CMAN 272 Final Exam 2023 with complete solution
Personality
The sum total of a person's internal and external patterns of adjustment of life
Personality traits
Enduring patterns of perceiving, relating to and thinking about the environment and
oneself; exhibited in social and personal contexts - introvert, extrovert
Personality disorders: Common characteristics
Inflexible and maladaptive responses to stress
Disability in working and loving
Ability to evoke interpersonal conflict
Capacity to have an intense effect on others
Cluster A Personality Disorders
Paranoid
Schizoid
Schizotypal
Cluster B Personality Disorders
Borderline
Narcissistic
Histrionic
Antisocial
Cluster C Personality Disorders
Avoidant
Dependent
Obsessive-compulsive
Cluster A: Paranoid Personality Disorder: Characteristics
May be apparent in childhood
Social anxiety in childhood
Jealous, controlling as adults
Difficulty in relationships
Unwillingness to forgive and projection of feelings - holds grudges
See the world as an unsafe place and that people are out to get you
Very suspicious
Think others can't be trusted
Hold grudges
Have difficulty with forgiveness
Very difficult to be in a relationship with because of paranoia
SUSPECT
Cluster A: Paranoid Personality Disorder: Treatment
Counteract mistrust by:
-adhering to schedules
-avoiding being overly friendly - have an even/neutral effect
-projecting a neutral but kind affect
,Psychotherapy (better) than group therapy
May be on short-term antidepressants
Most likely won't see in a psychiatric setting
Paranoid: SUSPECT
Spouse fidelity suspected
Unforgiving (bears grudges)
Suspicious of others
Perceives attacks and reacts quickly
Enemy or my friend (suspects associates, friends)
Confiding in others is feared
Threats perceived in benign events
Cluster A: Schizoid Personality Disorder: Characteristics
Symptoms appear in childhood and adolescence - teenagers that prefer to be alone,
prefer solitude, not involved in social things around school
Loners, poor academic performance
Increased prevalence of disordered family life
Avoids close relationships
Depersonalization - feel not like themselves sometimes
Detachment
Prefer to be alone
Likes solitary activities (e.g. reading a book, playing solitary games)
No interest in being with people
Have difficulty being with family
No want to go to a party/be with people
DISTANT
Cluster A: Schizoid Personality Disorder: Guide for Nurses & Treatment
Avoid being too "nice" or "friendly"
Don't try to increase socialization - don't force socialization, not a goal
Assess for symptoms the patient is reluctant to discuss
Protect against group's ridicule
May experience a lot of bullying in the school setting
Do well in psychotherapy
Don't do as well in group therapy
May be on antidepressants (if they're having some medical problems, losses, or other
issues) - typically not on meds
Schizoid: DISTANT
Detached (or flattened) affect
Indifferent to criticism and praise
Sexual experiences of little interest
Tasks done solitarily
Absence of close friends
Neither desires nor enjoys close relations
Takes pleasures in few activities
,Cluster A: Schizotypal Personality Disorder: Characteristics
Severe social and interpersonal deficits - come across as being awkward
Anxiety in social situations
Rambling conversation
Paranoia, suspiciousness, anxiety, distrust
Brief, intermittent episodes of hallucinations or delusions (if under a lot of stress)
Can be made aware of their own odd beliefs
May be vulnerable to involvement with cults or unusual religious/occult groups
Ideas of reference - magical thinking
Not much affect
Lack of close friends
Unusual beliefs
Superstitions
Interested in paranormal
Tend not to like to be with other people
Ideas of reference (delusions that make them feel like they have special power or that
things have special meaning)
Can become psychotic under stress
Magical thinking; can become psychotic under stress
ME PECULIAR
Cluster A: Schizotypal Personality Disorder: Nursing Care Guidelines &
Treatment
Respect patient's need for social isolation
Be aware of and intervene appropriately with patient's suspiciousness
Perform careful diagnostic assessment for symptoms that may need intervention (e.g.
suicidal thoughts) - explain everything to them
Withhold judgement or ridicule
Be consistent and reliable
Psychotherapy (investigate possible involvement with cults)
Low-dose antipsychotics if they exhibit psychotic features
Schizotypal: ME PECULIAR
Magical thinking or odd beliefs
Experiences unusual perceptions
Paranoid ideation
Eccentric behavior or appearance
Constricted (or inappropriate affect)
Unusual (odd) thinking and speech
Lacks close friends
Ideas of reference (thinking that certain things have certain meaning)
Anxiety in social situations
Rule out psychotic disorders and pervasive developmental disorders before
Cluster B: Borderline Personality Disorder: Characteristics
, Severe impairments in functioning - most severe in terms of issues they have to deal
with
See on the unit because of suicide attempts
Emotional lability - mood instability
Impulsivity
Self-destructive behaviors (e.g. attempting suicide, self-harm)
Antagonism
Splitting (inability to view both positive and negative aspects of others as part of a whole
- either see people as all good or all bad and that changes daily)
Hard time dealing with breakups
Abandonment issues
Can get very angry and/or suicidal
Identity issues
AM SUICIDE
Cluster B: Borderline Personality Disorder: Epidemiology and Comorbidity
10% risk of suicide and mortality rate - high suicide rate
85% of BPD patients have another mental illness (e.g. eating disorder, substance use
disorder, depression, anxiety)
Cluster B: Borderline Personality Disorder: Etiology
High genetic association
Separation-individuation factors
Cluster B: Borderline Personality Disorder: : Assessment
Semi-structure interview
Use of MMPI
Self-assessment - being in a relationship would be like a rollercoaster because some
days they really want to work with you and other days they'll want to stop and become
angry - hard to stay connected because they'll just you - don't take it personally
Cluster B: Borderline Personality Disorder: Nursing Diagnoses
Self-mutilation
Risk for suicide
Risk for self and/or other-directed violence
Impaired social interaction
Disturbed personal identity
Ineffective coping
Cluster B: Borderline Personality Disorder: Outcomes & Planning
NOC scales for measuring improvement
Importance of the therapeutic relationship - be consistent with them
Avoid manipulative behaviors
Cluster B: Borderline Personality Disorder: Implementation
Provide clear and consistent boundaries
Use clear, straightforward communication
Calmly review therapeutic goals
Teamwork and safety
Personality
The sum total of a person's internal and external patterns of adjustment of life
Personality traits
Enduring patterns of perceiving, relating to and thinking about the environment and
oneself; exhibited in social and personal contexts - introvert, extrovert
Personality disorders: Common characteristics
Inflexible and maladaptive responses to stress
Disability in working and loving
Ability to evoke interpersonal conflict
Capacity to have an intense effect on others
Cluster A Personality Disorders
Paranoid
Schizoid
Schizotypal
Cluster B Personality Disorders
Borderline
Narcissistic
Histrionic
Antisocial
Cluster C Personality Disorders
Avoidant
Dependent
Obsessive-compulsive
Cluster A: Paranoid Personality Disorder: Characteristics
May be apparent in childhood
Social anxiety in childhood
Jealous, controlling as adults
Difficulty in relationships
Unwillingness to forgive and projection of feelings - holds grudges
See the world as an unsafe place and that people are out to get you
Very suspicious
Think others can't be trusted
Hold grudges
Have difficulty with forgiveness
Very difficult to be in a relationship with because of paranoia
SUSPECT
Cluster A: Paranoid Personality Disorder: Treatment
Counteract mistrust by:
-adhering to schedules
-avoiding being overly friendly - have an even/neutral effect
-projecting a neutral but kind affect
,Psychotherapy (better) than group therapy
May be on short-term antidepressants
Most likely won't see in a psychiatric setting
Paranoid: SUSPECT
Spouse fidelity suspected
Unforgiving (bears grudges)
Suspicious of others
Perceives attacks and reacts quickly
Enemy or my friend (suspects associates, friends)
Confiding in others is feared
Threats perceived in benign events
Cluster A: Schizoid Personality Disorder: Characteristics
Symptoms appear in childhood and adolescence - teenagers that prefer to be alone,
prefer solitude, not involved in social things around school
Loners, poor academic performance
Increased prevalence of disordered family life
Avoids close relationships
Depersonalization - feel not like themselves sometimes
Detachment
Prefer to be alone
Likes solitary activities (e.g. reading a book, playing solitary games)
No interest in being with people
Have difficulty being with family
No want to go to a party/be with people
DISTANT
Cluster A: Schizoid Personality Disorder: Guide for Nurses & Treatment
Avoid being too "nice" or "friendly"
Don't try to increase socialization - don't force socialization, not a goal
Assess for symptoms the patient is reluctant to discuss
Protect against group's ridicule
May experience a lot of bullying in the school setting
Do well in psychotherapy
Don't do as well in group therapy
May be on antidepressants (if they're having some medical problems, losses, or other
issues) - typically not on meds
Schizoid: DISTANT
Detached (or flattened) affect
Indifferent to criticism and praise
Sexual experiences of little interest
Tasks done solitarily
Absence of close friends
Neither desires nor enjoys close relations
Takes pleasures in few activities
,Cluster A: Schizotypal Personality Disorder: Characteristics
Severe social and interpersonal deficits - come across as being awkward
Anxiety in social situations
Rambling conversation
Paranoia, suspiciousness, anxiety, distrust
Brief, intermittent episodes of hallucinations or delusions (if under a lot of stress)
Can be made aware of their own odd beliefs
May be vulnerable to involvement with cults or unusual religious/occult groups
Ideas of reference - magical thinking
Not much affect
Lack of close friends
Unusual beliefs
Superstitions
Interested in paranormal
Tend not to like to be with other people
Ideas of reference (delusions that make them feel like they have special power or that
things have special meaning)
Can become psychotic under stress
Magical thinking; can become psychotic under stress
ME PECULIAR
Cluster A: Schizotypal Personality Disorder: Nursing Care Guidelines &
Treatment
Respect patient's need for social isolation
Be aware of and intervene appropriately with patient's suspiciousness
Perform careful diagnostic assessment for symptoms that may need intervention (e.g.
suicidal thoughts) - explain everything to them
Withhold judgement or ridicule
Be consistent and reliable
Psychotherapy (investigate possible involvement with cults)
Low-dose antipsychotics if they exhibit psychotic features
Schizotypal: ME PECULIAR
Magical thinking or odd beliefs
Experiences unusual perceptions
Paranoid ideation
Eccentric behavior or appearance
Constricted (or inappropriate affect)
Unusual (odd) thinking and speech
Lacks close friends
Ideas of reference (thinking that certain things have certain meaning)
Anxiety in social situations
Rule out psychotic disorders and pervasive developmental disorders before
Cluster B: Borderline Personality Disorder: Characteristics
, Severe impairments in functioning - most severe in terms of issues they have to deal
with
See on the unit because of suicide attempts
Emotional lability - mood instability
Impulsivity
Self-destructive behaviors (e.g. attempting suicide, self-harm)
Antagonism
Splitting (inability to view both positive and negative aspects of others as part of a whole
- either see people as all good or all bad and that changes daily)
Hard time dealing with breakups
Abandonment issues
Can get very angry and/or suicidal
Identity issues
AM SUICIDE
Cluster B: Borderline Personality Disorder: Epidemiology and Comorbidity
10% risk of suicide and mortality rate - high suicide rate
85% of BPD patients have another mental illness (e.g. eating disorder, substance use
disorder, depression, anxiety)
Cluster B: Borderline Personality Disorder: Etiology
High genetic association
Separation-individuation factors
Cluster B: Borderline Personality Disorder: : Assessment
Semi-structure interview
Use of MMPI
Self-assessment - being in a relationship would be like a rollercoaster because some
days they really want to work with you and other days they'll want to stop and become
angry - hard to stay connected because they'll just you - don't take it personally
Cluster B: Borderline Personality Disorder: Nursing Diagnoses
Self-mutilation
Risk for suicide
Risk for self and/or other-directed violence
Impaired social interaction
Disturbed personal identity
Ineffective coping
Cluster B: Borderline Personality Disorder: Outcomes & Planning
NOC scales for measuring improvement
Importance of the therapeutic relationship - be consistent with them
Avoid manipulative behaviors
Cluster B: Borderline Personality Disorder: Implementation
Provide clear and consistent boundaries
Use clear, straightforward communication
Calmly review therapeutic goals
Teamwork and safety
