1. Mental Health Nursing IINURS 2310 Unit 12 Personality Disorders

2. Objective 1 Exploring personality disorders and the common characteristics associated with each

3. Personality = the totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time. Personality disorder = 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.

4. Personality disorders are grouped into 3 clusters according to the DSM-V • Cluster A: Behaviors are described as odd or eccentric • Cluster B: Behaviors are described as dramatic, emotional, or erratic • Cluster C: Behaviors are described as anxious or fearful

5. 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

6. Characteristics of Cluster A Disorders • Paranoid personality disorder • distrust and suspiciousness • interprets others’ actions as hostile • Schizoid personality disorder • detachment from social relationships • restricted range of emotional expression • Schizotypal personality disorder • acute discomfort with close relationships • cognitive and perceptual distortions • close relationships difficult due to behavioral eccentricities

7. Characteristics of Cluster B Disorders • Antisocial personality disorder • disregard for and violation of the rights of others • lacks remorse • Borderline personality disorder • instability in interpersonal relationships, self-image, and affect/mood • extreme impulsitivity • tries to avoid real or imagined abandonment at any cost • recurring suicidal behavior, gestures, threats

8. Cluster B Characteristics (cont’d) • Histrionic personality disorder • exaggerated and rapidly shifting expression of emotion • attention-seeking behaviors • sexual provocation or seductiveness in an effort to be the center of attention • Narcissistic personality disorder • grandiosity; exaggerated sense of self-importance • need for admiration • lack of empathy

9. Characteristics of Cluster C Disorders • Avoidant personality disorder • social inhibition • feelings of inadequacy • hypersensitive to negative evaluation • preoccupied with being rejected in social situations • reluctance to take personal risks

10. Cluster C Characteristics (cont’d) • Dependent personality disorder • submissive and clinging behavior • excessive need to be taken care of • needs others to assume responsibility for most major areas in life • difficulty initiating actions due to lack of confidence in own judgment and abilities • urgent seeking of relationship as source of care and support

11. Cluster C Characteristics (cont’d) • Obsessive-Compulsive personality disorder • preoccupation with orderliness and control • perfectionism • listing, ordering, or scheduling to the point of redundance • rigid and stubborn

12. Objective 2 Examining therapies appropriate for clients with a personality disorder

13. Interpersonal psychotherapy • cornerstone of effective treatment • therapy modalities are long-term • Psychoanalytical psychotherapy • Milieu or group therapy • Cognitive behavioral therapy (CBT) • Psychopharmacology • Anxiolytics • Antidepressants

14. Objective 3 Reviewing the use, classifications, side effects, and nursing care related to medications for personality disorders

15. Anxiolytics and antidepressants are used to treat the primary disruptive symptoms of personality disorders: anxiety and depression • Anxiolytics include antihistamines, benzodiazepines, and miscellaneous agents like buspirone (Buspar) • Buspar does not depress the CNS like other anxiolytics • Efficacy takes 10 days to 2 weeks • Not useful for PRN dosing • Common side effects are drowsiness, confusion, and lethargy

16. Antidepressants include tricyclics, SSRIs, MAOIs, and miscellaneous agents like bupropion (Wellbutrin) and venlafaxine (Effexor) • Antidepressants in general may decrease seizure threshold • Teach patient that gradual withdrawal is crucial • May increase suicide potential • Common side effects include dry mouth, nausea, and sedation • MAOIs have many concurrent dietary and medication restrictions • Hypertensive crisis is potentially fatal

17. Objective 4 Applying the nursing process to a client with a personality disorder

18. Assessment • Gather information about client’s mood and level of anxiety, thoughts to harm self/others • Diagnosis • Risk for self-directed violence R/T suicidal feelings • Risk for violence directed toward others R/T homicidal ideation • Disturbed sleep pattern R/T depression • Planning • Care plan • Concept map

19. Implementation • Establish trust • Provide for safety • Perform risk assessment • Administer scheduled and PRN medications • Evaluation • Mental health/psychiatric assessment tool • Review safety plan/contract • Assess for medication side effects