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Anxiety, Somatoform, Dissociative, & Personality Disorders

DISORDER CHARACTERISTICS MEDICAL TREATMENT NURSING CARE

Excessive worry/apprehension Relaxation training Assist to ID events that


Generalized Anxiety all the time. Benzodiazepines increase anxiety and those that
Disorder (GAD) Psychotherapy bring calm.
Relaxation
Accompany with activities
when too anxious to attend
alone.

Panic Disorder Episodes can last minutes to Relaxation training Safety is very important for
hours. Benzodiazepines him and others.
There are times when they Aerobic exercise (but be Stay with him during attack.
have no anxiety/panic. careful about panic that can Maintain calm environment.
Great fear of future attacks, so develop secondary to lactic Decrease stimuli as much as
limit lifestyle to prevent. acid buildup/pain in muscles) possible during an attack.
May develop phobias. Use short, clear sentences.
Get him involved in tasks that
are physically tiring to use up
energy .
Help him examine/find what
triggers panic attacks.

Obsessive- Inability to control thoughts Benzodiazepines. Initially, provide time to


(obsessions) and behaviors Non-reinforcement of carry out rituals. Then little
Compulsive (compulsions). Recognizes secondary gains. by little limit rituals (can't go
Disorder rituals are ridiculous but can't Modeling desired behavior. "cold turkey"). Do NOT
stop. The O/Cs greatly Response delay (wait longer interrupt a ritual once it is
interfere with ADLs. Could and longer intervals to act out started. Assist with self care.
be a secondary gain involved. compulsion). Get him to journal about
Thought stopping. events surrounding the O/Cs.

Phobia(s) Intense fear of someone or Benzodiazepines. Don't force.


thing. SSRIs (Paxil- social phobia). Behavioral techniques
Inability to overcome the fear. Behavioral techniques: social Initially adjust environment to
Goes to a lot of trouble to skills training and prevent exposure to object of
avoid the object of the fear. desensitization (exposure in fear.
small doses)

Post traumatic Grieving behaviors after a Benzodiazepines Encourage talk/expression of


major trauma (rape, fire, Antidepressants emotions
Stress Disorder MVA, war, etc.) Individual therapy to gain Be non-judgmental
(PTSD) Sense of powerlessness. cognitive mastery of the Safety
Extreme anxiety situation. Might need suicide
Acute: within 6 months Keep reliving event. precautions.
of event Support group for client and
Delayed: later than 6 family
months

DISORDER CHARACTERISTICS MEDICAL TREATMENT NURSING CARE

Acute Stress Occurs within 1 month of Relaxation techniques Same as PTSD


traumatic event Benzodiazepines
Must display 3 dissociative Individual therapy
symptoms (numbing,
detachment, derealization,
depersonalization,
dissociative amnesia, reduced
awareness of surroundings,
sense of absence of emotional
responsiveness from the
experience)

Somatoform
Disorders:
Conversion Disorder Conversion: Loss of physical Must carefully rule out a Remember it is real to them.
function but no physical physical problem first. Be non-judgmental.
basis (paralysis, blindness, Psychotherapy Encourage self-care as much
etc.). The loss of function is Rehabilitation to overcome as possible.
very real to the client. Could disability. Provide safety.
be a secondary gain. Anxiolytics, antidepressants Monitor for new symptoms.
Suicide precautions.
Support for family.

Hypochondriasis Hypochondriasis: Must carefully rule out Remember it is real to them.


Preoccupation with belief of physical problem first. Be non-judgmental.
having a serious illness. No Psychotherapy. Relaxation techniques, coping
physical basis. Could be Relaxation techniques. skills
secondary gain. Anxious, Anxiolytics, antidepressants. Monitor for new symptoms.
depressed. Suicide precautions.

Somatization Somatization Disorder: Must carefully rule out Listen objectively but don't
Many physical complaints or physical problem first. encourage dwelling on
belief of serious illness over Psychotherapy symptoms.
many years. No physical Anxiolytics, antidepressants. Be non-judgmental.
basis. Involve client in his care.

Factitious Disorder: Careful physical workup. Consider abuse and protocol


Factitious Intentionally produced Usually it is the mother (or for reporting.
physical or psychological other perpetrator) who needs Care for client and
symptoms to gain attention treatment, not the client. perpetrator.
Benzodiazepines
Malingering: symptoms Relaxation techniques
created for a secondary gain. Coping skills

Munchausen's Syndrome:
usually a mother telling of
child's S&S or actually
causing S&S so as to bring
attention to what a good
mother she is.

DISORDER CHARACTERISTICS MEDICAL TREATMENT NURSING CARE

Dissociative
Disorders:
Dissociative Identity Multiple, individual
Disorder personalities within a person

Can't recall personal


Dissociative Amnesia information

Can't recall personal


information and also shows
Dissociative Fugue up somewhere away from
normal place of living.

Out of body experience. Counseling Safety.


Depersonalization Doesn't feel real. Detached. Hypnotherapy Suicide precautions.
Disorder Oriented but has sense of Anxiolytics, antidepressants Encourage verbalization of
one's own reality temporarily feelings. Don't force issues
lost. they aren't ready to
accept/know

Personality All have denial of problems,


thus rarely seek psychiatric
Disorders: help. They are not the
problems--everyone else is.
Rigid, maladaptive behaviors.

Cluster A:
(odd & eccentric)
Neuroleptic therapy. Clarify meanings and contexts
Paranoid Suspicious. Misperceives. Symptoms management. of situations, conversations,
Confrontation not effective. etc. (Can't whisper, etc.)
Develop/nurture trust (He
might have to have foods in
unopened containers, etc.)

Schizoid Distant and aloof. Unable to Outpatient therapy to increase Safety.


form relationships. Usually interpersonal comfort. Allow physical and emotional
solitary. space as needed.
Assist to develop social skills.
Schizotypal Eccentric behavior. Magical
thinking. Difficulty with Neuroleptic therapy. Safety.
relationships. Social skills. Social skills.
Assistance with daily affairs. Assist with ADLs.
Intensive psychotherapy
usually not effective.
DISORDER CHARACTERISTICS MEDICAL TREATMENT NURSING CARE
Cluster B:
(dramatic/emotional)

Antisocial Irresponsible, impulsive. Group psychotherapy. Stable environment.


Manipulates and exploits Confrontation of Consistent and judicious
others. Hostile outbursts. inappropriate behaviors. behavioral limits.
Believes actions are Assist to take responsibility
justified. for consequences of actions.

Borderline Impulsive. Outbursts of Group psychotherapy Stable, structured, consistent


anger/rage. Self-mutilation. Individual psychotherapy environment.
Master of manipulation. Supervised, structured living. Adhere strictly to treatment
Can get staff fighting among Neuroleptics. plan.
selves (this is called splitting) Refuse to engage in 3rd party
conversations (don't talk with
him about others).

Histrionic Melodramatic. Highly Outpatient therapy Teach ways to delay needs


energetic. Bursts of for gratification.
exaggerated emotions. Assist in assuming mature,
Temper tantrums. adult behavior.
Demanding. Self-centered. Assist to find ways to express
self in socially acceptable
ways.

Narcissistic Inflated sense of Individual or group therapy Stable, safe environment.


importance. Feels entitled to Consistent limit setting.
recognition. Needs constant Assist to find ways to express
attention. self in socially acceptable
ways.
Enhance self-esteem and self-
worth.
Cluster C:
(anxiety & fear-
based)
Hypersensitive to rejection. Relaxation exercises. Role play--what if?
Avoidant
Uncomfortable in social Assertiveness training. Enhance ability to confront
settings. Social skills training. social situations.

Unassertive, passive. No Relaxation exercises. Enhance ability to speak up


Dependent decision making. Assertiveness training. and assume age-appropriate
Self-devaluation. responsibilities.
Give assignments that involve
risk-taking behaviors.
Preoccupied with order and
OCPD rules. Perfectionism. Behavior therapy. Confront invalid assumptions
Inefficient due to constant Cognitive therapy. and assist client to develop
worry about doing things Leisure activities. new perspectives.
right. Overly concerned with Assist to identify new
telling how to do things right. solutions to life situations.

Review overall interventions for any of the personality disorders at the end of the Blackboard outline provided for class.