Ch24 PPT

Clinical disorders dividing into clusters:
- Cluster A (Odd, Eccentric):
  - Paranoid
  - Schizoid
  - Schizotypal
- Cluster B (Dramatic, Erratic):
  - Narcissistic
  - Histrionic
  - Antisocial
  - Borderline
- Cluster C (Anxious, Fearful):
  - Avoidant
  - Dependent
  - Obsessive-Compulsive

Key questions in personality disorders:
- Are they inherited?
- Is brain structure affected?
- What is the role of repression, suppression, regression, undoing, and splitting?
- How much does the environment impact development?
Diathesis-Stress model: Explanation needed for understanding development.

Characteristics:
- Distrustful, suspicious, hypervigilant.
- Overuse of projection.
- difficult relationship due to their jealousy, controlling behavior and unwillingness to forgive
Treatment:
- Often reject treatment.
- Antianxiety drugs; antipsychotic medications for delusions.

Characteristics:
- Social withdrawal, emotionally detached.
- Functions poorly in social settings, feels like an 'observer'.
- Limited emotional expression.
Treatment:
- Medications: Bupropion, Risperidone, Olanzapine.
- Psychotherapy
- group therapy is isn’t the first choice should be tried after individual work.
- avoid being too friendly or too nice

Characteristics:
- Severe social and interpersonal deficits.
- Extreme social anxiety,
- odd ideas or behaviors,
- rambles in conversation—unclear, overly detailed,
- paranoid ( thinks ppl are out to get them)
- magical thinking.
Treatment:
- Low-dose antipsychotic medications; focus on treating symptoms.
- respect pt need for social isolation
- aware of pt suspiciousness and use appropriate intervention.

Characteristics: drama queen
- Attention-seeking behavior, self-centered, low frustration tolerance, excessive emotionality, seductive behavior.
Treatment:
- Individuals do not typically see a need for help; psychotherapy is recommended.
- help pt clarify their feelings, as they often have difficulty identifying them.

Characteristics:
- Arrogant, inflated self-importance, need for constant admiration, lack of empathy, feelings of entitlement.
- they suffer from weak self-esteem and hypersensitivity to criticism
- have intense shame and fear of abandonment
Treatment:
- No specific medications; cognitive-behavioral therapy may be utilized.
- remain neutral and recognize the source of narcissistic behavior
- avoid engaging in power struggles.
- don’t directly challenge grandiose statements.

Characteristics:
- Anxious or fearful traits, feelings of insecurity and inadequacy.

Characteristics:
- Low self-esteem, poor social function, avoidance of new experiences.
Treatment:
- SSRIs- citalopram (celexa)
- SNRIs- venlafaxine (effexor)
- psychotherapy and group therapy.
- nurse should use a friendly, accepting, and reassuring approach.
- assertiveness training

Characteristics:
- Submissive, insecure, easily taken advantage of, struggles with independence.
- clinging behavior related to an overwhelming need to be cared for. ( intense fear of separation)
Treatment:
- Psychotherapy and Cognitive Behavioral Therapy can help pt develop more healthy and accurate thinking by examining and challenging thoughts of fear; no specific medications.

Characteristics:
- Rigidity, inflexible standards, self-defeating pursuit of goals, emotional expression limitations.
- persist in goal-seeking behavior
Treatment:
- Clomipramine (Anafranil), fluoxetine (Prozac) psychotherapy, group therapy, self-help groups.
- help pt to identify ineffective coping and develop better coping techniques

Characteristics:
- Sociopathic behavior,
- dishonesty,
- manipulation
- hostile
- callousness( lack of remorse/empathy), high-risk taking,
- impulsivity,
- potential for substance abuse,
- criminal acts.
Treatment:
- Often forced into treatment;
- challenging cases with the potential for suicides and violence.
- Non-FDA approved medications; Lithium may help with aggression; Valproic acid(depakot) for mood stabilization.
- set limits

Characteristics:
- Marked instability in emotional control,
- identity distortions,
- impulsivity acting quickly in response to emotions
- unstable moods and relationships,
- emotional lability—rapidly moving from one emotional extreme to another
- potential for a high mortality rate (approx. 10%).
- self destructive behavior

Biological factors: Genetic having 5 times more common in 1st-degree biological relatives
neurobiological influence-
Psychological factors: Interaction with environmental factors.
Diathesis-stress model: Understanding the combination of predispositions and stressors.

Assessment tools include:
- Minnesota Multiphasic Personality Inventory (MMPI).
- Comprehensive patient history.

Implementation strategies:
- Focus on safety and teamwork.
- Pharmacological interventions used off-label to address symptoms.
- Emphasize case management support.

Which behavior indicates improvement in a patient with BPD?
- Options include crying, yelling, expressing feelings of safety, or believing they were excused from a group.

Which disorder is splitting most associated with?
- Options: Antisocial, Borderline, Dependent, Schizotypal.

Perfectionism is likely evident in which personality disorder?
- Options: Obsessive-compulsive, Narcissistic, Antisocial, Avoidant.