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Personality and Impulse DisordersPsychiatric Nursing: Contemporary Practice

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What does ACCEPTS stand for when used as a mnemonic for managing transient psychotic episodes in patients with borderline personality disorder?
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A-activities to distract from stress, C-contributing to others (volunteering), C-comparing self to less fortunate, E-emotions that are opposite to what is currently experienced, P-pushing away from situation for awhile, T-thoughts that are different from current ones, S-sensations that are intense like holding ice. Used to tolerate painful feelings or events.
___________ problems in patients with borderline personality disorder are linked to dissociation and self-injurious behaviors.
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Interpersonal
What is the best indicator of outcomes for a patient with borderline personality disorder?
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Increasing the length of symptom-free times
____________ is defined as a personality disorder that begins in early childhood or adolescence and continues into adulthood in which the individual is behaviorally impulsive, interpersonally irresponsible, lacks a sense of personal obligation and fails to conform to social norms.
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Antisocial personality disorder
What are the common characteristics of individuals with antisocial personality disorder?
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Impulsivity, failure to conform to social norms, lack of empathy, unable to express compassion, insensitive, callous, contemptuous of others, easily irritated, aggressive, lack remorse for transgressions and are unable to delay gratification.
What types of careers commonly attract individuals with antisocial personality disorder?
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Business, military or political careers
What are the childhood behavioral characteristics found in patients with antisocial personality disorder?
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Aggression towards people or animals, destruction of property, deceitfulness, theft, or serious rule violations
What is believed to be the source of impulsive aggression in patients with antisocial personality disorder?
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Low serotonin and dopamine levels
What brain abnormalities are believed to be the cause of poor judgment, emotional distance, aggression and impulsivity in patients with antisocial personality disorder?
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Dysregulation of catecholamines and dopaminergic pathways in the limbic-prefrontal cortex and dorsolateral prefrontal cortex.
What is the prevalent psychological theory as to the cause of antisocial personality disorder?
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Unsatisfactory attachments early in life leads to antisocial behavior later in life. For example, faulty interactions between a child and their primary caregiver.
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What are risk factors for developing antisocial personality disorder?
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Parental abandonment or neglect, loss of a parent/primary caregiver, multiple caregivers (like foster care) and physical or sexual abuse.
Extreme temperaments make one vulnerable to antisocial personality patterns, most specifically a difficult temperament. What are the 4 main characteristics of this type of temperament?
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Aggression, inattention, hyperactivity and impulsivity.
What are common family characteristics of a person who develops antisocial personality disorder?
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Chaotic with a alcoholism and violence as the norm.
What are the overall treatment goals for a patient with antisocial personality disorder?
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Developing a nurturing sense of attachment and empathy for other people and situations and live within societal norms.
What are the priorities when dealing with a patient with antisocial personality disorder?
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Protection of other patients and staff from manipulative or abusive behavior
Why is a therapeutic relationship not as successful when working with patients who have antisocial personality disorder?
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They don't attach to others and are often unable to use the relationship to effect change.
What are the goals of a therapeutic relationship when working with clients who have antisocial personality disorder?
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Identifying dysfunctional thinking and developing new problem solving behaviors.
What nursing activities are helpful within the framework of a therapeutic relationship for facilitating self-responsibility in patients with antisocial personality disorder?
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Holding the patient responsible for their behavior, monitoring the extent that the patient assumes self-responsibility, discussing consequences of not assuming responsibility, not arguing over rules/limits, providing positive feedback when patient accepts responsibility or changes behaviors.
When teaching patients who have antisocial personality disorder, what strategies are most beneficial?
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Avoid lecturing, be direct, engage the patient in a discussion and direct them to the major teaching points, maintain a sense of humor, have clear teaching goals, avoid being sidetracked.
What type of intervention modality is most effective when working on interpersonal relationships with a patient who has antisocial personality disorder?
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Group interventions are more effective than individual ones because other patients and staff can validate or challenge a patient's view of a situation.
Why is anger control a priority intervention for patients with antisocial personality disorder?
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They tend to strike out at those who are perceived to be blocking their immediate gratification.
  
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