaged, there will be physical or psychological distress

- Addictions are considered brain disorders because an addiction alters the functioning of the brain involving the ability for self-control, reward systems, and response to stress

Tolerance

The need for larger amounts of more frequent doses of a substance

Dependence

- In substance use, refers to the physical symptoms of withdrawal and tolerance

- Dependence and addiction may be used interchangeably in literature

Substance use disorders

A cluster of cognitive, behavioral, and physiological manifestations indicating continued use of a substance despite clinical impairment from the substance with diagnosis based on pathological patterns

SUD Clinical Onset

- Substance use throughout the lifespan teens are at higher risk due to their developing brains)

- Self-medicate to treat manifestations of mental illness

- Pain management

- Stress management

Reward pathway (limbic system)

Dopamine levels become abnormally high, and the need to continue using the substance persists

Basal ganglia

controls motivation

Amygdala

represents anxiety, irritability, and uneasiness

Prefrontal cortex

- becomes imbalanced with substance use, creating a compulsive need for the client to acquire the substance

- impulse control, as well as their ability to plan, think, make decisions, and solve problems, are all affected by substance use

Severity levels for SUD

Mild substance use disorder: The client has two or three manifestations.

Moderate substance use disorder: The client has four or five manifestations.

Severe substance use disorder: The client has six or more manifestations.

Risk factors for SUD

Mental illness, stress, gender, ethnicity, genetics, peer pressure, emotional abuse, sexual abuse, physical abuse, and environment, which includes negative effects of poverty, having limited resources, and/or poor treatment

Protective factors for SUD

- For adults, protective factors include positive self-image, employment, community and/or faith-based resources, and supportive personal relationships.

- For younger people, these include positive family support, caregiver involvement in a child's activities, self-control, doing well in school and maintaining a good school record, having positive relationships, and availability of school resources and anti-drug programs

Populations at higher risk for SUD

- Males, Indigenous Peoples, and white individuals are more likely to develop an addiction than other groups

- It is also known that having a sibling with an addiction increases the risk of a client developing one as well

really anyone can be at risk, SUD doesn't discriminate

Comorbidities with SUD

- Heart disease

- Stroke

- Dental issues

- Hepatitis

- Cirrhosis

- Mental illness

Withdrawal

When the chemical concentration of a substance begins to decrease in the body, causing physiological and psychological effects

Wernicke and Korsakoff Syndrome

Wernicke’s encephalopathy and Korsakoff’s amnesic syndrome represent two stages of the same disease process due to brain damage resulting from a lack of vitamin B1, or thiamine, which occurs with chronic alcohol use

Wernicke's encephalopathy

- Degenerative brain disorder caused by deficiency of thiamine and is considered an acute condition or phase

- Symptoms include mental confusion, vision disruption, coma, hypothermia, hypotension, and ataxia

- Most manifestations of Wernicke's encephalopathy can be reversed if detected early and treated promptly.

Korsakoff's amnesia syndrome

- Memory disorder that results in thiamine deficiency and is considered a chronic condition or the longer-lasting stage

- Clinical manifestations can include amnesia, tremors, coma, disorientation, and vision disturbances

- A major concern is the client has difficulty forming new memories and retrieving previous memories, and this can be life-threatening

- Reversal of symptoms and improvement of memory may be slow if possible

Wernicke and Korsakoff Syndrome treatment

Vitamin B1 (thiamine) replacement, proper nutrition, hydration, and stopping alcohol use are necessary treatments

Alcohol: symptoms of use

- Mood and behavior changes

- Unable to coordinate movement

- Slurring words

Alcohol: concerns when under the influence

- safety

- accident prone

- risk for bleeding

- risk for DUI charge and/or accident

Alcohol: symptoms and concerns with withdrawal

Agitation, anxiety, sweating, insomnia, delirium, mild, moderate, or severe tremor, DTs, vomiting, hallucinations, confusion, syncope, hypertension, tachycardia, seizures

Delirium tremors

- Severe and potentially fatal presentation of sudden alcohol withdrawal

- Sudden onset of severe confusion (i.e., delirium)

- Agitation, irritability, and sudden mood changes

- Disorientation

- Increased body temperature, breathing rate, and pulse

- Visual, tactile, or auditory hallucinations

- Severe body tremors and seizures

Hallucinogens: symptoms of use

Hallucination: false sensory experiences

Hallucinogens: concerns when under the influence

safety, sexual assault, out-of-control behaviors

Hallucinogens: symptoms and concerns of withdrawal

headaches, increased appetite, sleepiness, depression

Opioids: symptoms of use

- Can relieve pain and lead to relaxation

- Drowsiness, confusion, nausea, constipation, euphoria, and slowed breathing

Opioids: concerns when under the influence

Using with alcohol can create a dangerous decrease of heart rate and breathing, coma, death.

Opioids: symptoms and concerns of withdrawal

- Restlessness

- Muscle and bone pain

- Insomnia

- Diarrhea

- Vomiting

- Cold flashes with goosebumps ("cold turkey")

- Leg movements

Stimulants: symptoms of use

- Euphoria, "a rush," increased alertness, attention, energy

- Increased blood pressure and heart rate

- Narrowed blood vessels

- Increased blood sugar

- Opened-up breathing passages

Stimulants: concerns when under the influence

Used in combination with alcohol, there is a greater risk of cardiac toxicity than from either drug alone

Stimulants: symptoms and concerns of withdrawal

- Depression

- Tiredness

- Increased appetite

- Insomnia

- Vivid unpleasant dreams

- Slowed thinking and movement

- Restlessness

Sedatives: symptoms of use

- Decreased anxiety

- Ability to sleep, drowsiness

- Slurred speech

- Poor concentration, confusion

- Dizziness, problems with movement and memory

- Lowered blood pressure

- Slowed breathing

Sedatives: concerns when under the influence

Sometimes used as date rape drugs

- Flunitrazepam

- Gamma-hydroxybutyric acid (GHB)

- Gamma-butyrolactone (GBL)

- Ketamine

Sedatives: symptoms and concerns of withdrawal

- Must be discussed with a health care provider

- Withdrawal can cause a serious abstinence syndrome that may include seizures

Warning signs of substance use

- Changes in mood

- Change in peer group

- Change in weight or sleeping habits

- Loss of interest in overall health

- Decline in performance at work or school

- Loss of money, missing valuable, and borrowing

Most dangerous drugs to withdraw from ...

ALCOHOL AND BENZODIAZEPINES (due to risk of seizure development)

Detoxification protocol

- A structured plan of action used by the treatment team to allow the client's body to remove or decrease the amount a particular substance

- A detoxification protocol typically includes the use of a medication sliding scale for benzodiazepine use in alcohol withdrawal or opiate replacement for opiate withdrawal

CIWA and COWA

CIWA-Ar → Clinical Institute Withdrawal Assessment for Alcohol-Revised

COWA → Clinical Opiate Withdrawal Scale

Stage One of Alcohol Withdrawal

Client may begin to experience manifestations of withdrawal, which generally appear 4-8 hrs after last alcoholic drink

• Severity, intensity, and onset of manifestations are related proportionately to amount of alcohol intake and duration of client’s recent drinking hx

• Manifestations:

  • Anxiety

  • Insomnia

  • N/V

  • ABD discomfort

  • Loss of appetite

  • Fatigue

  • Tremors

  • HA

  • Increased HR/BP

Stage Two of Alcohol Withdrawal

Manifestations becoming more critical; may intensify and clients may experience irregular HR, confusion, sweating, increased irritability, and mood disturbances

• Body temperature and blood pressure increase

Stage Three of Alcohol Withdrawal

Severity of manifestations may worsen, resulting in delirium tremors (DT)

• DT symptoms may include:

  • Extreme confusion

  • Extreme agitation

  • Fever

  • Seizures

  • Hallucinations (tactile, visual, auditory)

• After peak, manifestations may become more protracted with some lasting 1+ weeks

CIWA - AR Scale 

Clinical Institute Withdrawal Assessment Alcohol Scale Revised 

• 10 alcohol withdrawal symptoms that tool assesses: 

  • Agitation

  • Anxiety

  • Auditory disturbances

  • Clouding of sensorium (altered mental status)

  • HA

  • N/V

  • Paroxysmal sweats

  • Tactile disturbances

  • Tremor

  • Visual disturbances

CIWA Score <8 

NO medication needed 

CIWA Score >8

Initiation of benzodiazepines or other medications prescribed for withdrawal process

Mild CIWA Score

CIWA-AR <10

• Mild or moderate anxiety

• Sweating

• Insomnia

• NO tremor

Moderate CIWA Score 

CIWA-AR 10-18

• Moderate anxiety 

• Sweating 

• Insomnia 

• MILD tremor 

Severe CIWA Score

CIWA-AR greater than or equal to 19 

• Severe anxiety

• Moderate to severe tremor

• NO confusion, hallucination, or seizure

Complicated CIWA Score 

CIWA - AR greater than or equal to 19 

• Seizure or s/sx indicative of delirium

  • Inability to fully comprehend instructions

  • Clouding of sensorium or confusion

  • New onset of hallucinations

C.A.G.E. acronym 

C - Cutting Down 

A - Annoyance by criticism 

G - Guilty feeling 

E - Eye opening 

CAGE

Yes/no questions:

1. Have you ever felt you should cut down on your drinking?

2. Have people annoyed you by criticizing your drinking?

3. Have you ever felt bad or guilty about your drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

Score of 2 or more = clinically significant 

Score of 1 = may indicate problem with alcohol and needs further assessment 

AUDIT

Alcohol Use Disorders Identification Test

• Used to assess alcohol consumption, behaviors, and problems associated with alcohol use

• Consists of 10 questions scored between 0-4 

MAST 

Michigan Alcohol Screening Test 

• 25-question test assesses risks associated with drinking patterns, neglect of responsibilities, loss of control, and other topics 

What is a personality disorder?

A mental health condition that involves long-lasting, pervasive, and inflexible patterns of thinking, mood, perceptions, behaviors, and ways of relating to others

- These behaviors and traits most often appear in late adolescence to early adulthood

Personality

Unique blend of traits, thoughts, attitudes, and behaviors that make a person unique

Five-Factor Model of Personality

Extraversion → Engagement in a large breadth of activities, rather than depth; enjoy interacting with others and gain energy from social situations

Agreeableness → A desire for social harmony; get along well with others and are generally kind and trustworthy

Conscientiousness → Predisposition for self-discipline and duty; focused and regulate their impulses

Neuroticism → Tendency to experience negative emotions; low emotional stability

Openness to Experience → General appreciation for experience, including art, emotion, and imagination; curious and willing to try new things

Cluster A

odd or eccentric

- Paranoid Personality Disorder

- Schizoid Personality Disorder

- Schizotypal Personality Disorder

Cluster B

dramatic, erratic, and emotional

- Antisocial Personality Disorder

- Borderline Personality Disorder

- Histrionic Personality Disorder

- Narcissistic Personality Disorder

Cluster C

anxious and fearful

- Avoidant Personality Disorder

- Dependent Personality Disorder

- Obsessive-Compulsive Personality Disorder

Personality Disorders Across the Lifespan

- Children may find it difficult to make friends at school or be successful at classwork due to personality traits

- The adolescent who has a personality disorder may find that their peers will tease them for having odd habits, ideas, or behaviors

- Adult clients who have personality disorders may have trouble forming intimate relationships or keeping a job for an extended time

Comorbidities with personality disorders

- Greater impairment of functional skills

- Higher rates of unemployment and homelessness

- Higher rates of relapse

- Poorer prognosis

- Poor adherence to treatment regimen

- Increased risk of suicide, abuse, and traumatic experiences​​​​​​​

Cluster A comorbidities

- Major depressive disorder

- Substance use disorder

- Obsessive compulsive disorder

- Agoraphobia

- Anxiety disorders

- Schizophrenia

- Delusional disorders

- Bipolar

- Phobias

- Posttraumatic stress disorder

Cluster B comorbidities

- Social phobias

- General anxiety disorder

- Substance use disorder

- Anxiety disorders

- Mood disorders

Cluster C comorbidities

- Mood disorders

- Social phobias

- Obsessive compulsive disorder

- Anorexia nervosa

- Substance use disorders

Risk factors and etiology of personality disorders

Risk Factors

While each of the 10 identified personality disorders has unique risk factors, there are some general risk factors that present with personality disorder (genetic and environmental)

Etiology

not well understood, several theories, diatheses stress model

Paranoid Personality Disorder

- Clients who have paranoid personality disorder often demonstrate manifestations of distrust and suspicion of others

- These clients also often believe that there are others out to deceive or harm them and that they could be harmed at any moment

- Clients who have paranoid personality disorder have difficulty developing and maintaining close relationships, which can lead to isolation and frustration

Paranoid Personality Disorder DSM 5 Criteria

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning in early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them

- Is preoccupied with unjustified doubts about loyalty or trustworthiness of friends or associates

- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them

- Reads hidden demeaning or threatening meaning into benign remarks or events

- Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights)

- Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack

- Has recurrent suspicions, without justification, regarding fidelity of spouse of sexual partner

Schizoid Personality Disorder

- Clients who have schizoid personality disorder are socially withdrawn and have little to no interest in forming close relationships

- These clients often exhibit limited emotional expression, a preference for solitary activities, avoidance of social interaction, and a lack of desire for meaningful close relationships

- Clients can function well at work when the job requires little to no social interaction

- Sexual activity is of little interest to these clients, although they may describe some “pain” in not being able to have social interactions like their peers

Schizoid Personality Disorder DSM 5 Criteria

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

- Neither desires nor enjoys close relationships, including being part of a family

- Almost always chooses solitary activities

- Has little, if any, interest in having sexual experiences with another person

- Takes pleasure in few, if any, activities

- Lacks close friends or confidants other than first-degree relatives

- Appears indifferent to the praise or criticism of others

- Shows emotional coldness, detachment, or flattened affectivity

Schizotypal Personality Disorder

- Clients who have schizotypal personality disorder may have peculiar or eccentric thoughts, behaviors, and patterns of speech; disturbances in the perception of events; odd beliefs or fantasies; and trouble with meeting people and maintaining close friendships

- These clients may believe that they have supernatural powers or that others can read their minds, for example

- They can be inspirational leaders, but the personality disorder can manifest behaviors that make relationships and fitting into the environment difficult

- They may incorrectly interpret ordinary events, have magical thinking, or misunderstand speech

Schizotypal Personality Disorder DSM 5 Criteria

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

- Ideas of reference (excluding delusions of reference)

- Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms

- Unusual perceptual experiences, including bodily illusions

- Odd thinking and speech (e.g., vague, circumstantial, metaphorical, over elaborative, or stereotyped)

- Suspicious or paranoid ideation

- Inappropriate or constricted affect

- Behavior or appearance that is odd, eccentric, or peculiar

- Lack of close friends or confidants other than first-degree relatives

- Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self​​​​​​​​​​​​​​

Antisocial Personality Disorder

- Clients who have antisocial personality disorder tend to disregard and violate the rights of other people and dismiss the rules of society

- The predominant features of antisocial personality disorder are lying, deception, aggression, violating laws, reckless disregard for the safety of self or others, irresponsibility, and total lack of remorse

- It is believed that there is a genetic contribution to these behaviors, but that dysregulation of serotonin further contributes to low arousal, poor fear conditioning, and deficits in decision-making

Antisocial Personality Disorder DSM 5 Criteria

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

- Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest

- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure

- Impulsivity or failure to plan ahead

- Irritability and aggressiveness, as indicated by repeated physical fights or assaults

- Reckless disregard for the safety of self or others

- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations

- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another​​​​​​​

Borderline Personality Disorder

- Clients who have borderline personality disorder often exhibit poor boundaries between themselves and others, excessive emotional reactions, fear of abandonment and impulsivity among many other manifestations

- The most concerning manifestations of borderline personality disorder are the tendency to self-harm and attempt or threaten suicide

- The client with borderline personality disorder may at times appear psychotic because of the intensity of their distortions

- Their behaviors can seem frantic, dramatic, attention-seeking, and overly expressive.

Borderline Personality Disorder DSM 5 Criteria

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and presents in a variety of contexts, as indicated by five (or more) of the following:

- Frantic efforts to avoid real or imagined abandonment

- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

- Identity disturbance: markedly and persistently unstable self-image or sense of self

- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

- Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior

- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

- Chronic feelings of emptiness

- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

- Transient, stress-related paranoid ideation or severe dissociative symptoms​​​​​​​

Dialectical behavior therapy (DBT)

An individual or group therapy used to teach clients coping skills to improve impulse control and affective lability. ​​​​​​​

Histrionic Personality Disorder

- Clients who have histrionic personality disorder have behaviors that are dramatic, emotional, and attention-seeking and may even be seductive

- The attention-seeking behavior may lead to safety issues and even accidental injury.

Histrionic Personality Disorder DSM 5 Criteria

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

- Is uncomfortable in situations in which they are not the center of attention

- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior

- Displays rapidly shifting and shallow expressions or emotions

- Consistently uses physical appearance to draw attention to self

- Has a style of speech that is excessively impressionistic and lacking in detail

- Shows self-dramatization, theatricality, and exaggerated expression of emotion

- Is suggestible (i.e., easily influenced by others or circumstances)

- Considers relationships to be more intimate than they actually are​​​​​​​

Narcissistic Personality Disorder

- A narcissistic personality disorder is characterized by a pattern of grandiose behaviors centering on self-superiority and the need to be admired, combined with a lack of empathy for others

- These clients often overestimate their abilities and accomplishments and are often preoccupied with thoughts of unlimited success, power, brilliance, beauty, or ideal love

- Clients with narcissistic personality disorder may either devalue the nurse or overidealize the nurse and other providers

- Even though these clients may seem to have inflated egos, the classic model for the development of this disorder is that it functions as a defense against the client dealing with feelings of low self-esteem

Narcissistic Personality Disorder DSM 5 Criteria

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following.

- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

- Believes that they are “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

- Requires excessive admiration

- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with their expectations)

- Is interpersonally exploitative (i.e., takes advantage of others to achieve their own ends)

- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

- Is often envious of others or believes that others are envious of them

- Shows arrogant, haughty behaviors or attitudes​​​​​​​

Avoidant Personality Disorder

- A client who has avoidant personality disorder may lack close friends, avoid social activities for fear of criticism, and feel anxious or embarrassed when in front of other people

- In most careers and relationships, these traits can hamper successful achievements because the client avoids responsibilities to prevent criticism from others

Avoidant Personality Disorder DSM 5 Criteria

A pervasive pattern of social inhibition, feeling of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following.

- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection

- Is unwilling to get involved with people unless certain of being liked

- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed

- Is preoccupied with being criticized or rejected in social situations

- Is inhibited in new interpersonal situations because of feelings of inadequacy

- Views self as socially inept, personally unappealing, or inferior to others

- Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing​​​​​​​ ​​​​​​

Dependent Personality Disorder

- The key feature of clients who have dependent personality disorder is the excessive and often pervasive need to be taken care of, with behaviors described as clinging or having an excessive fear of separation

- These individuals exhibit very submissive behaviors and often have difficulties making decisions without guidance, need reassurance, and depend on others to assume responsibility for major areas of their lives

- These clients often also have unrealistic fears about their ability to care for themselves, lack confidence, and may go to excessive lengths to obtain nurturance

Dependent Personality Disorder DSM 5 Criteria

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following.

- Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others

- Needs others to assume responsibility for most major areas of their life

- Has difficulty expressing disagreement with others because of fear of loss of support or approval (Note: Do not include realistic fears of retribution.)

- Has difficulty initiating projects or doing things on their own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)

- Goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant

- Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themself

- Urgently seeks another relationship as a source of care and support when a close relationship ends

- Is unrealistically preoccupied with fears of being left to take care of themself​​​​​​​

Obsessive-Compulsive Personality Disorder

- A client who has obsessive-compulsive personality disorder often has intense obsessive thoughts that are then relieved by compulsive, ritualized behaviors

- Clients who have this disorder are perfectionistic, demand control, lack flexibility, and are reluctant to delegate tasks to others

- The client with obsessive-compulsive personality disorder feels the need for control but is often unaware of the effects of their personality disorder

Obsessive-Compulsive Personality Disorder DSM 5 Criteria

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

- Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

- Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because their own overly strict standards are not met)

- Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by cultural or religious identification)

- Is overconscientious, scrupulous, and inflexible about matters or morality, ethics, or values (not accounted for by cultural or religious identification)

- Is unable to discard worn-out or worthless objects even when they have no sentimental value

- Is reluctant to delegate tasks or to work with others unless they submit exactly to their way of doing things

- Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

- Shows rigidity and stubbornness​​​​​​​

Treatment for personality disorders

PSYCHOTHERAPY

- Cognitive behavioral therapy

- Dialectical behavior therapy

- Psychodynamic psychotherapy

- Supportive therapy

- Social skills training

Diagnostic Tools for Personality Disorders

- DSM-5

- Minnesota Multiphasic Personality Inventory (MMPI)

- Eyesnick Personality Inventory

- Personality Diagnostic Questionnaire

- Gerontological Personality Disorder Scale (older adults)

- Lab tests (STIs, toxicology for substance use)

Prevention for personality disorders

- Advocate to decrease violence in the community, trauma in the home, and health disparities that lead to children not receiving early interventions for emotional and behavioral problems.

• Early treatment and empowering clients to solve problems productively and to manage both emotions and behavior can lead to improved relationships, careers, and mental health

Teaching for personality disorder

- Specific education related to the client's disorder

- Recognition of common clinical manifestations

- Resources and support groups available for the client in their community

- The nurse may also educate caregivers of clients who have a personality disorder, including parents of adolescent clients, on signs and symptoms of self-harm

- Teach, assess understanding, document

Therapeutic presence for personality disorders

- Clients who have cluster A personality disorders often have trouble relating to others (empathy)

- Clients who have cluster B personality disorders may find that others shun their dramatic behaviors (boundaries)

- Clients who have cluster C personality disorders have trouble taking on responsibilities that lead to success due to fear (decrease anxiety, empowerment)

Increasing emotionality ...

Can lead to aggression (antisocial personality disorder) or self-harm (borderline personality disorder)

Cluster A solutions

finding and maintaining interpersonal relationships

Cluster B solutions

safety and maintaining appropriate boundaries

Cluster C solutions

decreasing anxiety

Bipolar disorder general

- Client experiences episodes of depression and mania

- Bipolar disorder can be further identified as bipolar I, bipolar II, or cyclothymic disorder

- Substance or medication induced bipolar disorder

Bipolar I Disorder general

- Requires at least one manic episode

Manic episode must include:

- abnormally elevated, expansive, or irritable mood

- increased activity or energy

- lasting > 1 week (or any duration if hospitalization is needed)

Bipolar I Disorder Symptoms

During the episode, at least 3 symptoms must be present (4 if mood is only irritable):

- Inflated self-esteem

- Decreased need for sleep

- More talkative than usual

- Flight of ideas or report of thoughts racing

- Easily distracted by report or observation

- Increase in goal-directed activity or psychomotor agitation

- Increased involvement in risk activities (dangerous)

Bipolar I aftermath

- Mood disturbance requires hospitalization or causes significant impairment in social or occupational functioning

- Hospitalizations for individuals with bipolar I disorder generally occur due to mania and psychotic symptoms such as delusions or poor judgment, resulting in difficulties with the law

- Not caused by the effects of a substance such as drug abuse, medication, or other treatment for a medical condition

Hypomania vs. Mania

Hypomania → high energy, high level of creativity, decreased need for sleep, and talkativeness

Mania → manifestations escalate to include pressured speech, racing thoughts or flight of ideas, high distractibility, expansiveness, or grandiosity with poor judgment