sing Process in the Psychiatric Set

Anxiety and Anxiety Related Disord

Personality Disorder

Presented by:
MR . IRIL IAN B . ROLLO , R . N.
Nursing Process in the
Psychiatric Setting

The Different Standards in Nursing Care

he nursing process
he nursing process

NURSING CONDITIONS NURSING BEHAVIORS



Self – awareness Establishing nursing contract

Accurate observations Obtain information from

Therapeutic communication patient and family

Responsive dimensions of care Validate date with patient

Organize data
he nursing process
NURSING CONDITIONS NURSING BEHAVIORS

Logical decision making
Knowledge of normal parameters
Inductive and deductive reasoning
Sociocultural sensitivity
Identify patterns in data
Compare data with norms
Analyze and synthesize data
Problems and strengths
identified
Validate problems with patient
Formulate nursing diagnosis
Set priorities of problems
he nursing process

NURSING CONDITIONS NURSING BEHAVIORS


Critical thinking skills Hypothesizing
Partnership with patient and Specify expected outcomes

Validate goals with patient

family
he nursing process

NURSING CONDITIONS NURSING BEHAVIORS


Prioritize goals
Application of theory
Respect for patient and family Identify nursing activities
Validate plan with patient
he nursing process

NURSING CONDITIONS NURSING BEHAVIORS


Past clinical experiences Consider available resources
Implement nursing activities
Knowledge of research
Generate alternatives
Responsive and action
Coordinate with other team
dimensions of care
members
he nursing process

NURSING CONDITIONS NURSING BEHAVIORS


Past clinical experiences Consider available resources
Implement nursing activities
Knowledge of research
Generate alternatives
Responsive and action
Coordinate with other team
dimensions of care
members
he nursing process

NURSING CONDITIONS NURSING BEHAVIORS


Supervision Compare patient’s responses and
Self – analysis expected outcomes
Review nursing process
Peer review
Modify nursing process as
Patient and family

participation needed
Participate in quality

improvement activities
The Physiology of Anxiety

The Adaptive and Maladaptive ends of Anxiety

hat is anxiety?

§Greek root meaning “ to press tight ”

§Anxious is related to the Latin word angere

which means “ to strangle ” and “ to
distress ”
§
hat is anxiety?

§It is a subjective, individual experience

characterized by a feeling of apprehension,
uneasiness, uncertainty or dread.
§
§Occurs as a result of threats that may
be actual or imagined, misperceived or
misinterpreted.
Anxiety vs . Fear

§FEAR involves the intellectual appraisal of a

threatening stimulus;

§FEAR has a specific source or object that the

person identify and describe

§ANXIETY is the emotional response to that

appraisal.

§FEAR produces ANXIETY

 +1
MILD / ALERTNESS LEVEL

+2
MODERATE / APPREHENSION LEVEL

+3
SEVERE / FREE FLOATING LEVEL
vels of anxiety

+4
PANIC LEVEL
Assessment of Anxiety
 Behaviors

§Mild and moderate anxiety heightens the

person’s capacities.

§Severe and panic levels paralyze or overwork

capacities
§

The onset of our AUTONOMIC NERVOUS RESPONSES

ogic , Behavioral , Cognitive and Affective Res

PHYSIOLOGIC

BEHAVIORAL

COGNITIVE

AFFECTIVE
redisposing factors

PSYCHOANALYTIC VIEW
THE GABA SYSTEM
INTERPERSONAL VIEW
THE NOREPINEPHRINE SYSTEM
BEHAVIORAL VIEW
SEROTONIN SYSTEM
FAMILY STUDIES

BIOLOGICAL BASIS
ecipitating Stressors

§THREATS TO PHYSICAL INTEGRITY

§
§
iologic disability or decreased ability to perform t
§
§
§THREATS TO SELF ESTEEM
§

to a person’s identity, self-esteem, and integrated so

praisal of STRESSORS

A true understanding of anxiety requires

integration of knowledge from all the various
points of view.
Coping Resources

Resources such as economic assets, problem-

solving abilities, social supports, and cultural
beliefs can help the person integrate stressful
experience into his or her being and learn to
adopt successful coping strategies.
Coping Mechanisms

§TASK ORIENTED REACTIONS

§
§ Attack Behavior
§
§ Withdrawal Behavior
§
§ Compromise
§
§EGO ORIENTED REACTIONS
§
s use of certain defense mechanism is adaptiv
he defense mechanism by the nurse.

nterferes with the person’s functioning and his or her progre

ism.
Diagnosing Anxiety
al and Nursing Diagnoses Related to Anxiety Resp

RELATED MEDICAL DIAGNOSES RELATED NURSING DIAGNOSES

( DSM – IV – TR ) ( NANDA )

Panic disorder without Adjustment, Impaired

agoraphobia Anxiety
Panic disorder with Breathing pattern, Ineffective
agoraphobia Communication, Impaired verbal
Agoraphobia without panic Confusion, Acute
attacks Coping , Ineffective
Specific Phobia Coping , Readiness for
Social phobia Enhanced
Obsessive – Compulsive Denial, Ineffective
disorder Diarrhea
Post traumatic stress disorder Fear
Acute stress disorder Injury, Risk for
Generalized anxiety disorder Memory, impaired
al and Nursing Diagnoses Related to Anxiety Resp

RELATED MEDICAL DIAGNOSES RELATED NURSING DIAGNOSES

( DSM – IV – TR ) ( NANDA )

Post Trauma Syndrome

Powerlessness
Protection, Ineffective
Role performance, Ineffective
Self – esteem, situational low
Sensory perception, disturbed
Sleep pattern, disturbed
Social interaction, impaired
Thought process, disturbed
Tissue perfusion, ineffective
 Planning and
l demonstrate Implementation
adaptive ways of copi
Outcome Indicators for Anxiety Self - Control

üMonitors intensity of anxiety

üEliminates precursors of anxiety
üDecreases environmental stimuli when anxious
üSeeks information to reduce anxiety
üPlans coping strategies for stressful situations
üUses effective coping strategies
üUses relaxation techniques to reduce anxiety
üMonitors duration of episodes
ü
Outcome Indicators for Anxiety Self - Control

üMonitors length of time between episodes

üMaintains role performance
üMaintains social relationships
üMaintains concentration
üMonitors sensory perceptual distortions
üMaintains adequate sleep
üMonitors physical manifestations of anxiety
üMonitors behavioral manifestations of anxiety
üControls anxiety response
EDICAL AND NURSING INTERVENTIONS Severe or panic
üEstablishing a Trusting Relationship
ü
üNurse’s Self Awareness
ü
üProtecting the Patient
ü
üModifying the environment
ü
üEncouraging activity
ü
üMedication

ANTIANXIETY
ANTIDEPRESSANT DRUGS DRUGS
/ ANTIANXIETY
Selective serotonin reuptake inhibitors (SS
Benzodiazepines
Tricylics
Antihistamines
Monoamine oxidase inhibitor
Noradrenergic agents (MAOIs)
Other newer antidepressants
Anxiolytic
EDICAL AND NURSING INTERVENTIONS
üEducation
moderate
üRecognition of Anxiety
ü Patient Resistances to Recognizin
üInsight into the Anxiety
ü Screen Symptoms
üCoping with the Threat Superior Status position
ü Emotional seduction
üPromote the Relaxation Response
Superficiality
Circumlocution
Amnesia
Denial
Intellectualization
Hostility
Withdrawal
Evaluating Outcomes of Care
 efficiency , and flexibility in evaluating th

nt’s level of anxiety?

e relationship?
 Anxiety Disorders

Generalized Anxiety Disorders, Panic Disorder, Phobias,

Obsessive Compulsive Disorders
Generalized Anxiety
Disorder
( GAD )
Characterized by persistent,
unrealistic and excessive
anxiety that cannot be
controlled or displaced.
ASSESSMENT

üPersistent anxiety results in

continuous motor tension:
trembling, muscle aches,
jumpiness

üTension causes the person to be

irritable, exhausted, easily
tired

üAutonomic hyperactivity:
sweating, palpitations,
dizziness, upset stomach,
increased pulse and
respirations

üAffect: worried and fearful

üHyper alert, insomnia

EDICAL AND NURSING INTERVENTIONS Severe or panic
üEstablishing a Trusting Relationship
ü
üNurse’s Self Awareness
ü
üProtecting the Patient
ü
üModifying the environment
ü
üEncouraging activity
ü
üMedication

ANTIANXIETY
ANTIDEPRESSANT DRUGS DRUGS
/ ANTIANXIETY
Selective serotonin reuptake inhibitors (SS
Benzodiazepines
Tricylics
Antihistamines
Monoamine oxidase inhibitor
Noradrenergic agents (MAOIs)
Other newer antidepressants
Anxiolytic
Panic Disorder

Characterized by a core
symptom which is panic attack,
an overwhelming fear that
occurs out of the blue without
warning and for no reason.
ASSESSMENT

  A panic attack is a discrete

period of intense fear or
discomfort in which at least four
of the following symptoms develop
abruptly and reach a peak within
10 minutes:
ASSESSMENT
üFeeling dizzy, unsteady,
lightheaded, or faint
ü
üDerealization (feelings of
unreality) or
depersonalization (being
detached from oneself)
ü
üFear of losing control or
going crazy
ü
üFear of dying
ü
üParesthesias (numbness or
tingling sensations)
ü
üChills or hot flushes
 ASSESSMENT

üPalpitations, pounding heart,

or accelerated heart rate
ü
üSweating
ü
ious side effects ifüTrembling
panic attacks
or shakingare left u
ü
üSensations of shortness of
a breath or smothering
ry Anxiety ü
üFeeling of choking
ü
üChest pain or discomfort
ü
üNausea or abdominal distress
ü
EDICAL AND NURSING INTERVENTIONS Panic disorder
Main treatment options
are medication and
cognitive
behavioral therapy .
Cognitive
A number behavioral therapy consists of f
of medications
that are used to treat
depression also help from Learning
75% to 90% of patients Monitoring
with panic disorder.
Breathing
Rethinking
Exposing
 Phobia

Refers to an uncontrollable,
persistent and irrational fear
of an object or situation that
impairs normal functioning of
the person affected.
THREE TYPES OF PHOBIA

Specific Phobia
tyrophobia - Fear of peanut butter sticking to the roof of t
ia- Fear of swallowing air
ia- Fear of walking   An extreme or excessive fear of
a particular object or situation
hobia- Fear of sitting
that the person could not
phobia- Fear of mirrors
obia- Fear of hair overcome. This exaggerated fear
ia- Fear of food can greatly impair a person’s
functioning
bia- Fear of going to bed if the feared object
is a common one
obia- Fear of knowledge
omonstrosesquippedaliophobia - Fear of long words
ophobia- Fear of opening one’s eyes
bia- Fear of fear
THREE TYPES OF PHOBIA

Social Phobia

The cause of social

  This phobia
refers tohas beenoftraced to:
the fear
being watched, scorned or
arents humiliated in social situation,
while doing
ding exposure to traumatic injurysomething
) in front of
les, apparently this an
is audience or why
the reason while
it simply
is more prevalent a
socioeconomic statusinteracting with to
are more likely other people
develop social
. phobia
Social phobias generally develop
after puberty
THREE TYPES OF PHOBIA

Agoraphobia

  The fear of being in open

spaces and situations in which
the person thinks there is no
escape or help would be difficult
to obtain.
 EDICAL AND NURSING INTERVENTIONS phobias
Treatment for phobia
is either behavior
therapy or medication
or a combination of
both
 
1.Behavior therapy by
behavior
qTeach systemic
patients to recognize the signs of increas
ew qand feedback
Select and role
anxiety - playing measures appropriate fo
reduction
s desensitization
qScreen
2.on for
families suicidal ideation
the significance of phobiaand
as asubstance abuse
debilitating pro
3.Medications are used to q
control the panic
experienced during a
phobic situation.
4.
5.Nursing care:
Obsessive – Compulsive
Disorder
OBSESSIVE COMPULSIVE DISORDER

Obsessions
ples :
  are frequently occurring
irrational thoughts that cause a
of dirt and germs
great deal of anxiety but that
of burglary orcan
robbery
’t be controlled through
reasoning
ies about discarding something important
erns about contracting a serious illness
ies that things must be symmetrical and matchi
OBSESSIVE COMPULSIVE DISORDER

Compulsions
es :
is an uncontrollable urge to do
repetitive acts that are
it
ive is ego -recognized
handanwashing dystonic by thedisorder
that i
patient as
unnecessary and unreasonable.
ed checking of door and window locks
ng and recounting of objects in everyday life
ng of objects
ive straightening, ordering or of arranging th
ing words or prayers silently.
OCD vs . OCPD
OCPD
OCPD affects more men who
are preoccupied with order,
lists, rules, goals and
perfection. They are highly
successful achievers, often
at the expense of personal
and professional
relationships.
OCD
While OCD individuals are
preoccupied with their
intrusive thoughts and
rituals to the point of
impairing their entire
life.
 EDICAL AND NURSING INTERVENTIONS
1.Assessment and Diagnosis
ocd
of OCD
2.
3.Behavior Therapy
-exposure and response
prevention
4.
behavior5.Cognitive Therapy –
ew and feedback
helpsand role playing
patients to gain
s insights of their
families onirrational
the significance
thoughtsoforphobia as a debilitating pro
faulty beliefs system.
 EDICAL AND NURSING INTERVENTIONS
4.Group therapy provides
ocd
support and decreases
social isolation.
5.
6.Family Therapy
7.
8.Medications - SSRIs
ify the situations
9. that precipitate the behavior
rituals that may interfere with the client ’s physical well –
t interrupt the compulsive
10.Nursing Care : behaviors and allow time for clien
to verbalize concerns .
de for client safety related to the behaviors
en contract thatfor
will
theassist
clientthe client to gradually decrease
ment a schedule that distractsq
from the behavi
q
Anxiety Related Disorders

Somatoform and Dissociative Disorders

Somatoform Disorders

Characterized by presence of
physiologic complaints or
symptoms which are not under
voluntary control and do not
demonstrate organic finding.
Types of Somatoform
Disorders
 Somatization

Stems from a long standing and free

floating anxiety that is expressed as
alteration or loss of physical
functioning such as gastrointestinal
symptoms, pain, cardiopulmonary symptoms
or gynecologic symptoms.
ASSESSMENT
To be diagnosed the person
must complain at least 13
symptoms from a list of 35 .
The diagnostic criteria of
this disorder are :  

üOnset of physical complains

before the age of 30
ü
üA history of pain affecting
at least four different body
parts
ü
üTwo or more GI symptoms
ASSESSMENT

üAt least one sexual or

reproductive symptom
ü
üAt least one neurologic
symptom (excluding pain)
ü
üThe diagnosis is supported by
the dramatic nature of the
complaints and patient’s
exhibitionistic, dependent,
manipulative and sometimes
suicidal behavior.
ü
CAUSES

1.Inability of the central

nervous system to regulate
and interpret sensory input.
2.
3.Begins in childhood when the
child experiences gains
during childhood illness.
4.
5.Certain life experiences
6.
7.Other disorders such as:
depression, anxiety,
dependent, OC or histrionic
personality characteristics,
substance abuse.
8.
EDICAL AND NURSING INTERVENTIONS somatization
üThe best treatment is
calm, form, supportive
relationship.
ü
üThe nurse must
understand that there
is denial from the
patient that the
symptoms are
psychologic in nature.
ü
üAvoid judgmental
approach. Inform the
patient in a matter of
fact approach.
ü
EDICAL AND NURSING INTERVENTIONS somatization
üProvide empathy
ü
üHelp identify situations
in which the symptoms
arise.
ü
üSet limits
ü
Conversion Disorder

Psychologic conflict is
converted unconsciously into
functional symptoms such as
anesthesia, paralysis, and
dyskenisia (difficulty in moving
muscular movement).
EDICAL AND NURSING INTERVENTIONS conversion
üObtain a nursing history and
assess for physical
problems. Assure the client
that physical illness has
been ruled out.
ü
üFocus on anxiety reduction.
ü
üDo not provide secondary gain
ü
üAssist clients in recognizing
feelings and emotions.
ü
ü
EDICAL AND NURSING INTERVENTIONS conversion
üMatter of fact attitude.
ü
üProvide positive feedbacks
for accomplishments to
increase self-esteem.
ü
üRelaxation training to reduce
anxiety

ü
 Hypochondriasis

A disorder characterized by a person who

is preoccupied with bodily functions and
unrealistic belief of having serious
physical illness based on
misinterpretation of physical symptoms,
despite medical reassurances on the
contrary.
TYPES OF HYPOCHONDRIASIS

PRIMARY

SECONDARY

TRANSIENT
EDICAL AND NURSING INTERVENTIONS hypochondriasis
üEstablish trust and show
empathy.
ü
üReassure client that there is
no medical illness
ü
üExposure techniques
ü
üExplore alternative coping
skills.
ü
üSet limits on time spent with
the client - pt. tends to
manipulate
ü
üDo not provide secondary
gains
ü
Dissociative Disorder

Patients literally dissociates

himself from the situation or
experience too traumatic to
integrate with his conscious
self by purposeful forgetting.
CAUSES

1.Inability to recall important

personal information usually
of a traumatic or stressful
nature.
2.
3.Exposure to traumatic event
4.
5.Sexual abuse during childhood
6.
7.Psychopathology: an escape
mechanism.
Types of Dissociative
Disorders
Dissociative / Psychogenic
Amnesia

A sudden inability to recall important

personal information that is too
extensive to be explained by ordinary
forgetfulness and is not associated
with an organic disorder such as head
injury.
TYPES OF AMNESIA

Localized Amnesia

Selective Amnesia

Generalized Amnesia

Systematized Amnesia
EDICAL AND NURSING INTERVENTIONS Amnesia
üTreatment towards recovery is
initiated by providing the
person with a supportive
environment that
establishes a sense of
safety.
ü
üMemory retrieval strategies
such as questioning the
patient while under
hypnosis or in a drug –
induced semihypnotic state.
ü
üEncourage patient’s
verbalization of conflicts,
painful experience. - since
client uses the defense
mechanism of repression.
ü
 Dissociative
aumatic material (abreactions) withFugue
the help of a the

Characterized by sudden, unexpected

travel to faraway place accompanied by
an inability to recall’s one’s past and
identity confusion in an absence of
organic cause.
Dissociative Identity
Disorder /
Multiple Personality
The ultimate of dissociative disorders
in which fugue, amnesia and
depersonalization may all exist. It’s
hallmark is the presence of two or more
distinct personalities within an
individual.
 Multiple personali
EDICAL AND NURSING INTERVENTIONS
üPrimary Tx of DID is insight
– oriented psychotherapy,
with therapeutic abreaction
(reliving) of significant
childhood experience.
ü
üDiagnosis and establishing
rapport.
ü
üMapping
ü
üTherapeutic processing of
trauma
ü
üResolution of trauma
ü
ü
 Personality Disorders

Odd/Eccentric, Dramatic/Erratic, Anxious/Inhibited Personalitie

WHAT ARE PERSONALITY TRAITS?

Patterns of thinking,
percieving, reacting, and
relating that are relatively
stable over time and in
various situations.
WHEN DO PERSONALITY DISORDERS OCCUR?

PD’s occur when these traits

are so rigid and maladaptive
and individual uses
excessive immature and
maladaptive
etimes coping
called character disorder, the patient's problematic b
mechanisms that result in
e the impairment of
ess to situations
interpersonal or vocational
functioning.
M – IV TR PD CLASSIFICATION
§CLUSTER A ( Odd / Eccentric )
§
Paranoid, schizoid, schizotypal
§CLUSTER B ( Dramatic / Erratic )
§
§
Borderline
§ , Antisocial , Histrionic , Narcis
§CLUSTER C ( Anxious / Inhibited )
§

Dependent, Avoidant, Obsessive - Compul

Cluster A Personality
Disorders
Paranoid Personality
Disorder

Characterized by chronic
hostility that is projected
to others.
ASSESSMENT

Vigilant & suspicious

Bear grudges, unforgiving
Diff. close
relationship/work alone
Cold, lack of sense of humor
Very critical
Argumentative
Hostile aloofness
Rigid and controlling of
others
Hyper vigilant, guarding
EDICAL AND NURSING INTERVENTIONS paranoid
üApproach in a formal,
business-like manner.
üKeep commitments,
üBe straightforward,
üInvolve them in formulating
their care plans
üHelp them learn to validate
ideas before taking action
üNever reject client’s
paranoid delusions
üAvoid being too friendly/nice
üAntipsychotic medications
ü
ü
ü
Schizoid Personality
Disorder

The main personality trait of a

schizoid is the person’s
inability to form warm, close and
satisfying human relationship.
ASSESSMENT

Neither desire close

relationships.
Prefer solitary activities,
loners.
Cold, detachment, flattened
affect.
Occupation involves little
interpersonal contacts.
Introvert, cold and distant
Lacks interest in others
Dissociate from or no
bodily or sensory
pleasures
EDICAL AND NURSING INTERVENTIONS schizoid
üIndividual Psychotherapy
üNurse must acknowledge the
patient’s need for personal
distance.
üIt is important that the
nurse remembers that to
develop feelings of
security, possible sources
of disappointments in the
relationship should be
avoided.
üGroup Therapy
üSocial Skills Training
üAtypical Antipsychotics

ü
ü
ü
Schizotypal Personality
Disorder

The person displays abnormal or

highly unusual thoughts,
perceptions, speech and behavior
patterns.
ASSESSMENT

Similar to schizoid.
Ideas of reference, odd
beliefs, magical thinking,
illusions.
Paranoid fears
Lack of interpersonal
relationships.
Inappropriate affect
Odd, eccentric or peculiar.
Clairvoyance
Reports feeling of being
‘different’ or ‘not
fitting in’
EDICAL AND NURSING INTERVENTIONS schizotypal
üInitial step is to establish
relationship.
ü
üSocial skills training are
also necessary because of
lack of close human
relationships.
ü
üManage delusions
appropriately.
ü
üAtypical antipsychotics
ü
üSimilar interventions with
schizoid.
Cluster B Personality
Disorders
Borderline Personality
Disorder

BPD is a serious mental illness

characterized by pervasive
instability of moods, interpersonal
relationships, self-image and behavior.
ASSESSMENT

More frequent among women

History of abuse
Uses denial, splitting and
projection.
Impulsive, unpredictable,
unstable and intense.
Masochistic tendencies.
Manipulative
Intense fear of abandonment
Feeling of emptiness
Views themselves as
fundamentally bad or
unworthy
Sometimes self inflicting
or suicidal.
EDICAL AND NURSING INTERVENTIONS borderline
üLong-term therapy to resolve family
dysfunction and abuse
üHospitalization when client is
exhibiting self-harm behaviors or
having intense symptoms
üBrief hospitalizations to stabilize
condition
üPromoting the client’s safety (No-
self-harm contract)
üEstablishing boundaries in
relationships
üHelping the client to cope and
control emotions
üReshaping thinking patterns
Antisocial Personality
Disorder

APD is a Chronic disorder with onset

before the age of 15 and
characterized by a pattern of
behaviour that shows callous
disregard for the rights and feelings
of others
ASSESSMENT

Not diagnosed by mental

status but by behavior.
Highly manipulative,
charming, witty and
intellectual
Lacks SUPER EGO
Does not experience guilt
or remorse
Stealing, lying, cruelty to
animals, vandalism,
substance abuse.
Perceive the world as
hostile
Tolerate frustration poorly
EDICAL AND NURSING INTERVENTIONS antisocial
üProvide model for mature, appropriate
behavior
üObserve strict limit setting
(control manipulative charming
behavior)
üAvoid moralizing and judging
patient’s behaviors, thoughts and
feelings.
üPoint out to patient the effects of
his behaviors on other people.
üHelp the client identify connections
between their acting out behaviors
and feelings.
üThe nurse should avoid arguments and
taking sides on authority issues
and those who hold authority over
the patient.
Narcissistic Personality
Disorder

Narcissistics have exaggerated sense

of superiority and self importance.
They feel and think that they are
above everything. Due to their
grandiose thinking.
ASSESSMENT

Requires constant
admiration
Grandiose and lacks empathy
Extremely sensitive to
criticism, failure or
defeat
They expect favors and
become angry or surprised
when people do not do
what they want.
Overestimates abilities and
underestimates
contributions of others.
Relationships are
characterized by
disruption or control.
EDICAL AND NURSING INTERVENTIONS narcissistic
üRemain neutral
üAvoid power struggles
üConvey unassuming self – confidence
üUse self awareness to avoid anger
and frustrations
üUse matter of fact manner (c0ntrol
manipulative behaviors)
Histrionic Personality
Disorder

Histrionic personality is
characterized by overly dramatic and
intensely expressive behavior. Their
theatrical behaviors and appearance
that easily attracts attention is an
unconscious expression for dependency
.
ASSESSMENT

Conspicuously seek
attention
Vain and overly conscious
of appearance
Sexually seductive and
provocative
Childish and bores easily
Controlling of partner
Tend to consider recent
acquaintances as dear
friends.
Shallow personality
Without instant
gratification or
admiration from others –
depression or suicidal
EDICAL AND NURSING INTERVENTIONS histrionic
üConsistent limit setting is
necessary.
üClarify boundary and limitation of
the relationship at the onset –
therapist sexy
üFocus on short term alleviation of
difficulties in the pts’ life.
üPsychotherapy (individual not group
or insight – oreinted)
üProtect patient from self
destructive tendencies
üSelf help group – eliminate shallow
feelings
Cluster C Personality
Disorders
Avoidant Personality
Disorder

Characterized by extreme sensitivity

to criticisms and potential rejection
that causes them to avoid social
relationships and interaction.
ASSESSMENT

They desire affection and

acceptance yet avoid
social interaction.
Fear starting any
relationship
Have extremely poor self
esteem.
Pessimistic and have
difficulty in assessing
situations and
interactions objectively.
Prominent feelings of
inadequacy, anger,
depression.
Hypersensitivity
Social phobia
EDICAL AND NURSING INTERVENTIONS avoidant
üExplore positive self-aspects and
reasons for self-criticism.
üPractice self-affirmations and
positive self-talk.
üCognitive restructuring techniques,
such as reframing and
decatastrophizing
üTeach social skills
üA friendly, gentle reassuring
approach.
üMay involve in small group
activities.
üMAOI, benzodiazepines
ü
ü
Dependent Personality
Disorder

Dependent PDs extremely lacks self

confidence and the ability to
function independently.
ASSESSMENT

Submissive and clinging

behavior
Excessive need to be taken
care of
Pessimistic and self-
critical; other people
hurt their feelings
easily
Report feeling unhappy or
depressed;
Difficulty making decisions
Seek advice and repeated
reassurances
EDICAL AND NURSING INTERVENTIONS dependent
üHelp identify strengths and needs.
üUse cognitive restructuring
üAssist in daily functioning
üTeach problem solving and decision
making
üRefrain from giving advice
üThe nurse must monitor medications
to make sure that the patient is
not abusing it, due to patient’s
frequent somatic complaints.
üAssertiveness training is effective
in helping client become more self
reliant.

ü
ü
Obsessive Compulsive
Personality Disorder

Characterized by a personality that

is perfectionist, engages in over
devotion to work, reliable but
inflexible to change.
ASSESSMENT

Overly preoccupied with

rules and regulations
making them stubborn and
inflexible to change
Preoccupation with
orderliness,
perfectionism, and
control
constricted emotions,
problems with judgment and
decision making
Lacks leisure activities
and friendships.
Hoards worthless objects.
EDICAL AND NURSING INTERVENTIONS ocpd
üIndividual psychotherapy
üThe nurse should be prepared with
client’s verbal attacks, avoid
taking it personally.
üThe best way to enable the
individual to try a new idea would
be by simply stating the
effectivity supported by research
studies.
üReinforce positive relationships and
helps the patient reexamine harmful
relationships.
üSelf help groups
üControls compulsions as that of OCD.

ü
ü
Thank You Very Much !