Understanding Mood Disorders and Personality Disorders

1. Mental Health Nursing INURS 1300Unit VMental Health Alterations

2. Objective 1Describe the mood disorders • Mood disorder = a condition in which the prevailing emotional mood is distorted or inappropriate to the circumstances • Types of mood disorder • major depression • bipolar disorder • alternation between significantly depressed mood and significantly elevated mood (mania) over time • Mood disorders may present with psychotic symptoms

3. Objective 2Describe the nursing interventions and medical treatment for clients with a mood disorder See Objective 11 for medications for mood disorders

4. Objective 2 (cont’d) Electroconvulsive therapy (ECT) • may be indicated for clients with severe depression that does not respond to other treatment • acts more quickly than medications, and may produce fewer side effects in older clients

5. Objective 2 (cont’d) Nursing diagnoses for clients with a mood disorder – • Risk for self-directed violence R/T suicidal feelings • Risk for violence directed toward others R/T homicidal ideation • Low-self esteem R/T depression • Imbalanced nutrition, less than body requirements R/T lack of interest in food • Disturbed sleep pattern R/T depression

6. Objective 3Describe characteristics of an individual with suicide potential • Females attempt suicide 2-3 times more often than males • Males are 4 times more likely to complete a suicide • Suicide by firearm is the most common method of suicide for both men and women • Risk of suicide is higher for people with psychiatric conditions

7. Objective 3 (cont’d) Specific high-risk populations include – • previous suicide attempt • family history of suicide • suicide of a loved one, friend, co-worker, colleague, or role model • suicide pacts • anniversary dates • ANYONE THREATENING SUICIDE

8. Objective 4State common age groups for suicide • Adolescents • leading cause of death for people ages 13-18 • considered a solution to an environmental or psychological problem • experience hostility toward themselves • seek revenge on others by hurting themselves

9. Objective 4 (cont’d) • Elderly • Caucasian males over the age of 70 have the highest rate of suicide • fewer attempts, but more completed • methods more lethal • decreased ability to survive attempt • planned instead of impulsive • bereavement • real or perceived losses • often occur through covert measures • self-inflicted falls • refusing to eat or take medications

10. Objective 5Define personality disorders • A personality disorder is a pattern of perceiving, reacting, and relating to other people and events that is relatively inflexible and that impairs a person’s ability to function socially • Personality traits become rigid and dysfunctional • Personality disorders are chronic and maladaptive, impacting all aspects of one’s life

11. Objective 6Describe the types of personality disorders • Grouped into three clusters according to the traits that describe them • Cluster A traits are behaviors considered odd or eccentric • Cluster B traits consist of dramatic, emotional, and erratic behaviors • Cluster C traits include behaviors that are anxious or fearful

12. Cluster A disorders • Paranoid personality disorder • Schizoid personality disorder • Schizotypal personality disorder • Cluster B disorders • Antisocial personality disorder • Borderline personality disorder • Histrionic personality disorder • Narcissistic personality disorder • Cluster C disorders • Avoidant personality disorder • Dependent personality disorder • Obsessive-Compulsive personality disorder

13. Objective 7Identify the nursing interventions and medical treatments for personality disorders Medical Interventions – • psychotherapy • group therapy • behavior modification • medications • anxiety • depression

14. Objective 7 (cont’d) Nursing diagnoses – • Ineffective coping R/T personality disorder AEB reliance on maladaptive defense mechanisms • Risk for self-harm R/T unresolved fear of abandonment AEB attention-seeking behaviors and threats against self • Depression R/T self-directed anger AEB social withdrawal and isolation

15. Objective 8Describe behaviors of the schizophrenic client and identify causes of schizophrenia Schizophrenia refers to a group of very serious, usually chronic, thought disorders in which the affected person’s ability to interpret the world accurately is impaired by psychotic symptoms

16. Behaviors of schizophrenia • Disordered thinking • Unusual speech • Apathetic personality • Changing behaviors • Social isolation and withdrawal • Distorted perceptions of reality

17. Etiology of schizophrenia • The cause of schizophrenia is unknown • Individuals may be genetically vulnerable to developing schizophrenia • Influencing factors may include environmental exposure to anything that interrupts brain development

18. Objective 9Differentiate the types of schizophrenia • Catatonic type • prominent psychomotor disturbances • stupor • waxy flexibility • Disorganized type • disordered thoughts • flat affect

19. Types of schizophrenia (cont’d) • Paranoid type • delusions • hallucinations • Residual type • low intensity of symptoms • Undifferentiated type • presence of symptoms from more than one subtype of schizophrenia

20. Objective 10Discuss the medical treatment and nursing interventions for the schizophrenic client • Medical treatment for the client with schizophrenia involves therapy modalities and antipsychotic medication • Therapies include psychotherapy, family education, and community support • Hospitalization is often required to treat severe delusions, hallucinations, or self-care deficits

21. Nursing diagnoses for schizophrenia • Disturbed thought processes R/T delusions/concrete thinking/paranoia AEB bizarre statements and behaviors • Disturbed sensory perception R/T hallucinations/illusions AEB inability to tolerate group therapy, talking to self, or looking for or at something that is not there • Impaired verbal communication R/T delayed thinking AEB very slow and delayed speech • Self-care deficit R/T withdrawal and loss of motivation and judgment AEB poor hygiene, poor grooming, and avoiding others

22. Nursing assessment and interventions for a client with schizophrenia Refer to assigned readings for complete nursing assessment of the schizophrenic client Nursing interventions – • use nonconfrontational speech and mannerisms • encourage communication and expression of feelings and fears • decrease stimuli and offer quiet activity • seek clarification of statements • provide recognition for constructive self-care activities • make adjustments in food preparation and service for patients with paranoia

23. Objective 11Identify classifications, uses, actions, and side effects for selected classifications of psychoactive medications as they relate to the above mental health alterationsRefer to Psychoactive Medications handout