Obsessive Compulsive Personality Disorder By Rey-Ryan Mapiles | FEB 24, 2011 Obsessive Compulsive Personality Disorder Definition a pattern

of preoccupation with orderliness, perfectionism, and control Findings display an excessive devotion to work and productivity to the exclusion of leisure activities and friendships. there may be a great concentration on household chores, excessive cleaning unable to discard objects which are worn out or worthless, even when no sentimental value is attached. They are termed pack rats have difficulty working with others on a project, believing their way is the best way to accomplish the task. Tend to prefer to work alone tend to be rigid and stubborn (DSM IV TR) Treatment psychopharmacology: medication used to treat findings such as anxiety or depression. psychotherapy Nursing Care in Obsessive Compulsive Personality Disorder avoid engaging in power struggles as the need for control is high in these clients promote a predictable, structured schedule as much as possible notify about changes to schedule ahead of time to allow the client to plan Anxiety Disorders By Rey-Ryan Mapiles | FEB 24, 2011 Anxiety Disorders Definition: group of disorders in which anxiety is predominant symptom. Degrees range from mild anxiety to severe (panic attack) Seven types of Anxiety Disorders GAD: generalized anxiety disorder phobic disorders panic disorder dissociative disorder somatoform disorder obsessive-compulsive disorder (OCD) PTSD: Post-traumatic stress disorder Etiology found equally in men and women hereditary predisposition biochemical dysfunction decreased ability of GABA receptors to decrease anxiety current belief that the norepinephrine system mediates the fight/flight response; anxiety may be affected by an inappropriate activation of this system

problems in the neurotransmission of serotonin may also be the cause of anxiety disorders; medications that regulate serotonin (SSRIs) have been effective in treating some anxiety disorders Genetic Factors twin studies show that if one twin has an anxiety disorder, the second twin is more likely to have the disorder if they are identical twins psychologic and interpersonal factors early psychic trauma pathogenic parent-child relationship pathogenic family patterns loss of social supports Findings fear, dread, or apprehension feeling powerless crying irritability scattered thoughts, inability to concentrate or solve problems preoccupation with self rapid speech, hyperventilation, tachycardia palpitations, chest pains, jittery behavior diaphoresis insomnia diarrhea and/or urinary urgency and frequency Treatments for Anxiety Disorders Pharmacologic: anxiolytics (antianxiety drugs) such as alprazolam (Xanax) and diazepam (Valium) psychotherapy occupational therapy recreational therapy Nursing Care For Anxiety Disorders provide a nondemanding environment; stay with client if indicated acknowledge clients feelings of fear, worry, helplessness do not force contact with feared item or situation if client demonstrates compulsive behavior, allow the compulsion but set reasonable limits provide distracting activities allow temporary dependence speak calmly, slowly and clearly assist client in ADL as indicated encourage relaxation techniques and regular physical exercise administer medications as ordered limit caffeine intake limit contact with other clients or family members who are also anxious teach client medications and side effects relaxation techniques identify triggers

explore alternative behaviours Definition: the client demonstrates pervasive distrust and suspiciousness of others assumes that others will exploit or harm them preoccupied with unjustified doubts about the loyalty or trustworthiness of friends regardless of the lack of evidence (DSM IV TR) Findings suspicious of other people and of health care providers misinterpret others mistakes as deliberate attempts to harm client tend to bear grudges and not forgive others for mistakes reacts angrily to what is perceived as an insult attracted to cults where others have similar suspicions to their own needs to feel in control in relationships may experience short-term psychosis Treatment psychopharmacology: may be resistant and untrusting of medication; antipsychotics may relieve psychotic symptoms psychotherapy: Assess ability to tolerate any group-oriented treatment; may be too threatening Nursing Care in Paranoid Personality Disorder encourage a structured, predictable schedule nurses manner needs to be detached but supportive bring medications with individual packets closed avoid arguing with the client client may be distrustful of praise, viewing the nurse as attempting to be controlling give the client an option whenever possible

Nursing Care in Borderline Personality Disorder By Rey-Ryan Mapiles | FEB 24, 2011 Nursing Care in Borderline Personality Disorder protect client and others from harm administer medications as ordered establish a trusting relationship set limits, and provide a structured environment use a calm, controlled approach; see that other staff stay consistent do not argue with client encourage client to evaluate consequences of actions divert anger, or let client ventilate it in positive ways set limits on manipulative behaviors by communicating expected behaviors teach client medications and their side effects anger-control strategies

relaxation strategies Nine Infective Communication Techniques 1. Giving advice Telling the client what to do. Giving an opinion or making decisions for the client. Implies the client cannot handle life decisions and that the nurse is accepting responsibility for client. 2. False reassurance - Using clichs, pat answers, cheery words and comforting statements as an attempt to reassure client. 3. Changing the Subject Introducing new topics inappropriately. May result from poor listening skills 4. Social Response Responding in a way that either focuses attention on the nurse instead of the client, or is not goal-directed on behalf of the client. 5. Invalidation Ignoring or denying the clients thoughts or feelings. 6. Overloading Talking rapidly, changing subjects or asking for more information than can be absorbed at one time; for example, asking two questions at once. 7. Underloading Remaining silent and unresponsive, not picking up cues and failing to give feedback. 8. Incongruence Sending verbal and nonverbal messages that contradict one another; often called a double message. 9. Value Judgments Giving ones own opinion, evaluating , moralizing or implying ones own values by using words such as should, ought, good, or bad.

Types of Defense Mechanisms By Rey-Ryan Mapiles | FEB 24, 2011Types of Defense Mechanisms 1. Compensation extra effort in one area to offset real or imagined lack in another area Example: Short man becomes assertively verbal and excels in business. 2. Conversion A mental conflict is expressed through physical symptoms Example: Woman becomes blind after seeing her husband with another woman. 3. Denial treating obvious reality factors as though they do not exist because they are consciously intolerable Example: Mother refuses to believe her child has been diagnosed with leukemia. She just has the flu. 4. Displacement transferring unacceptable feelings aroused by one object to another, more acceptable substitute

Example: Adolescent lashes out at parents after not being invited to party. 5. Dissociation - walling off specific areas of the personality from consciousness Example: Adolescent talks about failing grades as if they belong to someone else; jokes about them. 6. Fantasy a conscious distortion of unconscious wishes and need to obtain satisfaction Example: A student nurse fails the critical care exam and daydreams about her heroic role in a cardiac arrest. 7. Fixation becoming stagnated in a level of emotional development in which one is comfortable Example: A sixty year old man who dresses and acts as if he were still in the 1960s. 8. Identification subconsciously attributing to oneself qualities of others Example: Elvis impersonators. 9. Intellectualization use of thinking, ideas, or intellect to avoid emotions Example: Parent becomes extremely knowledgeable about childs diabetes. 10. Introjection incorporating the traits of others Example: Husbands symptoms mimic wifes before she died. 11. Projection unconsciously projecting ones own unacceptable qualities or feelings onto others Example: Woman who is jealous of another womans wealth accuses her of being a gold-digger. 12. Rationalization justifying behaviors, emotions, motives, considered intolerable through acceptable excuses Example: I didnt get chosen for the team because the coach plays favorites. 13. Reaction Formation expressing unacceptable wishes or behavior by opposite overt behavior Example: Recovered smoker preaches about the dangers of second hand smoke. 14. Regression retreating to an earlier and more comfortable emotional level of development Example: Four year old insists on climbing into crib with younger sibling. 15. Repression unconscious, deliberate forgetting of unacceptable or painful thoughts, impulses, feelings or acts Example: Adolescent forgets appointment with counselor to discuss final grades. 16. Sublimation diversion of unacceptable instinctual drives into personally and socially acceptable areas. Example: Young woman who hated school becomes a teacher. Etiology of Mental Health and Mental Illness A. Biochemical research

Much productive research has been focused in this area in the past few decades Study of the brain and its functioning has helped researchers understand which parts of the brain are involved in each mental illness Medications are increasingly more effective as a result of better understanding of the neurotransmitters involved and their functioning The major neurotransmitters are norepinephrine, dopamine, serotonin, and gamma-aminobutyric acid (GABA) Neuroimaging through the PET scan or the CT and MRI allows researchers and diagnosticians to study the brain without surgery Researchers and diagnosticians can study brain functioning through the use of PET scans and other techniques B. Genetic research Studies for genes that cause mental illness are difficult and inconclusive They do show that familial and genetic factors are part of most major psychiatric illnesses C. Psychological theories Psychoanalytic theory developed by Sigmund Freud introduced concept of the mind as a structure incorporating the id, ego and superego part of each persons mental functioning is conscious and part unconscious treatment includes helping make the unconscious conscious Defense mechanisms are used to defend the ego from conflicts between the id and superego