Mental Health Nursing – Personality Disorders, Schizophrenia, Antipsychotics & Substance Use

These flashcards cover key concepts from the lecture notes including personality disorders (Borderline & Antisocial), schizophrenia symptoms and treatment, antipsychotic pharmacology (typical vs atypical, EPS, NMS, clozapine), substance use disorders (alcohol, opioids), withdrawal management, screening tools, and relevant nursing interventions.

What is the defining feature that turns personality traits into a personality disorder?

The traits become inflexible, maladaptive and cause dysfunction in multiple areas of life, especially interpersonal relationships.

Approximately what percentage of the general population is estimated to have a personality disorder?

About 9.1% of the general population.

Which personality disorder is most frequently seen in clinical settings?

Borderline Personality Disorder (BPD).

What defense mechanism involves seeing others as either all good or all bad and is common in BPD?

Splitting.

Describe ‘clinging and distancing’ behavior in BPD.

Alternating between intense attachment to others (clinging) and abrupt withdrawal or rejection (distancing) due to fear of abandonment.

List four hallmark characteristics of Borderline Personality Disorder.

Instability in relationships, impulsivity/self-destructive behaviors (e.g., cutting), chronic emptiness/poor self-image, and manipulation to reduce anxiety.

Why might a person with BPD engage in cutting?

To reduce tension, validate feelings through pain, counter a sense of emptiness, or seek attention—usually without suicidal intent.

Name three common defense mechanisms used by patients with BPD.

Denial, projection, and splitting.

What nursing action helps manage staff splitting?

Encourage the patient to address concerns directly with the staff member involved, avoid taking sides, maintain consistent limits, and rotate staff.

When should consequences for limit-setting with personality-disorder patients be stated?

At the same time the limit is set.

Key nursing outcome for a BPD patient at risk for self-mutilation?

The patient has not harmed self and can verbalize feelings that precede urges to self-injure.

Primary nursing diagnosis for a BPD patient who alternates between clinging and distancing?

Impaired social interaction.

Which personality disorder is often labeled "sociopathy"?

Antisocial Personality Disorder (ASPD).

State two core traits of Antisocial Personality Disorder.

Disregard for rights of others and pattern of irresponsibility/exploitation (e.g., lying, stealing, illegal acts).

Why are people with ASPD often difficult to treat?

They have little motivation to change and skillfully manipulate staff using psychological jargon.

What is the nursing priority when caring for an ASPD patient?

Set clear, consistent limits and boundaries; point out effects of manipulative behavior; avoid negotiating special rewards.

Identify one major difference between BPD and ASPD regarding self-destruction.

BPD patients commonly harm themselves; ASPD patients more commonly harm or exploit others.

Typical (first-generation) antipsychotics primarily target which type of schizophrenia symptoms?

Positive symptoms such as hallucinations and delusions.

Mechanism of action of typical antipsychotics?

Block postsynaptic dopamine receptors.

Atypical (second-generation) antipsychotics have stronger antagonism at which receptor type?

Serotonin receptors (5-HT2A).

Name three long-acting (depot) antipsychotic injections.

Haloperidol decanoate, fluphenazine decanoate, paliperidone palmitate, aripiprazole monohydrate, or risperidone microspheres (any three).

Define extrapyramidal symptoms (EPS).

Movement disorders caused by dopamine blockade, including dystonia, pseudoparkinsonism, akathisia, oculogyric crisis, and tardive dyskinesia.

Which drug class is commonly used to manage EPS?

Anticholinergics such as benztropine or trihexyphenidyl.

List three hallmark signs of Neuroleptic Malignant Syndrome (NMS).

Severe muscle rigidity, hyperthermia, and autonomic instability (e.g., fluctuating BP) accompanied by altered mental status.

First nursing priority when NMS is suspected?

Immediately discontinue the antipsychotic and begin supportive care (cooling, hydration, monitoring, possible dantrolene/bromocriptine).

What serious blood dyscrasia requires WBC monitoring in patients on clozapine?

Agranulocytosis.

Name three common side effects of clozapine besides agranulocytosis.

Weight gain, sedation, orthostatic hypotension, constipation, dry mouth, seizure risk, or cardiac arrhythmias (any three).

Most common hallucination type in schizophrenia?

Auditory hallucinations.

Differentiate positive and negative symptoms of schizophrenia with one example each.

Positive: hallucinations (added experiences); Negative: avolition (loss of motivation).

At what ages does schizophrenia typically onset for men and women?

Men: late teens–early 20s (≈18–25); Women: mid-20s–early 30s (≈25–35).

Define ‘cheeking’ a medication.

Hiding an oral pill in the cheek to avoid swallowing it.

Give two pharmacologic alternatives if a patient is cheeking risperidone.

Long-acting risperidone injection or liquid/quick-dissolving oral formulation.

Explain the purpose of the AIMS scale.

To monitor and rate abnormal involuntary movements, helping detect tardive dyskinesia early.

Legal blood-alcohol concentration (BAC) for intoxication in most U.S. jurisdictions?

0.08 g/dL.

Define binge drinking for men and women.

BAC of 0.08 g/dL within 2 hours—typically 5 drinks for men or 4 for women.

State two early warning signs of problematic alcohol use.

Drinking in secret and morning drinking (eye-opener).

Which vitamin is routinely prescribed to alcohol-dependent patients to prevent Wernicke’s syndrome?

Thiamine (vitamin B1).

Medication used as aversive therapy to maintain alcohol abstinence?

Disulfiram (Antabuse).

Preferred drug class for acute alcohol withdrawal management?

Benzodiazepines.

List three classic symptoms of alcohol withdrawal.

Tremors, diaphoresis, tachycardia, insomnia, anxiety, nausea/vomiting (any three).

What life-threatening condition may appear 48–72 h after heavy alcohol cessation?

Delirium tremens (DTs).

Name the opioid antagonist used to reverse an opioid overdose.

Naloxone (Narcan).

First action after naloxone wakes an overdose victim who refuses transport?

Explain that naloxone’s duration is shorter than opioids; encourage monitoring because respiratory depression can recur.

Give two medications used for long-term maintenance of opioid dependence.

Methadone or buprenorphine (Suboxone/Subutex) or naltrexone (any two).

Key signs of opioid withdrawal (name three).

Yawning, rhinorrhea, muscle cramps, gooseflesh, nausea/vomiting, anxiety, insomnia (any three).

Explain ‘tolerance’ in substance use.

Need for increasing amounts of a substance to achieve the same effect.

What are the four CAGE screening questions?

Cut down, Annoyed by criticism, Guilty feelings, Eye-opener drink in the morning.

Score on CAGE indicating possible alcohol problem?

Two or more ‘yes’ answers.

Which medication can blunt autonomic symptoms of opioid withdrawal but must be monitored for hypotension?

Clonidine.

Identify two nursing interventions to avoid enabling behaviors in substance-use patients.

Set firm limits; confront rationalizations/denial with reality; avoid providing alibis; encourage accountability (any two).

What class of prescription drugs is most commonly misused for anxiety and sleep?

Benzodiazepines.

If a patient repeatedly requests early refills of pain medications, what should the nurse suspect?

Possible prescription drug misuse, tolerance, or developing dependence.

Describe an effective community strategy to prevent prescription drug misuse.

Drug take-back programs or prescription drug monitoring databases to track controlled substances.

Define ‘co-occurring disorder’ (dual diagnosis).

Presence of a substance use disorder alongside a psychiatric disorder.

Why must antipsychotics be tapered rather than stopped abruptly?

Abrupt cessation can cause rebound psychosis, withdrawal symptoms, or relapse; tapering minimizes these risks.

What is the nurse’s role when a patient shows command hallucinations?

Assess content for harm, ensure safety, offer reality-based reassurance, and notify provider if risk of harm exists.

Primary nursing action if patient develops EPS such as acute dystonia on haloperidol?

Administer prescribed anticholinergic (e.g., benztropine) IM/IV and monitor airway.

What is a depot antipsychotic?

Long-acting injectable formulation that maintains therapeutic levels for weeks, improving adherence.

List two signs that differentiate schizophrenia from brief psychotic disorder.

Duration ≥6 months and functional impairment in work/self-care/relationships.

Which defense mechanism is most frequently used by patients with personality disorders in general?

Manipulation.

Why is nurse self-awareness critical when working with personality-disorder patients?

To recognize and manage personal reactions, avoid counter-transference, and maintain therapeutic boundaries.

Describe ‘negative symptoms’ of schizophrenia in one sentence.

Deficits such as blunted affect, avolition, anhedonia, and social withdrawal that remove normal functioning.