PSYCHIATRIC NURSING

ANXIETY AND ANXIETY DISORDERS

FEELING OF DREAD OR FEAR IN THE ABSENCE OF AN EXTERNAL THREAT OR
DISPROPORTIONATE TO THE NATURE OF THREAT. PREDISPOSED BY :
PROLONGED UNMET NEEDS
UNACCEPTABLE THOUGHTS OR FEELINGS
STRESS THREATENING SECURITY OR SELF ESTEEM

CAUSED BY A CONFLICT BETWEEN ID AND SUPEREGO

A PRODUCT OF FRUSTRATION

priority diagnosis:

INEFFECTIVE IDIVIDUAL COPING

ANXIETY

LEVELS OF ANXIETY:
MILD-HIGH DEGREE OF AWARENESS, MILD UNEASINESS,ALERT
MODERATE – POOR COMPREHENSION,NARROWED PERCEPTUAL FIELD AND
SELECTIVE INATTENTION
SEVERE-SIGNS AND Sx becomes the focus of attention, no problem solving
technique,impulsive,AMNESIA AND DISSOCIATION
PANIC – INABILITY TO FUNCTION , SEE OR HEAR, PERSONALITY
DISORGANIZED.DEFENSE MECHANISMS FAIL
USES EGO DEFENSE MECHANISMS TO MANAGE ANXIETY
PRINCIPLES OF CARE
CALM
ADMINISTER MEDICATIONS
LISTEN TO PATIENTS CONCERN
MINIMIZE ENVIRONMENTAL STIMULI

ANXIETY DISORDERS
THESE ARE EMOTIONAL ILLNESSES CHARACTERIZED BY FEAR, AUTONOMIC
NERVOUS SYSTEM SYMPTOMS AND AVOIDANCE BEHAVIOR
ASSESS LEVEL OF ANXIETY
KEEP ENVIRONMENTAL STRESSES/STIMULATION LOW
ASSIST CLIENT TO COPE W/ ANXIETY
MAINTAIN ACCEPTING AND HELPFUL ATTITUDE
PANIC ATTACKS
SUDDEN ATTACKS OF INTENSE ANXIETY
INTERVENTION : RELAXATION EXERCISE; ANTI ANXIETY
PHOBIA
APPREHENSION , ANXIETY , HELPLESSNESS WHEN CONFRONTED WITH PHOBIC
SITUATION OR FEARED OBJECT
AVOID CONFRONTATION AND HUMILIATION
PHOBIA

SIMPLE PHOBIA – FEAR OF A SPECIFIC OBJECT OR SITUATION

 ANTI ANXIETY and antidepressants;SYSTEMATIC DESENSITIZATION and relaxation
therapy
SOCIAL PHOBIA – FEAR OF SOCIAL SITUATIONS,WHEN THERE IS A POSSIBILITY OF
EMBARRASSMENT
ANTI-ANXIETY, SOCIAL SKILLS TRAINING
AGORAPHOBIA – FEAR OF BEING ALONE IN THE PUBLIC PLACE
ANTI-ANXIETY, SOCIAL SKILLS TRAINING

OBSESSIVE- COMPULSIVE DISORDER

OVERWHELMING NEED TO CARRY OUT A STEREOTYPICAL ACT TO RELIEVE ANXIETY
PRECIPITATED BY AN OBSESSIVE THOUGHT
obsession – repetitive, uncontrollable thoughts
compulsion – repetitive uncontrollable acts

INTERVENTIONS:
ANTI DEPRESSANTS; (Anafranil)
BEHAVIORAL TECHNIQUES SUCH AS stimulus RESPONSE PREVENTION AND
THOUGHT STOPPING
accept ritulistic behavior
provide for physical needs

GENERALIZED ANXIETY DISORDER

EXCESSIVE ANXIETY FOR AT LEAST 6 MONTHS, INTERFERES WITH A PERSONS LIFE
CHARACTERIZED BY ANXIETY, MOTOR TENSION, AUTONOMIC HYPERACTIVITY AND
COGNITIVE VIGILANCE
ANTI ANXIETY, PSYCHOTHERAPY,COGNITIVE STRUCTURING
POST TRAUMATIC STRESS DISORDER
REEXPERIENCING THE ORIGINAL TRAUMATIC EVENT( DISTRESSING RECOLECTIONS,
DREAMS OR NIGHTMARES,FLASHBACKS,HYPERVIGILANCE,NUMBING)
DURATION AT LEAST A MONTH,BUT CAN EMERGE MONTHS TO YEARS
ANTI-ANXIETY , ANTI-DEPRESSANT , GROUP THERAPY,FLOODING, ASSIST CLIENT TO
CHALLENGE EXISTING IDEAS
TEACH STRESS MANAGEMENT TECHNIQUES,ENHANCE SUPPORT SYSTEMS

ANOREXIA NERVOSA
MOST COMMON IN ADOLESCENT FEMALES-CHARACTERIZED BY FEAR OF OBESITY,
DRAMATIC WEIGHT LOSS AND DISTORTED BODY IMAGE, ANEMIA , AMENORRHEA,
PURGING AND INDUCED VOMITING,EXECISIVE EXERCISE
ANOREXIA NERVOSA
MONITOR WEIGHT , MIO , ELECTROLYTE BALANCE AND V.S.
PROVIDE ADEQUATE FLUIDS AND ELECTROLYTE AND NUTRITION
BEHAVIOR MODIFICATION AND FAMILY THERAPY
SUPPORT EFFORTS TO TAKE RESPONSIBILITY FOR SELF

AMENORRHEA
NO ORGANIC FACTOR –WEIGHT LOSS
OBVIOUSLY THIN BUT FEELS FAT
REFUSAL TO MAINTAIN BODY WEIGHT
EPIGASTRIC DISCOMFORT
X – SYMPTOMS – HIDING FOOD
INTENSE FEAR OF GAINING WEIGHT
ALWAYS PREOCCUPIED WITH FOOD
 BULIMIA
CHARACTERISTICS OF ANOREXIA AND BINGE EATING( HIGH CALORIE – SHORT PERIOD)
NORMAL WEIGHT OR OVERWEIGHT

MANAGED WITH ANTI-DEPRESSANTS, NUTRITIONAL ASSESMENTS AND

COUNSELING

BINGE EATING
UNDER STRICT DIETING/VIGOROUS EXERCISE
LACKS CONTROL OVER BINGES
INDUCED VOMITING
2 BINGE EATING PER WEEK FOR 3 MNTHS
INCREASED CONCERN OVER BODY SIZE
ABUSE OF DIURETICS AND LAXATIVES
INTERVENTIONS
REMAIN IN PUBLIC/ STAY W/ PNT. FOR TWO HOURS AFTER MEALS
MONITOR WEIGHT
FREQUENT ORAL HYGIENE
BEHAVIOR MODICATION THERAPY
CRISIS AND CRISIS INTERVENTION
SITUATION THAT OCCURS WHEN AN INDIVIDAULS HABITUAL COPING ABILITY BECOMES
INEFFECTIVE TO MEET THE DEMANDS OF THE SITUATION
TYPES :
CRISIS STATE
LAST 4-6 WKS,SELF LIMITING
INDIVIDUALIZED , AFFECTING SUPPORT SYSTEM
CAN PROMOTE GROWTH AND NEW BEHAVIORS
PERSONS BECOMES PASSIVE AND SUBMISSIVE
STAGES OF CRISIS
DENIAL
INCREASED TENSION AND ANXIETY
DISORGANIZATION
ATTEMPTS TO REORGANIZE
ATTEMPTS TO ESCAPE
GENERAL REORGANIZATION
TYPES OF CRISIS
MATURATIONAL / DEVELOPMENTAL CRISIS
SITUATIONAL / ACCIDENTAL
SOCIAL CRISIS

GOAL N- TO ENABLE THE PATIENT TO ATTAIN OLOF.

INTERVENTIONS
GOAL DIRECTED, FOCUS ON HERE AND NOW
FOCUS ON CLIENTS IMMEDIATE PROBLEM
ACTIVE AND DIRECTIVE
EXPLORE UNDERSTANDING OF PROBLEM
HELP CLIENT BECOME AWARE OF FEELINGS AND VALIDATE THEM
DEVELOP A PLAN
FIND NEW COPING SKILLS AND MANAGE FEELINGS
SITUATIONAL CRISIS
GRIEVING-4-8 WEEKS TO 1 YEAR
FOCUS ON HERE AND NOW
PROVIDE SUPPORT AND ENCOURAGE VERBALIZATION AND EXPRESSION
DYING
DABDA
KEEP COMMUNICATION OPENGIVE SENSE OF CONTROL AND DIGNITY
RAPE TRAUMA-3-4 WKS
REORGANIZATION LONG TEM
SELF BLAME , PHOBIAS , ANXIETY AND PSYCHOSOMATIC TENDENCIES
PROVIDE FOR PHYSIOLOGICAL NEEDS FIRST AND REFER FOR MEDICOLEGAL

DOMESTIC VIOLENCE
BATTERED WIFE SYNDROME-HUMILIATION , BEATING AND OTHER FORMS OF
AGGRESSION
ABUSIVE MEN – LOW SELF-ESTEEM
ABUSED WOMEN – DEPENDENT PERSONALITY
THEY COME FROM ABUSIVE FAMILIES
IMMATURE DEPENDENT AND NON- ASSERTIVE
STRONG FEELINGS OF INADEQUACY
DOMESTIC VIOLENCE
PRIORITY OF CARE – PROVISION OF SHELTER
STAGES
tension building
acute battering
aftermath honeymoon
CHILD ABUSE
INTENTIONAL PHYSICAL , EMOTIONAL , SEXUAL MISUSE /TRAUMA, OR INTENTIONAL
OMISSION OF BASICNEEDS(NEGLECT)(ABANDONMENT).USUALLY RELATED TO
DIMINISHED/LIMITED ABILITY OF PARENTS TO COPE WITH, PROVIDE FOR OR RELATE
TO CHILD

`
INDICATORS

S ERIOUS INJURIES IN VARIOUS STAGES OF HEALING

( INCONSISTENCIES)
HEALTHY HAIR IN VARIOUS LENGTH AND CNS OR ABDML. INJURIESSEVERE
A PATHY , NO REACTION
D EPRESSION/DISTURBANCE IN PARENT CHILD INTERACTION
E EXCESSIVE KNOWWLEDGE OF SEX
EMOTIONAL NEGLECT-FAILURE TO THRIVE
S ELF ESTEEM - LOW
CHILD ABUSE INTERVENTIONS
PROVIDE FOR PHYSICAL NEEDS FIRST
MANDATORY REPORTING TO APPROPRIATE AGENCY
NON JUDGEMENTAL Tx OF PARENTS.TEACH G AND D
PROVIDE EMOTIONAL SUPPORT FOR THE CHILD(PLAY THERAPY)
INITIATE PROSPECTIVE PLACEMENT
PROPER DOCUMENTATION
SOMATOFORM DISORDERS
PRESENCE OF PHYSICAL SYMPTOMS BUT WITHOUT EVIDENCE OF PHYSIOLOGIC
DISORDER.LINKED TO PSYCHOLOGIC FACTOR OR EMOTIONAL CONFLICT

SOMATIZATION DISORDER
RECURRENT AND MULTIPLE SOMATIC COMPLAINTS OF SEVERAL YEARS DURATION
AND SEEMINGLY WITHOUT PHYSIOLOGIC CAUSES, USUALLY BEGINS BEFORE 30
TEARS OF AGE, CHRNIC ACCOMPANIED BY ANXIETY AND DEPRESSED MOOD
 CONVERSION DISORDER
LOSS OR ALTERATION OF PHYSICAL FUNCTION THAT SUGGESTS A PHYSICAL
DISORDER RELATED TO EXPRESSION OF A PSYCHOLOGICAL CONFLICT.
PRIMARY GAIN- KEEP CONFLICT OUT OF AWARENESS
SECONDARY GAIN – AVOID DISTRESSING/UNCOMFORTABLE ACTIVITY WHILE
RECEIVING SUPPORT FROM OTHERS.
CONVERSION DISORDER
CONVERSION HYSTERIA
PHYSICAL SYMPTOMS WITH NO ORGANIC BASIS- blindness , paralysis, convulsions without
LOC, stocking nad glove anesthesia , la belle indefference
discuss FEELINGS RATHER THAN SYMPTOMS.
avoid secondary gain
DIAGNOSTIC EVALUATION AND ESTABLISH THER. RELATIONSHIP

HYPOCHONDRIASIS
PREOCCUPATION WITH FEAR OR BELIEF THAT THEY WILL HAVE A SERIOUS DISEASE
WHICH IS NEGATIVE ON PHYSICAL EVALUATION.

BODY DYSMORPHIC DISORDER

IMAGINED DEFECT ON APPEARANCE WHICH IS OUT OF PROPORTION TO ANY
ACTUAL ABNORMALITY
UNDIFFERENTIATED SOMATOFORM
MULTIPLE PHYSICAL COMPLAINTS AT LEAST 6 MONTHS W/O ANY ORGANIC
PROBLEM
SOMATOFORM PAIN DISORDER
PAIN IN ABSENCE OF PHYSIOLOGIC FINDINGS
DISSOCIATIVE DISORDERS
SUDDEN TEMPORARY CHANGE OF CONSCIOUSNESS, IDENTITY OR MOTOR BEHAVIOR
SO THAT SOME PART OF THE FUNCTIONS ARE LOST. THE REPRESSION OF IDEAS
THAT LEADS TO AMNESIA AND OTHER FORMS OF DISSOCIATION IS CONCEIVED AS A
WAY OF PROTECTING THE INDIVIDUAL FROM EMOTIONAL PAIN ARISING FROM
EITHER DISTURBING EXTERNAL CIRCUMSTANCES OR INTERNAL PSYCHOLOGIC
CONFLICTS
MULTIPLE PERSONALITY DISORDER
TWO OR MORE DISTINCT PERSONALITIES , TRANSITION FROM OE PERSONALITY TO
ANOTHER IS SUDDEN AND DRAMATIC
PSYCHOGENIC FUGUE
WANDERS FAR - FORGETS PAST LIFE AND ASSOCIATIONS, IS UNAWARE OF HAVING
FORGOTTEN ANYTHING. WHEN HE RETURNS DOES NOT REMEMBER THE PERIOD OF
FUGUE. GENERALLY RECLESIVE AND QUIET

PSYCHOGENIC AMNESIA
AWARE – TOTAL LOSS OF MEMORY FOR EVENTS THAT OCCURRED DURING A PERIOD –
RANGE FROM FEW HOURS TO A WHOLE LIFETIME

MOOD DISORDERS
DISTURBANCES IN EMOTIONAL AND BEHAVIORAL RESPONSE PATTERNS. RANGES
FROM ELATION AND AGITATION TO SEVERE DEPRESSION AND SERIOUS POTENTIAL
OFR SUICIDE
BIPOLAR DISORDERS
MOOD DISORDERS WHICH MAYBE OBSERVED AT ANY GIVEN TIME, BOTH OF WHICH
MAYBE PRESENT SIMULTANEOUSLY( Bipolar , mixed) or symptoms of one may alternate
with the other(Cyclothymia) . characterized by episodes of:
 mania-hyperactivity , excitement,agitation, decresaed need for sleep, impaired ability to
concentrate
depression – ubderactivity,apathy,profound sadness,guilt and low slef esteem
depression- psychodynamics
response to real or imagined loss
anger and aggression towards self result from feelings of guilt about negative or ambivalent
feelings
introjection occurs(incorporation of a loved or hated object or person into one’s own ego)
types:
MAJOR DEPRESSIONSEVERE – LASTS 2 WKS.
DYSTHYMIA- LESS SEVERE 2YEARS OR >
DEPRESSION NOT OTHERWISE SPECIFIED
2 DAYS –2WEEKS

MAINTAIN THERAPEUTICALLY SAFE ENVIRONMENT

SUPPORTIVE PROF. ATTITUDE
ONGOING ASSESSMENT
ENCOURAGING AND REASSURING
ECT AS ORDERED
ADMINISTER MEDICATIONS- ANTI DEPRESSANTS / ESKALITH
SHOW CONFIDENCE AND WORK WITH PATIENT

BIPOLAR DISORDERS
heredity important factor AS WELL AS BIOCHEMICAL
failure of individual to function successfully in preserving internal emotional equilibrium between
unconscious wishes and impulses vs moral conscience
precipitated by deep, emotionally traumatizing loss
inconsistent or abusive parenting
withdrawal of physical nurturance
BIPOLAR DISORDERS
mania – flight from reality to escape inner conflict, depression is the result of failing to deal
adequately with conflict
mania and depression – to gain attention , approval and emotional support
oral, greedy and demanding
repression and suppression
rationalization , projection and introjection
grandiosity and fantasizing a nurturing parent
SUBTYPES OF BIPOLAR D/O
MANIC – SEVERE , LASTS 1 WK
HYPOMANIC – LESS SEVERE ,4 DAYS
BIPOLAR 1 – WITH HISTORY OF MANIA
BIPOLAR 2 –NO HISTORY OF MANIA
CYCLOTHYMIA- EPISODES OF HYPOMANIA AND DEP. LAST 2 YEARS
MANIC TYPE
EUPHORIA – 1ST SIGN
ELATED BEHAVIOR MOOD INCREASE, DELUSIONS OF GRANDEUR AND SELF-
IMPORTANCE. IRRITABITY W/ DELUSION OF PERSECUTION
EASY DISTRACTIBILITY AND FLIGHT OF IDEAS
DECREASED SLEEP AND FOOD
DEPRESSED TYPE

IN TEREST LOW
SELF ESTEEM - LOW
DEPENDENCY
ENERGY LOW – FATIGUE
ELATION - MANIA
SUICIDAL

BIPOLAR DISORDER
AFFECTIVE DISORDER ,
ELATION AND GRANDIOSITY DEFENSE AGAINST UNDERLYING DEPRESSION/LOW SELF
ESTEEM
TESTING AND MANIPULATIVE BEHAVIOR INDICATIVE OF LOW SELF- ESTEEM
STRONG TENDENCY TO RECUR
TESTING , MANIPULATIVE , DEMANDING BEHAVIOR

INTERVENTIONS
PSYCHOTHERAPY NOT EFFECTIVE –PATIENT UNREACHEABLE
EMPHASIZE BEINGRATHER THAN DOING
RELATE FROM A NON COMPETITIVE FRAME OF REFERRENCE
DEVELOP REALISTIC ADULT RELATIONSHIPS AND CONTRACTS FOR CHANGE
PROVIDE FOR SAFETY AND UNDERSTANDING
INTERVENTRIONS
SIMPLIFY ENVT.
SET LIMITS
COMMUNICATE FIRM UNAMBIVALENT CONSISTENT APPROACH. MEE
MEET PHYSICAL NEEDS FIRST
ENCOURAGE REST
ADMINISTER LITHIUM – EAT NA RICH FOOS AND INCREASE FLUIDS
SPECIFIC INTERVENTION TECHNIQUES
PROVIDE UNDERSTANDING – PACING AND LEADING-GEN . INTERVENTION
PROVIDE FOR SAFETY
PROVIDE EMOTIONAL CONFRANTATION AND COGNITIVE RESTRUCTURING
DIFFERENTIATION:
MANIA
COLORFUL
AGGRESSION OUTWARDS
LITHIUM
NON-STIMULATING MILLIEU
QUIET ACT./AVOID COMPETITIVE
MATTER OF FACT
DEPRESSION
SAD
AGGRESION INWARDS
ECT
STIMULATING
MILLEU
MONOTONOUS ACT. COUNTING
KIND FIRMNESS

SUICIDE
VIOLENCE , SELF DIRECTED ; RISK FOR
SELF DESTRUCTIVE BEHAVIOR(INTROJECTION)ANFER AND RAGE TURNED
INWARDS OR INTO AN ATTEMPT TO PUNISH OTHERS
MOST COMMON AS DEPRESSION IS LIFTING 10-14 DAYS AFTER ANTI DEPRESSANT
MEDICATIONS/ NEW SIGNS OF ENERGY OR IMPROVEMENT
INDIVIDUAL FEELS GUILTY AND OVERWHELMED – SUICIDE SEEN AS RELIEF
AMBIVALENCE MAY LEAD TO CRY FOR HELP OR ATTENTION
 ATTEMPTS TO COPE FAIL-HOPELESSNESS AND HELPLESSNESS

RISK FACTORS:
SEX – WHITE MALE DIVORCED CAUCASIAN
UNSUCCESSFUL PREVIOUS ATTEMPT
IDENTIFICATION WITH SOMEONE WHO COMMITED SUICIDE
CHRONIC
ILLNESS
DEPRESSION/DEPENDENT PERSONALITY
AGE (18-25 AND >40) , ALCOHOLISM
LETHALITY OF PREVIOUS ATTEMPTS/LOSSES

KEY POINTS
ONE ON ONE MONITORING
FREQUENT UNSCHEDULED ROUNDS
SAFE ENVIRONMENT(REMOVE ALL POTENTIALLY DANGEROUS ITEMS
MONITOR FOR SIGNS
DISCUSS ALL BEHAVIOR WITH TEAM MEMBERS
INTERVENE QUICKLY AND CALMLY DURING ATTEMPTS
PROVIDE AFMILY THERAPY / GIVE CLIENT SENSE OF CONTROL OTHER RHAN
SUICIDE(PROB.SOLVING ,DECISION MAKING,SUICIDE CONTRACT)
SCHIZOPHRENIA
SPLITING OF THE MIND
DELUSIONS HALLUCINATIONS, DISORGANIZED SPEECH, GROSSLY DISORGANIZED
BEHAVIOR AND APATHY
ALTERED THOUGHT PROCESS
AUTISM
ASSOCIATIVE LOOSENESS
APATHY
AMBIVALENCE

BIOLOGIC THEORY – DECREASED IN DOPAMINE

SOCIAL ISOLATION
CATATONIA
HALLUCINATIONS
INCOHERENCE
ZERO INTEREST
OBVIOUS FAILURE TO ATTAINDEV.LEVEL
PECULIAR BEHAVIOR
HYGIENE IMPAIRED
RECURRENT ILLUSIONS/UNUSUAL PERCEP.
NO ORGANIC FACTOR
INABILITY TO RETURN
AFFECT IS INAPPROPRIATE

DISHARMONY BETWEEN THE PATIENT’S THINKING FEELIN AND ACTING

UTILIZES MECHANISMS OF DENIAL AND WITHDRAW FROM REALITY, USING FANTASY
CANNOT CONCEPTUALIZE OR FORM LOGICAL CONCLUSIONS
DELUSIONS AND HALLUCINATIONS TEND TO FULFILL DENIED WISHES

DEFECT IN FAMILY INTERACTION

HIGHLY CRITICAL , HOSTILE OR OVERINVOLVED
PSYCHOLOGIC – INFORMATION PROCESSING DEFICIT
BIOLOGIC-METABOLIC IMBALANCE
 GENETICS
BIOCHEMICAL – DOPAMINE HYPOTHESIS
BRAIN STRUCTURE ALTERATIONS =- > VENTRICLES
DISORGANIZED
INAPPROPRIATE BEHAVIOR , AFFECT AND TRANSIENT HALLUCINATIONS
INCOHERENCE, MARKEDLY LOOSENING OF ASSOCIATIONS
REGRESSION
IMPAIRED SOCIAL FUNCTIONING
ASSISTANCE W/ ADL

PARANOID
PREOCCUPATION WITH SYSTEMATIZED DELUSIONS OR AUDITORY HALLUCINATIONS
RELATED TO A SINGLE THEME
SUSPICION , IDEAS OF PERSECUTION AND DELUSIONS
MISTRUST AND FEELINGS OF REJECTION
PROJECTION
POTENTIAL FOR INJURY
NUTRITION AND SAFETY
CATATONIC
SUDDEN ONSET MUTISM , BIZARRE MANNERISMS, REMAINS IN STEREOTYPED
POSITION WITH AWXY FLEXIBILITY. MAY HAVE DANGEROUS PERIODS OF
AGITATION / EXPLOSIVITY
STUPOR, NEGATIVISM, RIGIDITY
,EXCITEMENT, POSTURING
REPRESSION AND IMPAIRED MOTOR ACTIVITY
CIRCULATION AND NUTRITION
UNDIFFERENTIATED
ONE OR MORE TYPES OF SCHIZOPHRENIA
DOES NOT MEET THE REQUIREMENTS OF OTHER TYPES
PROMINENT SYMPTOMS

RESIDUAL
ABSENCE OF PROMINENT DELUSION, HALLUCINATIONS, INCOHERENCE OR GROSSLY
DISORGANIZED BEHAVIOR.
NO LONGER EXHIBITS OVERT SYMPTOMS
OTHER
DELUSIONAL – NO HALLUCINATIONS
SCHIZOPHRENIFORM - < 6 MONTHS NORMAL FUNCTIONING POSSIBLE
SCHIZOAFFECTIVE D/O – DOMINANT SYMPTOMS- MOOD D/O
NURSING CARE
PROMOTE ADEQUATE COMMUNICATION
PROMOTE COMPLIANCE WITH MEDICAL REGIMEN AND PROVIDE PHYSIOLOGICAL
NEEDS (FLUID AND NUTRITION)
ASSIST WITH GROOMING , HYGIENE AND ADL’S
PROMOTE ORGANIZED BEHAVIOR
PROMOTE SOCIAL INTERACTION AND ACTIVITY
SOCIAL SKILLS TRAINING\PROMOTE REALITY BASED PERCEPTIONS
INTERVENE WITH DELUSIONS
PROMOTE CONGRUENT EMOTIONAL RESPONSES, FAMILY UNDERSTANDING AND
INVOLVEMENT, AND COMMUNITY CONTACTS.
PERSONALITY DISORDERS
RIGID MALADAPTIVE PATTERNS OF FUNCTIONING THAT ARE STABLE THROUGH TIME
AND LEAD TO UNHAPPINESS
GENETICS, TEMPERAMENTAL BIOLOGIC, PSYCHOANALYTICAL FIXATION
 PARANOID
SUSPICIOUSNESS, HYPERSENSITIVE AND HUMORLESS
INTERPRETS ACTIONS OF OTHERS AS PERSONAL THREAT USES PROJECTION AND
HOLDS GRUDGES
SCHIZOID
SHY,INTROVERTED LITTLE VERBAL COMM. , COLD AND DETACHED
USES INTELLECTUALIZATION, DESCRIBES EMOTIONAL RESPONSES IN MATTER OF
FACT
DAY DREAMING
CARE SAME
SCHIZOTYPAL
ECCENTRIC AND ODD,SENSITIVE TO REJECTION AND ANGER
VAGUE STEREOTYPICAL SPECH
SUSPICIOUS , BLUNTED OR INAPPROPRIATE AFFECT
RELATIVES OF SCHIZ., PROBLEMS IN THINGKING , PERCEIVING AND COMMUNICATING
LOW DOSE NEUROLEPTICS AND SAME

ANTI SOCIAL
DISREGARD FOR RIGHTS OF OTHERS. CHARMING INTELLECTUAL AND SMOOTH
TALKING, UNLAWFUL , RECKLESS AND AGGRESSIVE BEHAVIORS LACK OF GUILT
AND REMORSE.IMMATURE AND IRRESPONSIBLE
GENETICS,ASSOC. W/ SUBS.ABUSE AND DEPENDENCY PROB..RATIONALIZES AND
DENIES OWN BEHAVIOR
FIRM LIMIT SETTING, CONFRONT BEHAVIORS CONSISTENTLY, ENFORCE
CONSEQUENCES, GROUP THERAPY
BORDERLINE
REPETITIVE SELF DESTRUCTIVENESS, TEMPER TANTRUMS AND FIGHTS.BLAMES
OTHERS FOR OWN PROBLEMS,LABILE MOOD, BOREDOM,IMPULSIVE , FEARS
SEPARATION,UNSTABLE BUT INTENS RELATIONSHIP.HYPOCHONDRIAL
PROJECTIVE IDENTIFICATION, SEROTONIN ABN., PROBLEMS WITH IDENTITY SELF
IMAGE,HINKING AND MOOD
BORDERLINE
HELP IDENTIFY , VERBALIZE AND CONTROL NEGATIVE BEHAVIORS
EMPATHY
BEHAVIORAL CONTRACTS TO DECREASE MUTILATION
CONSISTENT LIMIT SETTING
SUPPORTIVE CONFRONTATION PSYCHOPHARMACOLOGY AND GROUP THERAPY
NARCISSISTIC
ARROGANT, GRANDIOSITY , LACK OF ABILITY TO FEEL
SHALLOW RELATION SHIPS,VIEWS OTHERS AS INFERIOR. NEEDS TO BE
ADMIRED.USES RATIONALIZATION TO BLAME OTHERS

NARCISSISTIC
SUPPORTIVE CONFRONTATION TO INCREASE SENSE OF SELF RESPONSIBILITY
LIMIT SETTING AND CONSISTENTLY
FOCUS ON HERE AND NOW, TEACH THAT MISTAKES ARE ACCEPTABLE ,
IMPERFECTIONS DO NO DECREASE WORTH
HISTRIONIC
DRAWS ATTENTION TO SELF
OVERLY CONCERNED WITH PHYSICAL APPEARANCE, ATTENTION SEEKING
BEHAVIOR, EXTROVERT
EASLY INFLUENCED, CANNOT DEAL WITH FEEKINGS
POSITIVE REINFORCEMENT FOR UNSELFISH BEHAVIOR
FACILITATE EXPRESSION
 DEPENDENT
PASSIVE , INCESSANT DEMANDS FOR ATTENTION FROM OTHERS, LACKS SELF
CONFIDENCE, NEED EXCESSIVE REASSURANCE AND ADVISE. ANXIOUS OR
HELPLESS WHEN ALONE.
FEAR OF LOSS OF SUPPORT AND WITHDRAWAL,SELF CONFIDENCE
AVOIDANT

WITHDRAWN , TIMID, , HYPERSENSITIVIVE TO CRITICISM

AVOID SITUATIONS WHERE THERE IS REJECTION POSSIBILITY
FEARS INTIMACY-RIDICULE
VIEWS SELF TO BE SOCIALLY INEPT,INFERIOR ,UNAPPEALING
GRADUALLY CONFRONT FEARS, DISCUSS FEELINGS BEFORE AND AFTER
ACCOMPLISHING A GOAL , TEACH ASSERTIVENESS, INCREASE EXPOSURE TO
SMALL GROUPS

OBSESSIVE COMPULSIVE
SETS HIGH PERSONAL STANDARDS FOR SELF OR OTHERS, PREOCCUPIED WITH
RULES /DETAILSRIGID, STUBBORN , OVERCONSCIENCIOUS AND INFLEXIBLE,COLD
AND INDECIISIVE
PERFECTIONISM INTERFERES TASK FULFILLMENT
EXPLORE FEELINGS, HELP WITH DECISION MAKING, TEACH THAT MISTAKES ARE
ACCEPTABLE