Transcript Mental Health Nursing II NURS 2310

Mental Health Nursing II
NURS 2310
Unit 12
Personality Disorders
Objective 1
Exploring personality disorders and
the common characteristics
associated with each
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.
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
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
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
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, selfimage, and affect/mood
– extreme impulsitivity
– tries to avoid real or imagined abandonment
at any cost
– recurring suicidal behavior, gestures, threats
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 selfimportance
– need for admiration
– lack of empathy
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
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
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
Objective 2
Examining therapies appropriate for
clients with a personality disorder

Interpersonal psychotherapy
– cornerstone of effective treatment
– therapy modalities are long-term
Psychoanalytical psychotherapy
 Milieu or group therapy
 Cognitive behavioral therapy (CBT)
 Psychopharmacology

– Anxiolytics
– Antidepressants
Objective 3
Reviewing the use,
classifications, side effects, and
nursing care related to
medications for personality
disorders
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

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
Objective 4
Applying the nursing process to a
client with a personality disorder

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

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