Professional Documents
Culture Documents
Discuss DSM-IV:
A. Clients diagnosis has 5 parts or AXIS:
A..1.
AXIS I: Psychiatric Dx
A..2.
A..3.
A..4.
A..5.
RIGHT TO TREATMENT:
A. People w/ mental illness have a right to tx.
B. State cannot detain individuals who are non-dangerous without providing some mode
of tx.
C. MHN has professional obligations to help pts. Seek out and engage tx for mental
illness 2 the least restrictive level.
II.
B. Emergency
C. Civil/judicial commitment- Legal basis
Describe Neuroanatomy:
LOBE
FRONTAL
NORMAL FXN
TEMPORAL
OCCIPITAL
PARIETAL
III.
vision
ANTIPSYCHOTIC MEDICATIONS:
A. Also called NEUROLEPTICS used for tx psychosis, behavioural problems in
children, schizophrenia etc. Controls symptoms like delusions, hallucinations and
thought disorders Two types:
A.i. CONVENTIONAL or TYPICAL - block dopamine, acetylcholine and
epinephrine Phenothiazines (first generation) and non-phenothiazines ex.
Haldol, Thorazine, Stelazine
A.i.1.a. Side effects: extrapyramidal symptoms, dry mouth,
orthostatic hypotension
A.ii. UNCONVENTIONAL or ATYPICAL blocks action of dopamine and serotonin.
Ex. Clozaril, Zyprexa, Risperdal, Abilify
IV.
A.ii.1.
A.ii.2.
ANTIDEPRESSANTS:
Side effects:
HYPERTENSIVE CRISIS
V.
VI.
ANTI-ANXIETY/ANXIOLYTIC MEDICATIONS:
A. Used to control anxiety and treat status epileptics; preoperative sedation, insomnia
B. Major group = benzodiazepines ex. Valium, Xanax...Buspar (non-benzodiazepine)
takes 4 weeks
C. M. Of. A= is to enhance the inhibiting action of Gamma-aminobutyric acid (GABA an
inhibitory neurotransmitter in the CNS)
1. Side effects: Fatigue, dry mouth, sedation
VII.
VIII.
MOOD STABILIZERS:
E. Used for tx. Bipolar disorder.
F. Eg. Lithium citrate and antiepileptic drugs (Tegretol, Depakote)
G. M. of. A= is alteration electrical conductivity in neuron
a.i.1.
d. Define EUTRESS: Stress response (nonspecific) assoc. with desirable events ex.
Wedding, job promotion, birth of child.
e. Define PSYCHOLOGIC STRESS: All processes of the person that require cognitive
appraisal of the event before a response
f.
g. Stages of GAS:
I.
Holistic/alternative care beliefs strengthen individuals inner resistance to dx, healing from
within, or enhance bodys innate healing powers
I.
ANXIETY DISORDERS:
I.
X.
DEFENSE MECHANISMS:
EGO DEFENSE
MECHANISMS
Conversion
DEFINITION
Unconscious expression of a mental conflict as a
physical symptom to relieve anxiety
Unconscious refusal to face reality.
EXAMPLE
Woman experiences blindness after
witnessing a robbery.
Woman denies that her marriage is
failing
Separation and detachment of a strong, emotionally Male victim of car-jacking exhibits
charged conflict from one's consciousness
symptoms of traumatic amnesia the
next day.
Unconscious attempt to identify with personality Teenager dresses, walks, and talks
traits or actions of another to preserve one's self- like his favourite basketball player.
esteem
Unconscious assignment of unacceptable thoughts Man who was late for work blames
or characteristics of self to others
wife for not setting the alarm clock.
Justification of one's ideas, actions, or feelings to Student states he didn't make the
maintain self-respect, prevent guilt feelings, or
golf team because he was sick.
obtain social approval
Demonstration of the opposite behaviour, attitude, Man who dislikes his mother-in-law
or feeling of what one would normally show in a is very polite and courteous toward
given situation
her.
Voluntary rejection of unacceptable thoughts or
Student who failed a test states she
feelings from conscious awareness
isn't ready to talk about her grade.
Use of external objects to become an outward
An engagement ring symbolizes
representation of an internal idea, attitude, or
love and a commitment to another
feeling
person.
Denial
Dissociation
Identification
Projection
Rationalization
Reaction-formation
Suppression
Symbolization
Nursing Interventions
Reducing Symptoms of Anxiety:
1. Maintain safety for the client and the environment
2. Assess own level of anxiety
3. Recognize the clients use of relief behaviours
4. Inform client limiting caffeine, nicotine, and other CNS stimulants
5. Teach client to distinguish anxiety that is connected to identifiable sources
6. Instruct client to practice stress reduction techniques
7. Help client build on coping methods
8. Activate the client to identify support persons
9. Assist client gain control of overwhelming feelings and impulses
10.
Help client structure quiet environment
11.
Assess the presence and degree of depression and suicide ideation
12.
XII.
Administer anxiolytics
Types of ANXIETY:
a.i. Panic Anxiety: Recurrent unexpected anxiety attacks with thoughts of
dread, impending doom, death and fear of being trapped.
a.ii. Phobias: Client experiences panic attack in response to particular situations
Types: Agoraphobia fear of being alone in public places, without escape,
Social Phobia - fear of social or performance situations. Eg. Speaking, eating
in public
a.iii. Posttraumatic Stress Disorder (PTSD): Describes and individuals reaction
to traumatic events eg. Combat, sexual abuse, physical abuse, disasters, and
grieving
a.iii.1.a. Efforts to avoid thoughts, feeling, or conversation about
the trauma
a.iii.1.b. Efforts to avoid persons or places that evoke memories of
trauma
a.iii.1.c.
a.vi.3.
Compulsions are repetitive behaviours that the person feels
driven to perform in response to an obsession
a.vii. Somatoform disorders: Characterized by physical symptoms that cant be
explained by known physical mechanisms. They:
a.vii.1.a. Involve multiple organs
a.vii.1.b. have early onset and are chronic without signs of
impairment
a.vii.1.c. No laboratory evidence of medical condition
Types:
a. BODY DYSMORPHIC DISORDER-Preoccupation with imagined defect
in appearance in a normal-appearing person
b. CONVERSION DISORDER- Development of Neurologic disorder
(blindness, deafness, loss of touch, or pain sensation) or Involuntary
motor function (aphonia, impaired coordination, paralysis, or seizures).
c. HYPOCHONDRIASIS-Preoccupation with fears of having/ has a
serious disease despite appropriate medical tests and assurances to
the contrary
d. SOMATIZATION DISORDER-History of many physical complaints
before age 30. History of pain in at least four different sites or
functions
a.viii. Dissociative disorders:
a.viii.1.a. Depersonalization disorder
a.viii.1.b. Dissociative amnesia-One or more episodes of inability to
recall important information (usually of a traumatic or stressful
nature)
a.viii.1.c. Dissociative fugue-Sudden, unexpected travel away from
home or one's place of work with inability to remember past
XIII.
XIV.
Anti-anxiety
A. Benzodiazapines
a. How it works: by enhancing the inhibitory action of GABA thus causing
generalized CNS depression
b. Therapeutic effect: relief of anxiety
c. Interactions: DO not use with MAOIs, additive effect when taken with
alcohol, antihistamines
B. Non-Benzodiazapine
A.a. How it works: decrease reputake of dopamine and increase serotonin in
the CNS
A.b. Therapeutic effect: decrease depression
A.c. Interactions: grapefruit juice can cause toxicity, use with MAOI may
cause HTN
A.c.1. Buspirone HCL (BusPAR) -5mg 2-3x/dy
A.d. SE: dry mouth, nausea, vomiting, agitation, headache, blurred vision,
constipation
XVI.
Antidepressant: 4 groups:
B. Tricyclics
B.a. How it works: blocks reputake of norepinephrine and serotonin
B.b. Interactions: do not use with MAOI and avoid concurrent use with
SSRIs
B.b.1. Amitriptyline (Elavil)-25mg 3xs up to 200mg/dy
B.b.2. Imipramin (Tofranil)-25-50mg 3-4 up to 300mg/dy
B.c. SE: orthostatic hypotension, sedation, suicidal thoughts, blurred vision,
dry mouth
C. SRRIs:
C.a. How it works: blocks reputake of serotonin
C.b. Interactions: St. Johns wart causes central serotonin syndrome
C.b.1. Fluoxetine (Prozac)
C.b.2. Sertraline (Zoloft)
C.b.3. Paraxentine (Paxil)
C.c. SE: nervousness, sexual dysfunction, headache, insomnia
D. MAOI:
D.a. How it works: inhibiting monoamine oxidase causing a rise in
neurotransmitters
tyramines
E. Atypical antidepressant:
E.a. How it works: effects serotonin, dopamine, and norepinephrine
E.b. Interactions: do not use w/ MAOI, should not be taken within 14dys of
MAOI use
E.b.1. BuPropion (Wellbutrint)
E.b.2. Venlafaxine (Effecor)
E.b.3. Doloxetine (Cymbalta)
E.c. SE: headache, dry mouth, seizures, appetite suppression
F. Mood Stabilizers:
F.a. How it works: alters electrical conductivity of cell
F.b. Interactions: make sure have adequate Na intake for Lithium
F.b.1. Lithium
F.c. Monitor: therapeutic levels
G. Anti-epileptics:
G.a. How it works: increases inhibitory action of GABA
G.b. Interactions: increased CNS depression with consumption of alcohol
G.b.1. Divalproex sodium (Depakote)
G.b.2. Carbamazepine (Tegretol)
G.c. SE: agranulocytosisso check WBC, sedation
G.d. Monitor: I/O
H. Beta-Blockers: Anti-anginals
H.a. How it works: blocks beta 1 receptors thus decreasing BP and HR
H.b. SHOULD NOT 50mg daily, Ccr=15-35mL/min
H.b.1. Atenolol (tenormin)- 50-200mg/dy
SLEEP DISORDERS:
I.
Types:
a. Dyssomnias- abnormalities in amt, quality or timing of sleep
NSG PROCESS:
a. Assessment: subjective and objective data sources and sleep hx
b. NSG DX:
b.i. Sleep deprivation
b.ii. Insomnia
b.iii. Ineffective bx
b.iv. Anxiety
b.v. Fatigue
b.vi. Ineffective coping
c. Outcome I.D
c.i. I.d primary causes sleep alteration
c.ii. Communicate interventions and implement them
c.iii. Demonstrate reduction sleep disturbance
c.iv. Participate discharge planning
d. Planning: participation multidisciplinary team
e. Implementation/Interventions:
e.i. Monitor sleep patter and id risks
e.ii. Have client keep sleep diary
e.iii. Develop hygiene plane
e.iv. Teach symptom management
e.v. Make environment quiet
GRIEF:
I.
Types:
a. Anticipatory grief- pre-mourning- grief assoc. With anticipation predicted death or
developing loss
b. Acute Grief- painful exper. After a loss
c. Dysfunctional grief- ex. PTSD. Lasts longer than other types and has greater
disability ex. Traumatic loss, complicated grief, chronic grief
d. Chronic sorrow- response to ongoing loss ex. Parents w/ disabled children.
II.
Interventions:
a. Assess risk kill or harm self and others
b. Promote ns-relationship
c. Facilitate expression feelings related to loss
d. Help client understand relationship between self and lost person
e. Facilitate full expression grief
f.
COGNITIVE DISORDERS:
I.
Types:
1. Dementia- It is the gradual and progressive deterioration of intellectual
functioning.
2. Delirium- an acute state of confusion, disorientation to person and place, rapid
onset and short duration
SYMPTOMS
DEMENTIA
Judgment
Impaired
Mood
Fluctuates
Apathetic
Memory
Impaired
Cognition
Disordered reasoning
Orientation
Disoriented
Thoughts
Confused
Suspicious
Paranoid
Perception
No change
Consciousness
Speech
DELIRIUM
May be impaired
Fluctuates (fluctuating consciousness)
Reduced ability sustain attention
Impaired
Disordered reasoning
Disorientation
Confused
Suspicious
Incoherent
Misinterpretations, Visual hallucinations and
delusions
Clouded
Sparse or fluent
Incoherent
Agitation
May wander
Insomnia
Poor testing
Improves when medically stable
Improves with treatment
Usually remain stable unless medically unstable
Normal
Sparse
Repetitive
Behavior
Agitation
Wanders
Insomnia
Mental status
Poor testing
Progressively worsens
Inappropriate answers
Activities of daily Deteriorate as dementia progresses
living
PROGNOSIS
No return to pre-morbid function, chronic, Return to pre-morbid function if cause is
depends on cause as is generally insidious correctable and is corrected in time. Generally
in onset
acute onset
II.
STAGES OF ALZHEIMERS:
1. Stage1: Mild (2-4yrs)
1.i. Recent memory loss, neologisms
Communicating
1.ii.2.
Calculating
1.ii.3.
Recognition
Catastrophic rxs
2.ii.2.
2.ii.3.
Preservation-excessive repetition
2.ii.4.
Aimless pacing
2.ii.5.
Wandering
2.ii.6.
Incontinence
2.ii.7.
Hypertonia
3. Stage3: Severe:
3.i. Stage2 symptoms increase
3.ii. Total incontinence
3.iii. Choking
3.iv. Emaciation
3.v. Total care needed
3.vi. Progressive gait disturbance leading to non-ambulatory status
III.
NSG DX:
1. Risk aspiration
2. Imbalanced body temp
3. Infection
4. Injury
5. Physical mobility
6. Anxiety
7. Impaired verbal communication
8. Chronic confusion
9. Grieving
IV.
OUTCOME IDENTIFICATION:
1. Maintain health and safety with caregiver help
2. Reach and maintain highest fxn level possible within capacity
3. Maintain best possible physical status
4. Participate therapeutic activity program
5. Participate planning for care
V.
INTERVENTION:
1. Inform all caregivers nsg plan
2. i.d client current fxnal; state and encourage use of skills
3. set up structured routines
4. allow client time alone
5. remain flexible with schedule
6. keep all interactions with client calm and reassuring
7. do not ask client participate ADLs when agitated
8. attempt understand feeing
9. respond clients feelings and validate them
10.
11.
CRISIS INTERVENTIONS/RAPE-TRAUMA:
I.
Types crisis:
a. External (situational)- external stressor which is apparent to another observer.
Centres on real events threaten health, shelter, loss loved one.
b. Internal (subjective) crisis- internal stressor threatens well being ex. Aging, loss
independence
c. Phase-of-life (maturational) crisisd. Disaster (adventitious crisis)- man-made and natural disasters ex. Terrorism,
tornados
II.
a.i. Assess the individual and the problem- in the field and in office (physical
safety principles, medical hx, introduction and boundaries, chief complaint,
hx present illness, family/social hx, mental status, past medical & psychiatric
hx, drug & alcohol hx, cultural and spiritual issues, strengths and support,
coping skills, GAF etc
b. Plan therapeutic intervention:
b.i. Express caring and consolation
b.ii. Assess reality of situation
b.iii. Develop and begin to utilize an immediate plan for intervention
b.iv. Coordinate w/ other agencies
b.v. Anticipate future needs related to crisis
c. Intervention
d. Resolution of the crisis
e. Anticipatory planning
III.
DOMESTIC VIOLENCE:
I.
II.
b. Within the last year, have you been hit, slapped, kicked, or physically hurt by
someone? By whom? How many times?
c. Within the last year, has anyone forced you to have sexual activity? Who? How
many times?
d. Are you afraid of your partner or anyone else?
III.
Rape-trauma syndrome:
a. Acute Phase:
a.i. Occurs immediately after the assault
a.ii. May lst for a few weeks
a.iii. Lifestyle disorganized
a.iv. Somatic symptoms are common
a.v. Reaction in cognitive, affective and behavioural functions
b. Long-term reorganization phase:
b.i. Intrusive thoughts
b.ii. Increased motor activity
b.iii. Increased emotional lability
b.iv. Fears and phobias
IV.
Violence Interventions:
a. Follow your institutions protocol for sexual assault
b. Do not leave the person alone
c. Maintain a non-judgemental attitude
d. Ensure confidentiality
e. Encourage the person to talk, listen empathetically
f.
Emphasize that the person did the right thing to save his/her life
i.
j.
Alert client as to what he/she may experience during the long-term reorganization
phase
Low self-esteem
g. Sexual dysfunction
h. Somatic complaints
MOOD DISORDERS:
A. Leading cause of disease burden
a.i. Types:
a.i.1.
Major depression
a.i.2.
a.i.3.
Bipolar disorder-pattern of manic, hypomania and depressed
episodes
a.i.4.
b. Nsg process:
b.i. Assessment- mood, affect and temperament
b.i.1.
Mood
b.i.1.b.
Affect
b.i.1.c.
Temperament
b.i.1.d.
Emotion
b.i.1.e.
Emotional reactivity
b.i.1.f.
Emotional regulation
b.i.1.g.
Range of affect
Activity intolerance
b.ii.2.
Anxiety
b.ii.3.
b.iii. Interventions:
b.iii.1.
b.iii.2.
b.iii.3.
b.iii.4.
b.iii.5.
b.iii.6.
b.iii.7.
Promote self-care
b.iii.8.
b.iii.9.
Refer p.235
c. Pharmacology:
c.i. SSRIs- citalopram (celexa), fluoxetine (Prozac), paroxetine (paxil), sertraline
(Zoloft), venlafaxine (Effexor)
c.ii. Atypical antidepressants
SUICIDE:
I.
Assessment:
a. The observable behaviour of client e.g increased irritation, increase in energy
b. Hx from the client- gathering self-defeating coping patterns
c. Information from friends and familyd. Hx suicidal gestures or attempts
e. MSE-disturbance concentration, memory, orientation
f.
g. Nurses intuition
II.
Interventions:
a. Provide safety and prevent violence: ex. Safe environment, remove all weapons
b. Assist with improvement of coping skills
c. Enhance family and support system
EATING DISORDERS:
Sign/Symptoms:
1. Anorexia:
a. Self-starvation
b. Rituals/compulsive behaviours
regarding food
c. Self-induced vomiting, laxatives,
diuretics, or excessive exercise
d. Weight loss 15% below ideal
e. Amenorrhea
Bulimia Nervosa:
1. Recurrent episodes binge eating
2. Purging behaviours: self-induced
vomiting, use laxatives, diuretics, diet
pills, ipecac, enemas, exercise, periods
fasting
3. Purging
4. Hypokalemia
f.
g.
h.
i.
j.
k.
l.
m.
n.
Slow pulse
Cachexia-muscle wasting
Lanugo
Constipation
Cold sensitivity
Denial seriousness
Irrational fear gaining weight
Preoccupation food
Delayed psychosexual
development
Outcomes anorexia:
1. participate therapeutic contact staff
2. consume adequate calories
3. achieve normal weight
4. maintain normal fluid and electrolyte
balance
5. resume normal menstrual cycle
6. demonstrate improvement body image
7. demonstrate effective coping skills
8. manage family conflicts
III.
5. Alkalosis
6. Dehydration
7. Idiopathic edema
8. Hypotension
9. Cardiac arrhythmias
10.
Cardiomyopathy
11.
Hypogycemia
12.
Constipation
13.
Esophageal reflux
14.
Mallory-weiss syndrome
15.
Dental enamel ersosion
16.
Paratid gland enlargement
17.
gastroparesis
Outcomes Bulimia:
1. participate therapeutic contact staff
2. maintain normal fluid and electrolyte
levels
3. consume adequate calories
4. cease binge/purge episodes
5. demonstrate effective coping skills
6. Demonstrate age-approp. Boundaries
7. Verbalize improved body awareness
8. Normal perception of body weight and
shape
Complications:
a. Electrolyte imbalance
b. Cardiac arrhythmias
c. Cardiac arrest
d. Diabetes mellitus
e. hypertension
IV.
Interventions:
a. Provide safety
b. Assess suicide
c. Engage therapeutic relationship
d. Restore min. Body weight and nutritional balance
e. Create structured, supportive environment, with limits
f.
j.
SCHIZOPHRENIA:
I.
Neurobiologic brain disorder, results impaired thoughts, perceptions, cog. Fxn, mood and
motivation
II.
III.
Types:
a. Paranoid
b. Disorganized
c. Catatonic
d. Residual
e. Undifferentiated
IV.
Positive symptoms:
a. Alterations perceiving: hallucinations (false perceptions), delusions (false
beliefs), loss ego boundaries
b. Alterations thinking: concrete thinking, loose associations, flight of ideas, ideas of
reference, ideas persecution, ideas grandiosity, ideas being controlled, though
broadcasting, thought insertion, thought withdrawal
c. Alterations speech: neologisms, echolalia, clang assoc, word salad,
circumstantiality, tangential (superficial speech)
V.
Negative symptoms:
a. Cognitive: Poverty of speech (alogia), Poverty of thought. Thought blocking,
Problems with attention, memory, Impaired decision making/judgement, problem
solving, Disorganized think
b. Behavioural: anhedonia, anergia, avolition, depression, hopelessness, social
isolation, decreased spontaneity, anxiety, irritability, drug abuse. Medical
comorbidity
VI.
VII.
VIII.
Psychopharmacology:
a. Typical antipsychotics, which block dopamine, phenothiazines: treat positive
symptoms
a.i. Ex. Thorazine, Mellaril, Navane, Stelazine, Haldol and Prolixin
a.ii. SE: anticholinergic- dry eyes, mouth, constipation, sedation, orthostatic
hypotension, lowered seizure thresholds, jaundice, ESP (use antiparkinson
drugs...cogentin, artane), dystonica, neuroleptic malignant syndrome, tardive
dyskineasia
b. Atypical antipsychotics- block serotonin and norepinephrine. Work on pos and neg
symptoms. Produce metabolic syndromes (so check weights)
b.i. Ex. Clozoril (monitor for agranulocytosis and WBC), seroquel (quetiapine),
Risperdal (risperidone), geodon (ziprasidone), abilify(aripiorazole)
EPS S.E:
Akathsia
Akinesia
Dystonias
Acute distonic rx
Pseudo parkinsonism
Tardive dyskinesia
Neuroleptic malignant syndrome
SUBSTANCE ABUSE:
Support groups: AA, NA, CA Al-Anon, Al-a-teen, Adult children of alcoholics, inpatient,
outpatient, hospitalization, intensive outpatient, halfway houses.
IX.
Signs/symptoms:
CNS Depressants:
Decreased inhibitions
Impaired judgement,
attention, memory
Drowsiness
Slurred speech
CNS stimulants:
Euphoria
Feelings impending
doom
Agitation or
combativeness
Hallucinogens:
Panic attack/anxiety
Psychosis
Delirium
Altered moods
flashbacks
X.
Unsteady gate
Hypotension
Bradycardia
Pinpoint pupils
Weak rapid pulse
Depressed respirations
Can lead com/death
Hallucinations/paranoia
Seizures
Cardiovascular events,
palpitations,
tachycardia,
Hypertension, irregular
rhythms, can lead to
infarct
Tx emergency CNS
depressant:
Life support
Narcan
(naloxone)
Lavage or
dialysis
Control seizures
with
phenobarbitol
Tx CNS depressants
withdrawal symptoms:
Opiod
substitution
Methadone
(dolophine)
Buprenorphine
(subutex)
Naltrexone
(ReVia)
Suboxone-used
for
maintenance
XI.
Tx acute overdose
alcohol:
ABCs
Thiamine
Nutritional
glucose
Clonidine
(catapress) for
GI symptoms
Benzos
Long-term tx:
Antabuse
Naltrexone
Zofran and
topamax
decrease
cravings as
well
Tx CNS intoxication:
Treat cardiac
symptoms
Benzos for
agitation and
seizures
Antipsychotics
for
hallucinations
Anabolic-androgenic steroids
Interventions SA:
a. Maintain airway, monitor vitals
b. Maintain safety
c. Observe s/s overdose, withdrawal, drug-drug interactions
d. Assess physiologic/Psychologic symptoms withdrawal
e. Initiate interventions to treat withdrawal symptoms
f.
j.
PERSONALITY DISORDERS:
I.
In General PD:
a. Higher death rates
b. Higher rates suicide attempts
c. Increased rates separation, divorce and involvement legal proceedings
d. Increased rate criminal behaviour, alcoholism, and drug abuse
II.
4 common characteristics:
a. Inflexibility, maladaptive response stress
b. Disability in working and loving
c. Ability cause interpersonal conflict in others
d. Capacity to irritate others
III.
4 maladaptive patterns:
a. Faulty perceptions
b. Emotional lability
c. Poor impulse control
d. Difficult interpersonal functioning
IV.
Characteristics:
a. Repetitive maladaptive behaviour
b. Behaviour not recognized as abnormal so dont seek treatment
General interventions:
1. Asses suicide ideation
2. Implement suicide precautionsevery 15min
3. Establish contract for safety
4. Encourage attendance all group sessions
5. Assess for escalating anger or rage
6. Contract not to harm staff or others
7. Teach manage anger and impulsive feelings and behaviours
8. Discuss angry and aggressive feelings
9. Assess client for evidence self-mutilation.
s/s antisocial
personality:
1. Hx
antisocial
behaviour
2. Deceitful,
liar
3. Aggressive
towards
others
4. Lack
remorse
hurting
others
5. Presents as
charming,
self-assured
and adept
6. Interacts
others
through
manipulatio
n,
aggressiven
ess and
exploitation
7. Lack
empathy or
concern
Interventions:
1. Prevent/decrease
effects
manipulation
2. Guard against
being
manipulated
3. Set clear and
realistic limits
behaviour
4. All limits must be
adhered to by all
staff
5. Carefully
document
objective physical
signs of
manipulation/
aggression
s/s borderline
personality;
1. Relationship
with others
intense and
aunstable
2. Poor impulse
control
3. Recurrent
suidical/self
mutilation
4. Attention
seeking/manip
ulative
5. No boundaries
6. Outbursts odd
anger and
hostility
7. Intense and
primitive rage
8. Rapid
idealization
and
devaluation
Interventions:
1. Set limits
2. Provide
boundaries
and limits
that are
clear and
consistent
3. Consistent
staff: asses
for suicide
and self
mutilating
behaviour
VI.
Etiology/factors:
a. Lower socioeconomic status
b. Substance abuse
c. Genetics