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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)