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Personality Disorders Substance Disorders

Personality Disorders Substance Disorders. Personality Disorders. Objectives Identify the 3 clusters of personality disorders Describe the major characteristic of personality disorders from each cluster Formulate nursing diagnosis and plan for interventions

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Personality Disorders Substance Disorders

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  1. Personality Disorders Substance Disorders

  2. Personality Disorders Objectives • Identify the 3 clusters of personality disorders • Describe the major characteristic of personality disorders from each cluster • Formulate nursing diagnosis and plan for interventions • Discuss issues related to the nursing care- ethical and cultural consideration

  3. Introduction • Lifelong, inflexible, dysfunctional patterns or relating and behaving -> distress to others, not to themselves unless from others’ reactions or behaviors toward them. • Listed on DSM axis II – with others • Mostcommonly treated – borderline personality disorder • Interventions focus primarily on N-P R • Etiology – combination of psychosocial & biological variables

  4. Criteria for a personality disorder Disturbances in 2 or more of the following • Cognition (thinking about self, people, & events) • Affectivity (range, intensity, lability, & appropriateness of emotional response) • Interpersonal functioning • Impulse control

  5. Clusters A. Odd or eccentric behaviors Paranoid, schizoid, schizotypal personality disorder B. Dramatic, emotional or erratic behaviors Antisocial, borderline, histrionic, narcissistic personality disorder C. Anxious or fearful behaviors Avoidant, dependent obsessive-compulsive disorder

  6. Odd- eccentric cluster of PD

  7. Criteria for paranoid personality disorder • Suspicious of others • Doubt trustworthiness or loyalty of friends & others • Fear of confiding in others • Suspicious, without justification, of spouse’s or sexual partner’s fidelity • Interpret remarks as demeaning or threatening • Hold grudges toward others • Become angry & threatening when they perceive they are attacked by others

  8. Criteria for schizoid personality disorder • Lacks desire for close relationships or friends • Chooses solitary activities; a lifelong loner • Little interest in sexual experiences • Avoids activities • Appears cold & detached • Lacks close friends • Appears indifference to praise or criticism

  9. Criteria for schizotypal personality disorder • Ideas of reference • Magical thinking or odd beliefs • Unusual perceptual experience, including bodily illusion • Odd thinking & vague, stereotypical, overlaborate speech • Suspicious • blunted or inappropriate affect • Odd or eccentric appearance or behavior • Few close relationships • Excessive social anxiety

  10. Dramatic-erratic cluster of PD

  11. Criteria for antisocial personality disorder • Deceitfulness as seen in lying or conning others • Engages in illegal activities • Aggressive behavior; violence • Lack of guilt or remorse • Irresponsible in work & with finances • Impulsiveness • Reckless disregard of safety for self or others • Insensitivity

  12. Criteria for borderline personality disorder • Frantic avoidance of abandonment; real or imagined • Unstable & intense IPR; Identity disturbances • Impulsivity; Affective instability • Recurrent suicidal behavior or self-mutilating behavior – to express feelings of anger/frustration • Rapid mood shifts • Chronic feelings of emptiness • Transient dissociative & paranoid symptoms

  13. Criteria for narcissistic personality disorder • Grandiose self-importance • Fantasies of unlimited power, success, or brilliance • Believes he/she is special or unique; Needs to be admired • Sense of entitlement (i.e., deserves to be favored or given special treatment) • Takes advantage of others for own benefit • Lacks empathy • Envious of others or others are envious of him/her • Arrogant or naughty

  14. Criteria for histrionic personality disorder • Needs to be center of attention • Displays sexually seductive or provocative behaviors • Shallow, rapidly shifting emotions • Uses physical appearance to draw attention • Uses speech to impress others but is lacking in depth • Dramatic expression of emotion • Easily influenced by others • Exaggerates degree of intimacy with others

  15. Anxious-fearful cluster of PD

  16. Criteria for dependent personality disorder • Unable to make daily decisions without much advice & reassurance • Needs others to be responsible for important areas of life • Seldom disagrees with others because of fear of loss of support or approval • Problem with initiating projects or doing things on own because of little self-confidence • Performs unpleasant tasks to obtain support from others • Anxious or helpless when alone because of fear of being unable to care for self • Urgently seeks another relationship for support & care after a close R ends • Preoccupied with fear of being alone to care for self

  17. Criteria for avoidance personality disorder • Avoids occupations involving interpersonal contact because of fears of disapproval or rejection • Uninvolved with others unless certain of being liked • Fears intimate Rs due to fear of shame or ridicule • Preoccupied with being criticized or rejected in social situations • Inhibited & feels inadequate in new interpersonal situations • Believes self to be socially inept, unappealing, or inferior to others • Very reluctant to take risks or engage in new activities due to possibility of being embarrassed

  18. Criteria for obsessive-compulsive personality disorder • Preoccupied with details, rules, lists, organization • Perfectionism that interferes with task completion • Too busy working to have friends or leisure activities • Over conscientious & inflexible • Unable to discard worthless or worn-out objects • Others must do things his/her way in work or task related activity • Reluctant to spend and hoards money • Rigid and stubborn

  19. Related Nursing Diagnoses • Anxiety • High risk for self-mutilation • Hopelessness • Impaired communication • Ineffective individual coping • Self-esteem disturbance • Social isolation

  20. Nursing Care • Nurse-Patient relationship – trust, empathy, authenticity • Focus on specific behaviors, distress to self or others or both & awareness of dysfunctional & self-defeating patterns • Case management – stress reduction & crisis intervention • Assertive training; Social skill training • Psychobiological therapy (with caution) • Milieu therapy – setting limits

  21. Conclusion • Personality traits -> individualization • Disorder = rigid, dysfunctional, distress • Distress come from others’ reaction to or behaviors toward that person -> evoke interpersonal conflict • Usually have more than one DSM diagnosis • Long-term hospitalization is unnecessary • Limit setting – multidisciplinary work • Px - have a fairly good prognosis only with therapy

  22. Substance-related disorders Objectives • Understand terminology & criteria for diagnoses • Describe personal and societal toll caused by substance abuse • Formulate nursing diagnosis, care plan and interventions • Recognize the relapse symptoms

  23. Introduction • Epidemiology - # 1 health problem in the US -> effects on cost, quality of life, society • Types - Alcohol, tobacco, other drugs ie opium, heroin, codeine, synthetic narcotics. • Cigarettes and alcohol – gateway drugs • History – medical use, social use, illegal use • Central nervous system (CNS) was affected • Substance dependency – Client experiences tolerance and withdrawal symptoms

  24. Substance • Prescribed medications i.e. Ritalin, OxyContin • Over-the-counter cough, cold, sleep, and diet medication • Narcotics ie. Heroin, morphine, demerol, methadone • Inhalants • Hallucinogen ie. Marijuana, LSD, PCP… • Stimulants ie. cocaine, amphetamines

  25. Other Substance & Trends • Club drugs ie MDMA (ecstasy), GHB, Rohypnol, ketamine, methamphetamine, LSD • CNS depressants ie. Valium, phenobarbital • Steroids • 1960 – hallucinogens, amphetamines – • 1970 – heroin, marijuana, sedatives • 1980 – cocaine – injection, smoking

  26. Terminology • Dependence – physical & psychological • Codependence - • Tolerance – • Cross-tolerance – • Withdrawal – abstinence syndrome • Dual diagnosis - • CAGE – cutdown, annoy, guilty, eye opener • Blackout -

  27. A continuum of substance use

  28. Comorbidity & drug abuse a variety of diseases commonly co-occur with drug abuse and addiction (e.g., HIV, hepatitis C, cancer, cardiovascular disease) Drug abuse is a complex brain disease characterized by compulsive, at times uncontrollable drug craving, seeking, and use despite devastating consequences— behaviors that stem from drug-induced changes in brain structure and function. These changes occur in some of the same brain areas that are disrupted in other mental disorders, such as depression, anxiety, or schizophrenia.

  29. Drug Use and Other Mental Disorders Many people who regularly abuse drugs are also diagnosed with mental disorders and vice versa. persons diagnosed with mood or anxiety disorders, antisocial syndrome (antisocial personality or conduct disorder) are about twice as likely to suffer also from a drug use disorder (abuse or dependence) compared with respondents in general. persons diagnosed with drug disorders are roughly twice as likely to suffer also from mood and anxiety disorders

  30. Higher prevalence (%) of Mental Disorders among Patients with Drug Disorders National Epidemiologic Survey on Alcohol and Related Conditions (Conway et al., 2006).

  31. Smoking & mental illness more than 40 percent of the cigarettes smoked in this country are smoked by individuals with a psychiatric disorder, such as major depressive disorder, alcoholism, post-traumatic stress disorder (PTSD), schizophrenia, or bipolar disorder. smoking by patients with mental illness contributes greatly to their increased morbidity and mortality.

  32. Higher Prevalence (%) of Smoking among Patients with Mental Disorders 1989 U.S. National Health Interview Survey (Lasser et al., 2000).

  33. Concerns of drug abuse Drugs of abuse can cause abusers to experience one or more symptoms of another mental illness. Mental illnesses can lead to drug abuse – a form of self-medication Both drug use disorders and other mental illnesses are caused by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma.

  34. Etiology • Biological theories – genetic predisposition • Psychological theories – psychoanalytic theories, interpersonal theories • Family theories – family system theory • Learning theories – positive effect of mood alternations, media reinforcement, peer pressures • Psychosocial and behavioral factors increase the client’s vulnerability to drug or alcohol abuse.

  35. Perinatal concerns • 25-30% of women expose their children to nicotine in utero • 3 out of every 5 women of childbearing age drink alcohol • 10% of women of childrearing age use an illicit drug • Substances = teratogens -> malformations in the fetus, intrauterine growth retardation, subtle mental and behavioral deficits.

  36. Fetal Alcohol Syndrome (FAS) • Low birth weight • Certain facial characteristics ie. microcephaly, microthalmia, short palpebral fissures, poorly developed philtrum, thin upper lip, short nose, small chin, flattening of the maxillary area • Neurological abnormalities ie developmental and/or intellectual delays; it is a preventable cause of mental retardation • Fetal Alcohol Effect (FAE)- Less severe cases

  37. Other problems of FAS & FAE • Other organs – heart, hearing, visual, dental, genital anomalies • Hyperactivity, poor coordination, short attention spans, dependency, social withdrawal, impulsivity… • Co-morbidity • Depression, anger, suicidal ideation, antisocial behaviors • Preventable health problem for children

  38. Adolescent Substance Abuse • Health & social problem • School drop-out • Victim of abuse – child/parental, sexual • Experienced trouble with law • Suicide attempts • Feelings of inferiority, history of mental problems

  39. Signs of Adolescent Drug Use • Sudden behavioral changes • Sweating, especially at night • Needle marks • Inebriation (intoxicated, drunk) • Change in nutritional intake • Nasal congestion • Rhinorrhea with cocaine use • School problems

  40. Warning Ss of Teen Sub. Abuse

  41. Prevention of Adolescent substance Use • Positive role modeling • Reinforce positive behaviors • Support – cope with social pressure • Establish normative expectations • Help to anticipate pressures • Involve in life skills training programs • Open communication

  42. Alcohol Abuse • Body damage - brain cell -> neurological S/S Liver, G-I, muscle, heart, sexual function … • Blackouts – • Wernicke’s syndrome - intact intellectual function but poor memory, ataxia, confusion, vit B deficiency • Korsakoff’s syndrome – disorientation • Alcohol withdrawal syndrome (AWS) - • Alcohol withdrawal delirium - Delirium tremens (DT) – confusion, disorientation, hallucination, tachycardia, tremor, …

  43. Wernicke’s encephalopathy • Clouding of consciousness with an abrupt onset of confusion and mental status changes along with drowsiness. • Ocular motor abnormalities. • Ataxia of gait from weakness in limbs or coordination of muscles or poor balance

  44. Korsakoff syndrome • Difficulty in acquiring new information or learning new skills • Lack of insight into their deficit • Amnesia • Impaired short term memory • Tendency for confabulation • Apathy • Inattention • Impaired fine motor skills • Impaired sense of smell • Talkative an repetitive behaviors

  45. Treatment of WKS • IV or IM thiamine • Medications • Cholinersterase inhibitors • Atypical antipsychotics • SSRI • Alcohol cessation • Dietary consumption

  46. Clinical Description • Denial • Dependence – compulsive use • Abuse – dysfunction in work, … • Intoxication • Withdrawal • Delirium • Psychotic disorders

  47. Alcohol-related Disorders

  48. Alcohol • Detoxification – 3Ss- • Secure environment • Sedation • Supplements

  49. CNS depressant - Narcotics • Opioids – endorphin agonist, euphoria • Increasing pain threshold, reducing anxiety and fear • Decreased pulmonary ventilation/esp. elders • Respiratory depression in neonates/preg • Withdrawal is rarely fatal, but painful ie yawning, tearing, rhinorrhea, sweating, flushing, tachycardia, tremor, restlessness, irritability, muscle spasm, fever, nausea, diarrhea, vomiting, repetitive sneezing, abdominal cramps, backache

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