Classification of Personality Disorders

Patterns of thinking, feeling or behaviour that are persistent across time and situation.The result of the genetic template and outside influences. Expression of individuals characterise lifestyle methods and relating to others.

  • Relates to personal identity and traits
  • People with personality disorders perceive the world from a different perspective than most people
  • Personality disorders are maladaptive patterns of thinking feeling and behaviours that are expressed in lifestyle and interpersonal interaction.
  • Onset traced back to early adulthood

A personality is an enduring pattern of inner experience and behaviours that deviate from the norm of the individual’s culture

The patterns are seen in two or more of the following

  1. Cognitive
  2. Affect
  3. Interpersonal functioning
  4. Impulse control

The Pattern

  • Inflexible and pervasive across a broad range of personal and social situation
  • Typically leads to distress
  • Impairment in social work or other areas of functioning
  • The pattern is stable and long duration.

Three Theories have been Provided to help us Understand

  • Genetic vulnerability
  • Child abuse, neglect and or trauma
  • Genetic vulnerability + abuse/neglect =personality disorder?

Treatment Consideration

  • Treatment requires clinicians with expertise; transference and countertransference issues
  • Is it in the generalist nurses role to provide treatment beyond initial stabilisation of the immediate situation
  • Generalist clinicians may become unwittingly involved in long-term care
  • Unless clear boundaries are devised and limits set, clinicians may sometimes find themselves more involved than is comfortable.

Classification of Personality Disorders

Cluster A: Withdrawn

ODD/eccentric:

  • Paranoid; suspicious, overassertive, defensive, hyperalert, unemotional and humourless, typically withdrawn and socially isolated
  • Schizoid; shy, emotionally cold, introverted, detached
  • Schizotypal

 

Cluster B: Antisocial

  • Borderline
  • Antisocial
  • Histrionic; the centre of attention, dramatic egocentric, vain
  • Narcissistic; self-admiration, exhibitionist, craves and demands attention, exploits others and lack of interest in other needs.

Cluster C

Fearful/ anxious

  • Avoidant anxious, self-conscious, fears rejection, timid, nervous cautious, overreact to rejection and fear and frequent attendance to healthcare facilities
  • Dependant; passive, weak-willed, over accepting, avoids responsibility, seeks the support of others, intense discomfort when they are alone
  • OCD inflexible, rigid, perfectionist, pedantic, stubborn and egocentric

Assessment

  • People are rarely admitted for personality disorders, they are normally admitted because of coexisting conditions. Depression or substance abuse, self-harm and suicide.
  • Assessment requires a lengthy interview
  • Clinicians must observe keenly
  • Findings best considered provisional rather than definitive

Assessment of people with potential personality disorders will need to include

  • Drug and alcohol use
  • Self-harm and mutilation
  • Suicidal ideation and or attempts
  • Instances of aggression or violence
  • Unexplained visible injuries to the body
  • Sexual activity
  • Family relationships

Treatment of personality an area of Speciality

  • Hospital admissions are rare- no more than 24 hours to stabilise medical risk
  • Treatment can alleviate symptoms, distress and reduce problematic behaviours
  • Best practice is to release the client back into the community. MH services for long-term management
  • Plans need to be initiated to promote quality of life

Factors that require consideration

When planning care for a person with PD, these are the factors that need consideration

  • Culture
  • Self-destructive behaviours
  • Comorbidity
  • Insight
  • Self-harming behaviours

General principles of care

  • Monitor the signs of self-harm
  • Consistency; continuity of care
  • Limit setting
  • Client involvement
  • Treat maladaptive behaviours

Accepted treatment protocols

Best guidelines of most personality disorders

  • Interactive therapies
  • Pharmacological therapies
  • Therapeutic communities
  • Team nursing interventions

Interactive therapies

  • CBP
  • IPT- interpersonal psychotherapy
  • Dialectical behaviour therapy

Pharmacological therapies

  • These do not treat PD themselves
  • Mood stabilisers (e.g. Lithium)
  • Antidepressants
  • Some antipsychotics

Therapeutic Communities

What is a therapeutic community

  • Participative group-based approach to long-term mental illness, personality disorders and drug addiction
  • Team nursing interventions – a system of care where a patient is a care is distributed among members of a group working in a coordinated effort

 

Borderline Personality Disorder

  • Is somewhere between neurosis and psychosis. Sometimes the question is asked: who are they today. Typically categorised as having extraordinary unstable affect, mood and behavioural difficulties with relationships and self-image including self-destruction.

Other Features of Borderline Personality Disorder 

  • Difficulty controlling emotions or impulses – lack of self-control
  • Wide mood swings; short but intense episodes of anxiety or depression
  • The pattern of unstable and intense relationships
  • Uncertainty/ confused about self-image ( feeling misunderstood and neglected)
  • A chronic feeling of emptiness and excessive efforts to avoid abandonment
  • Impulsive, risky behaviour or self-destructive

Psychopaths

  • Tend to be borne. It likely has a genetic predisposition, might be related to physiological brain differences- under-developed potion of the brain thought to be responsible for emotion regulation and impulse control
  • Social paths tend to be made by the environment

DSM-V categories define Antisocial Personality Disorders as Someone who has 3 or More of the Following:

  1. Regularly breaks the law or flouts
  2. Constantly lies or deceives others
  3. Is impulsive and does not plan
  4. Can be prone to fighting and aggressiveness
  5. Has little regard for the safety of others
  6. Irresponsible and cannot meet financial obligations
  7. Does not feel remorse or guilt

Antisocial Personality Disorders

  1. Inability to conform to social norms
  2. Often characterised by anti-social or criminal acts
  3. Callous unconcern for others feelings
  4. Gross persistent irresponsible disregard for social norms
  5. Low frustration tolerance and violence
  6. Incapacity to experience guilt
  7. Blaming others

Pharmacology in Mental Health

  • The nurse in mental health is involved in all phases of medication administration
  • Assess and monitors for compliance, reduction in symptoms and side effects

Biomedical models of health – a conceptual model of illness that excludes psychological and social factors and only includes biological factors in an attempt to understand a personas mental illness. Focusses on the cure. According to the biomedical model, the focus is on the physical process – pathology, biochemistry and physiology

How the Medication Work

  • The brain pharmacology (mimic or block natural chemicals)
  • Neurotransmission ( 3 main related to MH disorders)
  1. Dopamine
  2. Serotonin
  3. Noradrenaline
  4. Opiate system
  5. Calcium channels and cholinesterase

Neurotransmitters

  • Nerves – the neurotransmitters, dopamine, serotonin, noradrenaline pass along the nerves and attach to the neurotransmitters.
  • If there an issue along the line/ interruption of the system the message does not get through
  • This may be under or over – functioning
  • Medication (agonist) chemical that binds to the receptor and activates the receptors to produce a biological response encourages uptake of medication
  • Antagonist: blocks the action and uptake of medication and does not allow for the attachment of receptors

Dopamine

  • A neurotransmitter that helps control the brains reward and pleasure centres of the brain
  • Helps regulate movement and emotional responses and it enables us not only to see rewards but also the actions to move towards them
  • Has an influence on cognition
  • Excessive dopamine is associated with schizophrenia
  • low deficiency Parkinsons
  • Antipsychotic medications- block dopamine receptors

Serotonin

  • Active is constructing smooth muscles, transmitting impulses between nerve cells, regulating cyclic body process and contributing to well-being and happiness.
  • Regarded by some researchers as a chemical that is responsible for maintaining mood balance
  • Association made between depression serotonin deficit- scientists remain unsure as wor whether decreased levels of serotonin contribute to depression or depression causes a decrease in serotonin

Noradrenaline

  • Works as both hormone and neurotransmitter
  • Increases blood flow to your muscles
  • Provide people with a boost of energy
  • Low levels are linked to lower arousal (E.g. sedation) lower alertness and depression
  • Abnormally high levels of are linked to over aroused or anxious

The Brain

  • Responsible for all Affect and Cognition
  • It controls functions of eating, sleeping and controlling the temperature
  • Imbalances in mental functions can happen as a result of disturbances

We have three Functional parts

  • Cerebrum: centre for communication, motor and sensory function, intellect
  • Thalamus: sits in the middle of the brain – relay station and hub for communicating sensory information
  • Hypothalamus- endocrine gland initiates hormone synthesis and release

4 phases of Drug Administration

Phase 1 Initiation

  • Before commencing medication, you should perform a full mental health history, and a physical examination should be made
  • After administration- close observation, monitor the effect of symptom reduction, monitor side effects and if the mental state allows it education may commerce

Phase 2 – Stabilisation

  • Dosage adjustments
  • Medication changes
  • Adverse reactions
  • Symptoms management
  • Additional medication to argument the primary medication
  • Medication monitoring

Phase 3 – Maintenance

  • After symptom management – medication continue until relapse or cessation
  • Patient education of the side effects, management of side effects and compliance
  • Ongoing monitoring – serum levels of blood

Phase 4

  • Cessation
  • Compliance and monitoring is important
  • Can relapse if not managed
  • Tampered discontinuation – gradually lessened over a specific period of time and closely monitor for the symptoms of reoccurrence
  • Some meds require long-term management

What are Psychotropics

  • Medicines that alter chemical levels of the brain which impact mood and behaviour

Classification

  • Antidepressants – they correct the chemical imbalances of the neurotransmitters in the brain which probably causes changes in mood and behaviour. Primarily for the management of depression but also anxiety disorders

They Relive Depressive Symptoms which include Suicidal Thoughts and Feelings

  1. Tricyclics –
  2. SSRIs
  3. Selective noradrenaline reuptake inhibitors
  4. Monamine oxidase inhibitors
  • Anxiolytics and hypnotics
  • Antipsychotics
  • Anticholinergics
  • Mood stabilisers
  • Psychostimulants

 

For more information and services regarding mental health, please click here

 

Sources 

Tyrer, P., Reed, G. M., & Crawford, M. J. (2015). Classification, assessment, prevalence, and effect of personality disorder. The Lancet385(9969), 717-726.

Kim, Y. R., Tyrer, P., Lee, H. S., Kim, S. G., Connan, F., Kinnaird, E., … & Crawford, M. (2016). Schedule for personality assessment from notes and documents (SPAN‐DOC): Preliminary validation, links to the ICD‐11 classification of personality disorder, and use in eating disorders. Personality and mental health10(2), 106-117.

 

Disclaimer: These notes were used as exam study notes, if there are any factual inaccuracies, point them out in the comment section and we will fix them as soon as possible. 

 

Mental health Hotline 

  • 13 11 14

If life is in danger call

  • 000

 

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