Download Document

Dissociative Disorders
Dissociative D/Os
• Dissociative Amnesia
• Dissociative Identity D/O, aka Multiple Personality D/O
• Depersonalization D/O
– Define
» Depersonalization
» Derealization
DID
• Historically caused from childhood trauma
such as physical, emotional or sexual abuse.
• A learned method for avoiding stress and
anxiety
• Develops dissociation to defend against pain
and the memory of it
• An alter personality holds the painful memory
Depersonalization Disorder
• 1- Recurrent experience of feeling detached from
and outside of one’s mind or body
• 2-Reality testing is normal
• 3- Causes impairment of social and occupational
functioning
Dissociative Amnesia
• Inability to recall important personal information
which is often of stressful events
Dissociative Fugue
• Inability to recall where they are. Wander off
Outcome goals through therapy
•
•
•
•
•
Can verbalize clear personal identity
Will have decreased stress
Will develop coping strategies
No self injury
Will require psychotherapy in milieu setting
Personality Disorders
• Common Diagnostic Criteria
–Based on personality patterns or
traits that are inflexible,
maladaptive, and cause significant
impairment or distress in social or
occupational functioning
Personality Disorders
• In Personality disorder, the traits are rigid and
exaggerated leading to dysfunction in their
relationships
• -inflexible and maladaptive response to stress
• -disability in work and personal relationships
• Self defeating cycle of behavior
• They feel like everyone else is like them and they
don’t feel odd or different
• If anything it is you not I that have the problem
•
•
•
•
•
•
•
•
•
Traits:
Fear of rejection
Blurring of boundaries
Insensitive to others needs
Demanding/fault finding
Can’t trust
Passive-aggressive
Will provoke conflict
Splitting- Expressing loving and hating at one time
Cluster A
• Odd & Eccentric
– Paranoid
– Schizotypal-avoid relationships, unusual beliefs, odd
behavior, magical thinking,eccentric
– Schizoid-Isolated, lonely, flat affect,cold,could show
interest in math,science but not in relationships
– Can later develop schizophrenia
•
•
•
•
•
•
•
•
•
Traits:
Fear of rejection
Blurring of boundaries
Insensitive to others needs
Demanding/fault finding
Can’t trust
Passive-aggressive
Will provoke conflict
Splitting- Expressing loving and hating at one time
Paranoid personality
• Hallmark- unfounded distrust and
suspiciousness of others
• Sx: jealous, controlling, unwilling to forgive
• Family hx- rage and humiliation
• Defense mech. Use-projection. Blame others
for their mistakes
• Usually reject treatment due to distrust in
others
Schizoid Personality Disorder
• Emotional detachment-loners no
relationships,shy
• Will function well in jobs that don’t require
much interaction with others.
• Family hx- cold and neglectful home
• Can lead to schizophrenia
• Antidepressants are given and psychotherapy
aimed at teaching social cues from others
Cluster B
• Dramatic & Emotional/Erratic
•
•
•
•
•
CHAOS!!
1-lack of sense of identity
2-unstable relationships
3-feelings of anxiety
4-chronic depression
• Characteristics
– Unstable interpersonal
relationships
– Dysfunctional behavior
– Affective instability
– Cognitive dysfunctions
– Manipulative
– Aggressive & irritable
– Deceitful
– Impulsive & reckless
– Egocentric & grandiose
– Superficial charm
Cluster B
Histrionic Personality Disorder
• Emotional attention seeking
• Impulsive and melodramatic
• Sometimes flirtatious and provocative
Relationships difficult as partner feels smothered
or reacts to insensitivity of the histrionic person
• Family hx- Intense attachment to opposite sex
parent and feels fear of same sex parent in
retaliation
• Tx-psychotherapy and sometimes
antidepressants help
Narcissistic Personality Disorder
• Appear arrogant with inflated view of self
• Needs constant admiration and shows lack of
empathy for others
• Feels intense shame and fear of abandonment
• Family hx- childhood neglect and criticism.
Doesn’t learn people can be a source of comfort
and support
• Tx- psychotherapy cognitive-behavioral therapy,
family therapy, group therapy. No medications
Antisocial Personality Disorder
• Also known as sociopaths
• Start seeing sx in late teen years
• Sx- antagonistic behavior for personal gains,
hostile, high risk behavior, disregard for
responsibility. Criminal misconduct and substance
abuse common
• Seek personal power, pleasure and in
relationships only focus on their needs, no
capacity for intimacy
• Profound lack of empathy but can act caring and
charming to manipulate others
Borderline Personality Disorder
• Instability in emotional control, impulsively,
identity or self image distortions, unstable mood
and unstable relationships
• Emotional liability rapidly moving from one
emotion to another usually out of proportion to
the situation
• Pathological fear of separation and rejection
• Impulsive with no thought to consequences
• Self destructive behaviors-cutting, promiscuous
sexual activity, chronic suicidal attempts
Nursing dx-borderline
•
•
•
•
•
•
Self-mutilation
Risk for suicide
Risk for self directed violence
Social isolation
Impaired social interaction
Disturbed personal identity
• Anxious-Fearful
– Dependent
– Obsessive-Compulsive
– Avoidant
• OCD
Cluster C
Avoidant personality
• Sensitive to rejection and avoid situations that need
socialization
• Desire for affection and acceptance
• Fearful of disappointment and criticism
• Low self esteem, feel inferior to peers
• They withdraw
• Family hx- parental and peer rejection and criticism
• Tx- Antidepressants work well especially SSRI’s
• Individual and group therapy to address anxiety
symptoms and handling situations
Dependent Personality Disorder
• Much need to be cared for leading to
submissiveness and fears of abandonment
and separation
• Family hx: overdependency demanded from
parents punishment of independent behaviors
• Tx- psychotherapy aimed at greater
independence and ability to form meaningful
healthy relationships (cognitive-behavioral)
OCPD-Obsessive compulsive
personality disorder
• Orderliness, perfectionism, control,neatness
• Inflexible
• Obsessed with rules and details and follows them
rigidly
• Lack of sense of humor
• Limited interpersonal skills
• Uncomfortable with anything they cant control
• Family hx- excessive parental criticism, control, shame
• Tx- SSRI’s, group therapy to share and learn from
others
• All personality disorders show inflexibility,
problems with relationships, impaired social
functioning
• All are usually caused by a combination of
biological and psychosocial factors
NUR271 Psych/Mental Health
Nursing
Childhood Issues
Factors
• Genetic
• Biochemical –decreases in norepinephrine
and serotonin levels
• Environmental –abuse and
neglect,poverty,maternal psychiatric problems
Child/Adolescent D/O
• Pervasive Developmental D/Os
– Autistic D/O
• Impairment in social interaction
• Impairment in communication &
imaginative play
• Restricted repetitive & stereotyped
patterns of behavior, interests, and
activities
• May involve some degree of mental
retardation
– Asperger’s D/O
Nursing Diagnoses
• Risk for self-mutilation
• Impaired verbal
communication
• Impaired social interaction
Autistic D/O
• Interventions
– Milieu Therapy
• Assign same nurse to work with child one-to-one
• Develop ways to relate to the child
• Underlying factors (anxiety, distress) that trigger self-mutilating
behaviors
• Intervene with diversion or replacement activities
• Provide support & guidance for ADL’s
• Provide familiar objects
• Give positive reinforcement for desired responses
• Treatments
– Therapeutic drawing, play, games
• Psychopharmacology
Child/Adolescent D/O
• Attention Deficit
Hyperactivity D/O (ADHD)
Conduct D/O
• Oppositional Defiant D/O
• Anxiety D/Os
– Separation Anxiety D/O
– Posttraumatic Stress D/O
(PTSD)
Signs/Symptoms of ADHD
• Difficulty performing ageappropriate tasks
• Inattention
• Impulsivity
• Distractible
• Hyperactive
• Disturbed self-esteem
• Disturbed social interactions
• Disruptive and intrusive
• Labile mood
• Aggressive
• Injury prone
Nursing Diagnoses
• Risk for injury
• Impaired social
interaction
• Low self-esteem
ADHD
• Interventions
–
–
–
–
–
–
–
Ensure child safety
Set limits
Establish realistic goals
Establish consequences for misbehavior
Communicate calmly, clearly and concisely
Encourage child to seek assistance
Make eye contact with child
• Treatments
–
–
–
–
–
Techniques for managing disruptive behaviors
Behavioral therapy
Therapeutic games
Art Therapy
Family teaching
Psychopharmacology
• Stimulants
– methylphenidate
• Ritalin, Ritalin SR, Methylin ER,
Metadate ER & CD, Concerta
– dexmethylphenidate (Focalin &
Focalin XR)
– dextroamphetamine (Dexedrine)
– amphetamine mixture (Adderall &
Adderall XR)
• Non-stimulant
– atomoxetine (Strattera)