Personality Dis PST

Personality
disorder
Definition
A persons characteristic totality

of emotional and behavioral traits
apparent in ordinary life, a
totality that is usually stable and
predictable.
- Kaplan And Sadock

[1998]
Definition :
enduring patterns of perceiving ,

relating to , and thinking about the
environment and oneself that are
exhibited in a wide range of social and
personal contexts .
- DSM IV [APA]
HISTORY
Hippocrates - 4th century
He was concluded that disease

originated from an excess of four
bodily humors.
PERSONALITY DISORDERS:
An enduring (long-standing) pattern
in two or more of the following areas:
1) Cognition (thoughts) - ways of interpreting
and perceiving events
2) Affectivity (emotions) - range, intensity,
lability, & appropriateness
3) Interpersonal functioning (behavior)
4) Impulse control (behavior)
Personality Traits vs. Disorders
Deviation from social & cultural norms consider
contribution of situational & cultural context
Inflexibility rigid patterns of behaviors &
responses
Pervasive present in a variety of contexts
Clinically significant distress for self or others
Impairment in functioning highly maladaptive
Stable & long-lasting - onset by early adulthood,
long-term pattern vs. occasional
TYPES
Cluster A
Cluster B
Cluster C
CLUSTER A PERSONALITY
DISORDERS
Characterized by: Includes:

Odd behavior, Paranoid Personality
reactions, emotions Disorder
Eccentric thoughts & Schizoid Personality
behaviors e.g. Disorder
illusory or magical
thinking, Schizotypal
inappropriate social Personality Disorder
interactions May represent mild
Isolative behavior variations of
social withdrawal Schizophrenia, but
Suspiciousness reality testing is
paranoia intact
PARANOID PERSONALITY DISORDER
A. A pervasive pattern of distrusting,
being suspicious of, and attributing
malevolent intention to others
B. Pattern of behavior is not due to
Schizophrenia, a Mood Disorder
with Psychotic Features, another
Psychotic Disorder, the effects of a
substance, or a general medical
condition
PARANOID PERSONALITY
DISORDER
Indicated by 4 or more of the following 7:
1. Assuming others will exploit, harm, or deceive
them
2. Continually doubting the loyalty or
trustworthiness of friends or associates
3. Reluctance to confide in others because fear info
will be used against them
4. Reading hidden demeaning or threatening
meanings into benign remarks or events
5. Persistently bearing grudges
6. Often believing they have been attacked or
slighted and are quick to react angrily or with
counterattack
7. Continually suspecting spouse or sexual partner
of being unfaithful
DISORDER
What it looks like:
Chronically suspicious of others
Distrusting of others
Assuming the worst intention
Not open
Continually doubting loyalty of others
Unforgiving
Hold grudges
DISORDER
Facts & Figures:
Prevalence 0.5-2.5% in general population
Gender more common in males
Onset often first apparent in childhood and
adolescence
Cultural Factors need for caution in diagnosing
members of minority, ethnic, immigrant, refugee
groups
Treatment Considerations:
Importance of developing trust & a solid therapeutic
alliance
Cognitive therapy to counter mistaken assumptions
and negative beliefs about others
No evidence that therapy is very successful
SCHIZOID PERSONALITY
DISORDER
A.Characterized by a pervasive pattern
of:
-detachment from social relationships
-restricted range of emotional
expression in interpersonal settings
B. Pattern of behavior is not due to
schizophrenia, a Mood Disorder with
Psychotic Features, another Psychotic
Disorder, or a Pervasive
Developmental Disorder.
DISORDER
1. Neither desiring nor enjoying close
relationships, including being part of a
family
2. Almost always choosing solitary activities
3. Having little, if any, interest in sexual
experiences/relationships
4. Taking pleasure in few, if any, activities
5. Lacking close friends or confidants
6. Indifference to praise or criticism
7. Emotional coldness, detachment, or flatness
DISORDER
What it looks like:
Emotionally cold & distant
Great difficulty forming relationships
Social isolation loner
Restricted affect lack of emotional
expressiveness
Lack of interest in people,
relationships, & most activities
DISORDER
Facts & Figures:
Prevalence uncommon; <1%
Gender slightly more common and
impairing in males
Onset often first apparent in childhood
and adolescence
Cultural need for caution in
diagnosing people from different cultural
backgrounds, environments, or
immigrants
DISORDER
Contributing factors:
Childhood shyness
Genetics
Parenting: neglectful & cold parenting; intrusive
mother; absent father
Lower density of dopamine receptors
Traumatic experiences
Treatment:
Modeling healthy relationship skills & emotional
expression
Empathy training teaching the person how to
identify, express, & respond to emotion
Social skills training, including role playing
Building a support network
SCHIZOTYPAL PERSONALITY
DISORDER
A. A pervasive pattern of social and
interpersonal deficits marked by:
-acute discomfort with close relationships
-a reduced capacity for close relationships
-cognitive or perceptual distortions
-eccentric behaviors
B. Pattern is not due to schizophrenia, a
Mood Disorder with Psychotic Features,
another Psychotic Disorder, or a Pervasive
Developmental Disorder
DISORDER
1. Ideas of reference
2. Odd beliefs or magical thinking
3. Unusual perceptual experiences
4. Odd thinking & speech
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Odd, eccentric or peculiar behavior or
appearance
8. Lack of close friends or confidants
9. Excessive social anxiety that does not
diminish with familiarity and tends to be
associated with paranoid fears
DISORDER
What it looks like:
Social impairment & isolation
Social discomfort & anxiety
Variety of odd beliefs & cognitions
Unusual perceptions & perceptual
experiences
Odd speech & presentation
Eccentric & peculiar behavior
Inappropriate or blunted affect
DISORDER
Facts & Figures:
Prevalence 3-5% of general population
Gender slightly more common in males
Onset often first apparent in childhood
and adolescence
Course chronic; some go on to develop
Schizophrenia
Cultural need to consider cultural
context when evaluating symptoms
DISORDER
Contributing Factors:
Biological and genetic factors have
been emphasized Schizotypal PD as
a milder variant of schizophrenia
Psychotropic medication
antidepressants, antipsychotics
Cognitive-behavioral therapy
Social skills training
Cluster A Scenario
An individual receives an
invitation to attend the birthday
party of a supervisor at work.
This supervisor is not well known
to the individual, in fact, they
have only spoken on a couple of
occasions.
Paranoid Personality
Disorder
Cognitions include: Behaviors include:
This person reached their Approaching the
position through supervisor to research
dishonesty or fraud they these suspicions in a
are not to be trusted. hostile and accusatory
My colleagues are out to manner
get me it will not be Finding an excuse to not
safe to be in an attend the birthday party
unfamiliar setting with Increased irritability in
them. the workplace
My job security is being
Hypervigilance for
threatened.
suspicious behavior
from colleagues
Schizoid Personality
Disorder
Cognitions Behaviors include:
Include: Not attending the
Not wanting to go party
to the party Telling the
I would rather be supervisor she
alone. wont attend in a
This party wont be cold, detached way
enjoyable.
Schizotypal Personality
Disorder
Cognitions Include: Behaviors Include:
I was meant to go to Wearing an unusual
this birthday party ceremonial costume to
because something the party
supernatural will occur Remaining detached
from others at the
I wonder why the
party
supervisor chose me?
Speaking to others in
Will I be prepared to an elaborate way
handle what is to
come?
CLUSTER B
PERSONALITY DISORDERS
Characteristics: Includes:
Dramatic Antisocial Personality
Emotional Disorder
Erratic behavior Borderline
Impulsiveness Personality Disorder
Reduced capacity Histrionic Personality
for empathy Disorder
Unstable emotions Narcissistic
& relationships Personality Disorder
ANTISOCIAL PERSONALITY
DISORDER
A. Pervasive pattern of disregard for and
violation of the basic rights of others
B. Beginning in childhood or early
adolescence (must have evidence of
Conduct Disorder prior to 15 years)
C. Continuing into adulthood (must be at
least 18 years)
D. Occurrence of antisocial behavior is
not exclusively during a course or
Schizophrenia or Mania
DISORDER
1. Failure to conform to social norms and laws, e.g.
repeatedly performing acts that are grounds for arrest
2. Deceitfulness & manipulation, e.g. repeated lying, using
aliases, or conning others for personal profit or pleasure
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness, e.g. repeated physical
fights or assaults
5. Reckless disregard for safety of self or others
6. Consistently & extremely irresponsible, e.g. repeated
failure to sustain consistent work or honor financial
obligations
7. Lack of remorse, e.g. being indifferent to or
rationalizing having hurt, mistreated, or stolen from
another
ANTISOCIAL PERSONALITY DISORDER
What you see:
Aggressiveness
Superficial charm
Self-centered
Bore easily, high need for stimulation, sensation-
seeking, thrill-seeking
Lie easily
Conning, manipulative
Relationships of utility
Lack of remorse little or no guilt about the harm
they cause others
Lack of empathy may seem cold & insensitive
Enjoy testing, provoking, pushing, playing with
others
Criminal behavior feel rules dont apply to them
DISORDER
Facts & Figures:
Prevalence: 3% males; <1% females
Gender: more common in males
SES: associated with low SES & urban
settings; important to consider the
social and economic context for
behaviors
Course: chronic, but symptoms tend to
lessen or remit by 4th decade of life
Antisocial Personality
Disorder
Strong biological roots:
Genetic influence
Low levels of 5HT
Low arousability
Excessive theta waves
Poor impulse control
Fearlessness
Environmental factors:
Parenting: harsh, inconsistent, neglectful, uninvolved,
abusive
Chronic stress, trauma
Treatment:
Psychotherapy is not very effective; often court-
mandated
Lithium & SSRIs may help control impulsive,
aggressive behaviors
BORDERLINE PERSONALITY
DISORDER
A pervasive pattern of marked impulsivity
and unstable relationships, self image,
and emotions
1. Frantic efforts to avoid real or imagined
abandonment
2. A pattern of unstable and intense
interpersonal relationships shifts from
extreme idealization to devaluation
3. Identity disturbance sudden & dramatic
shifts in self image, e.g. goals, values,
career plans & aspirations, sexual identity,
types of friends
DISORDER
4. Impulsive behavior that is potentially self-
damaging, e.g. spending, sex, substance abuse,
reckless driving, binge eating
5. Recurrent suicidal behavior, gestures, or threats, or
self-mutilating behavior
6. Affective instability due to highly reactive mood,
e.g. episodes of dysphoria, anxiety, panic,
irritability, anger, despair
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling
anger; e.g. frequent temper, biting sarcasm,
enduring bitterness, verbal outbursts, recurrent
fights
9. Transient, stress-related paranoia or dissociative
symptoms, such as depersonalization
DISORDER
What it looks like:
Unstable mood & emotions lack
control over emotions
Unstable self-concept
Unstable interpersonal relationships
Poor impulse control
Self-destructive
Good at splitting
Vacillating between extremely positive
& negative evaluations of self & others
DISORDER
Facts & Figures:
Prevalence: 1-3% of general population
Gender: 75% female
Completed suicide rate: 6-10%
Course:
greater instability, impairment, and suicide
risk in adolescence & young adulthood
symptoms gradually wane with advancing
age
by 30s & 40s, most attain greater stability
in relationships and vocational functioning
DISORDER
Biological factors low levels of serotonin
Family history of mood disorders
Environmental factors invalidating &
neglectful parenting; history of abuse;
trauma
Treatment:
Drug therapies SSRIs for dysphoria;
mood stabilizers for mood instability
Long-term therapy
Dialectical Behavior Therapy
Trauma work
HISTRIONIC PERSONALITY
DISORDER
A pervasive pattern of excessive emotionality
and attention-seeking behavior
Indicated by 5 or more of the following
8:
1. Feels uncomfortable or unappreciated
when not the center of attention
2. Inappropriately seductive or provocative
behavior
3. Displays rapidly shifting and shallow
emotions
DISORDER
4. Consistently uses physical
appearance to draw attention to self
5. Have strong opinions & impressions,
but cant back up with facts, details,
examples, evidence
6. Is overly dramatic, theatrical and
emotionally expressive
7. Is suggestible, i.e. easily influenced
by others, fads, or circumstances
8. Considers relationships to be more
intimate than they actually are
DISORDER
What it looks like:
Flamboyant self expression & presentation
Over-blown, overly dramatic emotional
rxns
Needy & solicitous of others
Require excessive approval & reassurance
Frequently dependent
Impressionistic & superficial
Overly concerned with appearance
Seductive & charming
DISORDER
Facts & Figures:
Prevalence: 2-3% in general population
Gender: diagnosed more frequently in women;
prevalence may be equal for males & females
Sex role stereotypes influence the behavioral
expression of the disorder
Aging presents special difficulties
Course: chronic, but sx may improve with age
Unmet needs for attention & success
NARCISSISTIC PERSONALITY
DISORDER
Pervasive pattern of grandiosity in fantasy
or behavior, need for admiration, and
lack of empathy
1. Grandiose sense of self importance, e.g.
overestimating ones abilities, exaggerating
ones accomplishments,
underestimating/devaluing others.
2. Fantasies about unlimited success, power,
brilliance, beauty, or love.
3. Belief that one is special, superior, or unique.
DISORDER
4. Need for excessive admiration and/or constant
attention
5. Sense of entitlement, i.e. expecting especially
favorable treatment or automatic compliance
from others
6. Conscious or unwitting exploitation of others
7. Lack of empathy for others; e.g. insensitivity,
emotional coldness, lack of interest in others
8. Envying others; believing others envy them
9. Arrogant, haughty, patronizing, snobby, or
disdainful behaviors or attitudes
DISORDER
What it looks like:
Self-enhancing, self-aggrandizing
Self-centered, self-absorbed
Readily dismiss opinions of others
Need to feel special
Love to receive special treatment
Can become rageful & attacking in
response to perceived threat
DISORDER
Facts & Figures:
Prevalence: <1% in general
population
Gender: up to 75% male
Age: narcissistic traits are
particularly common in adolescents
Course: the aging process presents
special difficulties; may improve
over time
DISORDER
Causes:
Parental factors: failure in modeling empathy;
rejecting, abandoning, or cold; capricious,
unreliable; treating the child as an extension of
themselves; overvaluation; lack of genuine,
sincere affection
Treatment:
Usually seek treatment at insistence of family
member or as a result of a major life crisis
Coping skills to improve ability to accept criticism
& rejection and to help person develop a more
realistic view of their abilities and talents
Empathy building
Addressing depression & other underlying
problems that may exist
Cluster B Scenario
An individual sees someone
they occasionally date out at
the movies with another date.
Antisocial Personality
Disorder
Cognitions
Include: Behaviors Include:
Thoughts about Socially unacceptable
what could be done or unlawful behavior
to ensure that they to interrupt the date
are the one (calling in a bomb
selected for the threat to the movie
date next time it theatre)
is, after all, a dog Starting rumors about
eat dog world. the person who their
romantic interest was
on a date with, or
about the romantic
interest themselves.
Borderline Personality Disorder
Cognitions Behaviors Include:
Include: An emotional
She must hate me outburst
now. Self injurious
I am worthless. behavior
I will never have a Calling attention to
relationship. himself impulsively
My life is over. in the moment
I was in love with
her.
Histrionic Personality
Disorder
Include: A dramatic
I cant stand that outburst
person (either the Sexually seductive
romantic interest behavior
or the date). Excessive
Didnt someone tell emotional response
me he was that is prolonged
promiscuous? and involves many
We were in love. people
Narcissistic Personality
Disorder
A brief thought of Loudly discussing
being rejected accomplishments in the
Thoughts of being movie theatre so the
superior to the other romantic interest and date
date are sure to hear
Thoughts that the Showing how well known
date would be they are by greeting every
envious if they knew acquaintance in the movie
who she was theater
Approaching the romantic
interest and asking them to
call or actually starting up
a conversation
Cluster C Personality
Disorders
Characterized Includes:
by: Avoidant Personality
Anxious Disorder
behavior Dependent
Personality Disorder
Chronic fears
Obsessive-
Perfectionism Compulsive
Constant self- Personality Disorder
doubt
AVOIDANT PERSONALITY
DISORDER
A pervasive pattern of social inhibition,
feeling inadequate, and
hypersensitivity to negative evaluation
1. Avoid work or school activities involving
significant interpersonal contact because
fear disapproval, criticism, or rejection
2. Resist getting involved with people without
assurance that they will be liked and
accepted without criticism
3. Are restrained in intimate relationships
because fear being shamed or ridiculed
DISORDER
Continued:
4. Are preoccupied with being criticized or
rejected in social situations (confirmatory bias)
5. Inhibited in new interpersonal situations due to
feeling inadequate & having low self-esteem
6. See self as socially inept, unappealing, or
inferior to others
7. Unusual reluctance to take personal risks or
engage in any new activities because these
may prove embarrassing
DISORDER
What it looks like:
Feel inadequate
Low self-esteem
Socially incompetent
Worry about being criticized
Avoid situations, activities, relationships,
and people where there is any potential
for them to be criticized, rejected,
ridiculed, embarrassed, or disapproved
of
AVOIDANT PERSONALITY DISORDER
Facts & Figures:
Prevalence: 0.5%-1.0% in general population
Gender: equally frequent for men & women
Course: avoidant/shy behavior often starts in infancy or
childhood & increases during adolescence & early
adulthood
Prognosis: modest improvements with treatment
Need for caution with: (1) different cultural/ethnic
groups; (2) immigrants; (3) children & adolescents
Causal Factors:
Parental rejection
Sensitive temperament
Treatment:
Behavioral interventions systematic desensitization,
behavioral rehearsal, social skills & assertiveness training
DEPENDENT PERSONALITY
DISORDER
A pervasive and excessive need to be taken care
of that leads to submissive and clinging
behavior and fears of separation.
1. Difficulty making everyday decisions without
an excessive amount of advice and
reassurance from others.
2. Allow others to assume responsibility for
major areas of his/her life.
3. Difficulty expressing disagreement with others
because they fear losing support or approval.
DISORDER
4. Difficulty initiating projects or doing things on own
because lack self confidence
5. Go to excessive lengths to obtain nurturance and
support from others, e.g. volunteering to do things
that are unpleasant
6. Feel uncomfortable or helpless when alone due to
exaggerated fears of being unable to take care of self
7. Urgently seek another relationship as a source of care
and support when a close relationship ends; become
quickly & indiscriminately attached to people
8. Preoccupied with fears of being left to take care of
self
DISORDER
What it looks like:
Worry about being abandoned
Lack self-confidence
Submissive, clingy, needy
Urgency, desperation with relationship-seeking
Need for others to assume responsibility for
them
Rely on others for almost everything:
To take care of them
To do things for them
To make decisions for them
To support and nurture them
DISORDER
Facts & Figures:
Prevalence: 2%; one of the most frequently reported
personality disorders in mental health clinics
Age & cultural factors need to be considered
Gender: diagnosed more frequently in females; may be
equally prevalent for men & women
Causes:
Disruption in early bonding/attachment due to
early death of a parent or neglect or rejection by
caregivers
Treatment:
Long-term psychotherapy
Assertiveness training, self-esteem work, skills building
OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
A pervasive pattern of preoccupation with

orderliness, perfectionism, and control, at the
expense of flexibility, openness, and efficiency
1. So preoccupied with procedures, details, lists,
order, and schedules that the major point of the
activity is lost.
2. Perfectionism interferes with task completion
and causes significant dysfunction and distress.
3. Excessive devotion to work and productivity to
the exclusion of leisure activities and
friendships (not accounted for by obvious
economic necessity).
4. Excessively conscientious, scrupulous, and

inflexible about matters of morality, ethics or
values (not accounted for by cultural or religious
identification)
5. Inability to discard worn-out or worthless objects,
even when they have no sentimental value
6. Reluctance to delegate tasks or work to others
unless they submit to exactly their way of doing
things
7. Overly miserly and stingy with money: hoard
money for future catastrophes
8. Rigidity and stubbornness
What it looks like:
Controlling have to have control over everything in their
life
Believe they have to be perfect to be accepted by others
Follow rigid routines & become anxious when routines are
disrupted
Orderly
Lose the forest for the trees
Inefficient at completing tasks
Workaholics unable to delegate
Rigid morals & values
Pack rats
Rigid and stubborn
Overly frugal and stingy with money
Facts & Figures:
Prevalence: 1-4% of community samples
Gender: diagnosed twice as often among males
Special considerations: individuals reference group
May seek Tx due to depression or slipping productivity
Dont like the loss of control inherent in therapy tend
to counter by providing a detailed, orderly account of
Sx & issues
Therapist needs to avoid competing with client to
direct the session
Antidepressants may be helpful for underlying anxiety
& depression
Cluster C Scenario
This individual is going to
meet her boyfriends parents
in another city for the first
time.
Avoidant Personality
Disorder
Include: Speaking very little
Is it possible to get around the family
out of this? Avoiding the
They wont situation altogether
approve of me. Taking excessive
measures to ensure
They might be that she is
mean to me. approved of
How could they (bringing luxurious
ever like me? gifts)
Dependent Personality
Disorder
What will I wear, Volunteering to babysit
do, say? (Followed all the children while
the adults go out to
by asking her
dinner
boyfriend for input
Sticking by her
about this.)
boyfriends side the
I have to make entire time
sure they like me. Agreeing to everything
the family suggests and
with all the opinions
they offer
Obsessive-Compulsive Personality
Disorder
Cognitions Include:
Everyone here is doing Behaviors Include:
everything wrong. Planning out activities
Distress about having to fill the entire trip.
to delegate work tasks Making extensive lists
while away, and about of things to bring but
the dogsitters ability not packing until the
to perform tasks (or last minute.
the babysitters) Exhibiting a great deal
of distress when
conforming to others
ways of doing things
or being stubborn and
ensuring that things
are done her way.
Passive aggressive
personality disorder
definition
The DSM IV defines this disorder as a
pervasive pattern of negativistic
attitudes and passive resistance to
demands for adequate performance in
social and occupational situations that
begins by early adulthood and occurs
in a variety contexts.
Causes
Unknown
Combination of genetic and
environmental factors
Martin kantor suggest three areas,

conflicts about dependency
control
competition
Symptoms
Acting sullen
Avoiding responsibility by claiming
forgetfulness
Being inefficient on purpose
Blaming others
Complaining
Feeling resentment
Having a fear of authority
Having unexpressed anger or hostility
Procrastinating
Resisting other peoples suggestions

Diagnostic criteria
Passively resists fulfilling routine social
and occupational tasks.
Complains of being misunderstood and
unappreciated by others
Is sullen and argumentative
Unreasonably criticizes and scorns
authority
Alternates between hostile defiance
and contrition .
Voices exaggerated and persistent
complaints of personal misfortune
NURSING INTERVENTIONS
Show acceptance of the person at all times
Provide safe environment
Set and maintain limits with consequences
Explain all unit rules
Require the patient to take responsibility

for his own behavior
Indentify inappropriate behavior
Encourage the patient to express their

feelings
Provide positive feedback
Monitor medication
Encourage the patient to participate in unit

activities
Encourage problem solving process
Discuss with the patient about the behavior

Theories of Personality
Disorders:
Family dynamics growing up in a dysfunctional,
abusive, invalidating, overprotective, controlling,
or uncaring environment; poor parenting; parent-
child relationship
Genetic Influences
Biological/biochemical Influences
Trauma & other significant experiences
Continuum model personality disorders
represent extreme variations of normal
personality traits
Treatment for Personality
Disorders
Long-term supportive, structured psychotherapy
Dialectical Behavior Therapy (DBT) accepting &
validating client, setting limits, skills training
Cognitive Behavioral Therapy (CBT) challenging
maladaptive thoughts, beliefs, schemas; skills
training; behavioral experimentation
Psychodynamic/Object Relations Therapy
emphasis on transference, the effect of past
relationships on the present, raising insight
Relational/Interpersonal Therapy using the
therapeutic relationship and other significant
relationships to foster growth, change, and healing

Personality Dis PST

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Personality Dis PST

Transféré par

Droits d'auteur :

Formats disponibles

Personality

A persons characteristic totality

- Kaplan And Sadock

enduring patterns of perceiving ,

He was concluded that disease

Characterized by: Includes:

A pervasive pattern of preoccupation with

4. Excessively conscientious, scrupulous, and

Martin kantor suggest three areas,

Resisting other peoples suggestions

Provide safe environment

Set and maintain limits with consequences

Explain all unit rules

Require the patient to take responsibility

Encourage the patient to express their

Encourage the patient to participate in unit

Discuss with the patient about the behavior

Vous aimerez peut-être aussi