Personality Disorders - Essay Example

Psychiatric and Mental Health Nursing Topic Personality Disorders Grade Level Setting Assistive Technology Devices Infrared Beam, Computers/Laptops with Internet access for each student, Projector, Laptop with Internet access for Instructor, Speakers Rationale of Lesson : Psychiatric mental health nurses work in different kinds of settings assessing mental health needs, planning the care of patients with these needs, implementing the plans and evaluating their effectiveness. Even as they work with multi-professional teams promoting recovery for the patients, they often have to connect with them on a one-to-one basis in a meaningful way. Most times these connections go beyond involvement with the service user alone and extend to his/her care givers and families. To establish and maintain the connections psychiatric mental health nurses need not just communication skills but also specialized skills in understanding and accepting mental health problems along with a strong sense of ethics and responsibility. This lesson is designed to help the students gain a comprehensive understanding of the various personality disorders that affect patients. It proposes to help them recognize these disorders within patients based on their outward features and to help plan patients’ care based on their evaluation. Long Term Content Goal : To understand the different kinds of personality disorders that afflicts patients and recognize the nursing care needed by each different group Learning Outcomes : The learning outcomes from this lesson are identified as follows – Examining of linkages between psychology and nursing practice on the illness-health continuum. Knowledge and understanding of personality disorders and its various clinical features needed to meet the needs of patients. Demonstrating proficiency in professional judgment while identifying personality disorders among patients. Sensitively developing therapeutic relationships with patients, their care givers and family members. Decisively analyzing nursing care solutions within the mental health settings. Learning Objectives : At the end of this lesson, students should be able to – Explain how psychology contributes to evolving notions of personality and personality disorders. Define and classify personality disorders. Identify the key symptoms and characteristics of each disorder. Recognize the treatment plan available for treating the various disorders. Explain the ethical role psychiatric mental health nurses have to play while administering nursing care. Prerequisite Learner Skills : The learner should posses the following characteristics while attempting to follow the lesson plan – Analytical thinking Self-learning abilities Social cohesion while working in a team Striving for personal improvement Skills in creatively solving problems Knowledge of using technology tools Instructional Design Model : This lesson plan hopes to focus its energies on the learner and hence the instructional design model adapted for this lesson is the Morrison, Ross and Kemp model (Morrison, Ross, & Kemp, 2004). The model consists of nine elements arranged in an oval shape – 1. Instructional problem identification and goal specifications of an instructional course, 2. Examination of learner’s characteristics based on instructional decisions, 3. Subject content identification with task analysis related to goals and purposes, 4. Instructional objective specifications, 5. Instructional units arranged in logical and sequential order for learning, 6. Instructional strategies designed to meet the mastery of lesson objectives, 7. Plan and develop instruction, 8. Evaluation instruments for measuring course objectives and 9. Resource selection for instruction and learning activities. (Morrison, Ross, & Kemp, 2004) Figure 1: The Morrison, Ross & Kemp Model Content Outline : Learning Objectives Content Instructional Method Introduce the topic The DSM-IV characterizes personality traits as enduring patterns of perceiving, relating to, and thinking about the environment and oneself, which are exhibited in a wide range of important social and personal contexts (American Psychiatric Association, 2000). Make the students take the Color Quiz developed by Dr. Max LAscher to understand their personality by following this link: http://www.colorquiz.com/ Lecture Interactive Computer-Marked Personality Assessments Explain how psychology contributes to evolving notions of personality and personality disorders Dr. David Myers, a renowned psychologist, states that there are four major perspectives on understanding personality. Two of these are historic perspectives – The Psychoanalytic Perspective and The Humanistic Perspective, while the other two are labeled as contemporary perspectives –The Trait Perspective and The Social-Cognitive Perspective. (Myers, 2005) Lecture (using PowerPoint) with Discussion Define and classify personality disorders. It is only when personality traits are maladaptive and rigid, that they cause significant practical impairment or anguish so as to constitute Personality Disorders. About 13% of people in the world have some form of personality disorder (Gunderson & Choi-Kain, 2012). DSM-IV General Diagnostic Criteria for a Personality Disorder: A. Experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: 1. Cognition (perception and interpretation of self, others, and events) 2. Affect (emotional response) 3. Interpersonal functioning 4. Impulse control B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood. E. The pattern is not better accounted for as a manifestation or consequence of another mental disorder; or due to the direct physiological effects of a substance or a general medical condition such as a head injury. (American Psychiatric Association, 2000) The new classification on personality disorders identifies six types, they are – schizotypal, borderline, antisocial, narcissistic, avoidant, and obsessive-compulsive (Gunderson & Choi-Kain, 2012). Lecture with Discussion Handout Lecture Identify the key symptoms and characteristics of each disorder. 1. Schizotypal Personality Disorder: People with schizotypal personality disorder are socially withdrawn and emotionally detached. In addition, they have odd ways of thinking, perceiving, and communicating similar to those of people with schizophrenia. 2. Borderline Personality Disorder: Borderline personality disorder occurs in about 2 to 5% of the population. People with this disorder have dramatic changes in their interpersonal relationships, self-image, moods, and behavior. Borderline personality disorder usually becomes evident in adolescence or early adulthood and becomes less common with age. 3. Antisocial Personality Disorder: This type occurs in 6 times as many men as women. People with this disorder typically have a callous disregard for the rights and feelings of others; they may exploit others for materialistic gain or personal gratification. Many become frustrated easily and tolerate frustration poorly. As a result, they act impulsively and irresponsibly, sometimes committing criminal acts. 4. Narcissistic Personality Disorder: This type is characterized by an inflated view of self-worth (called grandiosity). People with this disorder expect to be treated with deference and may exploit others because they think their superiority justifies it. Their relationships are characterized by a need for admiration, and they often think that others are jealous of or envy them. They are extremely sensitive to failure, defeat, and negative reactions from others, including criticism. Such reactions from others can trigger sudden rages or depression. 5. Avoidant Personality Disorder: This type is characterized by severe self-consciousness, anxiety, and fearfulness. People with avoidant personality disorder withdraw from people or situations when they think rejection, failure, or conflict might occur. They fear and avoid starting relationships or anything new because they may be disappointed, be shamed, or fail. 6. Obsessive-Compulsive Personality Disorder: People with obsessive-compulsive personality disorder are preoccupied with conscientiousness, orderliness, perfectionism, and a need for control. They are inflexible and typically resist change. They take their responsibilities seriously, but because they cannot accept mistakes, they can become entangled with details and forget their purpose. (Gunderson & Choi-Kain, 2012) Watch testimonial videos and movie clippings on the different personality disorders by following the links: http://www.youtube.com/user/thecrackwalker http://www.youtube.com/watch?v=8tIvMUy8UDs http://www.youtube.com/watch?v=stcwcXbGCiM http://www.youtube.com/watch?v=8lOg8PzEaWs http://www.youtube.com/watch?v=0fiZRbezP_I Lecture (using PowerPoint) with Discussion Educational Videos Recognize the treatment plan available for treating the various disorders. Treatment of personality disorders is largely done with psychosocial therapy, which includes individual psychotherapy, group therapy, and family therapy. Though drugs do not change personality traits, but they can help relieve symptoms of distress. Hence, drugs are used in limited capacities to treat depression or psychosis, if they are present. Specific types of personality disorders are treated differently: 1. Schizotypal personality disorder may be treated with antipsychotic drugs and individual therapy. Therapy (using reality testing) helps people view the external world as something distinct from their thoughts and feelings and helps them learn more appropriate ways to behave in various situations. The benefits of these therapies are modest. 2. Borderline personality disorder may be treated with individual, group, family, and/or drug therapy. Such therapies can help reduce suicidal tendencies, the need for hospitalization, and use of the emergency department. They can also help relieve depression. One type of therapy is dialectical behavior therapy. This therapy provides weekly individual and group sessions and a therapist who is available 24 hours a day by telephone. In such calls, the therapist helps the caller resist urges to behave self-destructively. This therapy aims to help people find more appropriate ways of responding to stress. Another effective therapy is general psychiatric management. It provides weekly individual therapy sessions and sometimes drug therapy. Drugs that can help stabilize mood, particularly topiramate and lamotrigine (both anticonvulsants), may help, particularly in managing anger and changes in mood. 3. Antisocial personality disorder is the most difficult to treat. Currently, it has no effective treatment. People with this disorder tend to use being in therapy as a way to avoid the negative consequences of negligent or illegal behavior or to avoid social responsibilities. Thus, therapy focuses on encouraging accountability. 4. Narcissistic personality disorder is sometimes be helped by psychodynamic forms of individual psychotherapy. This therapy emphasizes the identification of unconscious patterns in current thoughts, feelings, and behavior. However, to be effective, such therapy requires therapists who emphasize empathy and do not confront people when they express feelings of entitlement or exaggerate their sense of self-worth and self-importance. 5. Avoidant personality disorder often responds to individual and group therapy. However, people with this disorder strongly resist exposing themselves to what they usually avoid. For them, avoiding things spares those conflicts and the experience of failure or rejection. 6. Obsessive-compulsive personality disorder responds to psychodynamic forms of individual psychotherapy that focuses on helping people tolerate uncertainty and accept their world. The resulting changes are usually gradual. (Gunderson & Choi-Kain, 2012) Expert practioner facilitated discussion and debate Explain the ethical role psychiatric mental health nurses have to play while administering nursing care. Read the journal article before coming to class – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375348/pdf/jmedeth00258-0013.pdf Brain Storming Evaluation of the Lesson : Attendance in Lectures and Discussions (10%) On-the-spot Quiz (10%) End of Module Assessment (80%) – Visit a psychiatric mental health nurse and discuss with him/her a case handled by them on any one of the personality disorders. Based on the case discussed answer the following questions: 1. How did the practioner distinguish the patient with having one particular type of personality disorder? (1,000 words, plus or minus 10%, 900-1100 words) 2. What was the treatment plan followed by the practioner? (1,000 words, plus or minus 10%, 900-1100 words) 3. What were the prejudices that the patient encountered within the care setting? (1,000 words, plus or minus 10%, 900-1100 words) Referencing requirements – APA, 6th Edition Cite your answers with peer-reviewed insights. References : (n.d.). Retrieved February 2, 2013, from http://www.colorquiz.com/ American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (4th Edition ed.). Washington DC: American Psychiatric Publication. Barker, P. (Ed.). Psychiatric and Mental Health Nursing: The craft of caring (2nd Edition ed.). Hodder Arnold. Gunderson, J. G., & Choi-Kain, L. (2012, August). Personality Disorders. Retrieved February 2, 2013, from About The Merck Manual Home Health Handbook (Online Version): http://www.merckmanuals.com/home/mental_health_disorders/personality_disorders/personality_disorders.html?qt=&sc=&alt= Morrison, G. R., Ross, S. M., & Kemp, J. E. (2004). Designing Effective Instruction (4th Edition ed.). Hoboken, NJ: John Wiley & Sons, Inc. Myers, D. G. (2005). Exploring Psychology (6th Edition ed.). New York: Worth Publishers. Wilson-Barnett, J. (1986). Ethical Dilemmas in Nursing. Journal of Medical Ethics , 12, 123-126. Read More