MH114.pdf

11/27/23, 3:34 AM Realizeit for Student Treatment Several treatment strategies are used with clients with personality disorders; these strategies are based on the disorder’s type and severity or the amount of distress or functional impairment the client experiences. Combinations of medication and...

11/27/23, 3:34 AM Realizeit for Student Treatment Several treatment strategies are used with clients with personality disorders; these strategies are based on the disorder’s type and severity or the amount of distress or functional impairment the client experiences. Combinations of medication and group and individual therapies are more likely to be effective than is any single treatment. Not all people with personality disorders seek treatment, however, even when significant others or family members urge them to do so. Typically, people with schizotypal, narcissistic, or obsessive–compulsive personality disorders are least likely to engage or remain in any treatment. They see other people, rather than their own behavior, as the cause of their problems. Individual and Group Psychotherapy Therapy helpful to clients with personality disorders varies according to the type and severity of symptoms and the particular disorder. Inpatient hospitalization is usually indicated when safety is a concern, for example, when a person with BPD has suicidal ideas or engages in self-injury. Otherwise, hospitalization is not useful and may even result in dependence on the hospital and staff. Individual and group psychotherapy goals for clients with personality disorders focus on building trust, teaching basic living skills, providing support, decreasing distressing symptoms such as anxiety, and improving interpersonal relationships (Cloninger & Svrakic, 2017). Relaxation or meditation techniques can help manage anxiety for clients. Improvement in basic living skills through the relationship with a case manager or therapist can improve the functional skills of people with schizotypal personality disorder. Assertiveness training groups can assist people to have more satisfying relationships with others and to build self-esteem when that is needed. Cognitive–behavioral therapy has been particularly helpful for clients with personality disorders. Several cognitive restructuring techniques are used to change the way the client thinks about him or herself and others: thought stopping, in which the client stops negative thought patterns; positive selftalk, designed to change negative self-messages; and decatastrophizing, which teaches the client to view life events more realistically and not as catastrophes. Dialectical behavior therapy was designed for clients with BPD by Dr. Marsha Linehan. It focuses on distorted thinking and behavior based on the assumption that poorly regulated emotions are the underlying problem (May, Richardi, & Barth, 2016). ELDER CONSIDERATIONS Personality disorders are not first diagnosed in elder people but may persist from young adulthood into older age. Some individuals with personality disorders tend to stabilize and experience fewer difficulties in later life. Others are described as “aging badly”; that is, they are unable or unwilling to acknowledge limitations that come with aging, refuse to accept help when needed, and do not make reasonable decisions about their health care, finances, or living situation. These individuals seem chronically angry, unhappy, or dissatisfied, resulting in strained relationships and even alienation from family, friends, caregivers, and health care providers, resulting in social isolation. The most common personality disorders reported in later life are paranoid, avoidant, dependent, and obsessive–compulsive (Agronin, 2017). Older adults with personality disorders are at increased risk for depression, suicide, and dementia. Community-Based Care Caring for clients with personality disorders occurs primarily in community-based settings. Acute psychiatric settings such as hospitals are useful for safety concerns for short periods. The nurse uses skills to deal with clients who have personality disorders in clinics, outpatient settings, doctors’ offices, and many medical settings. Often, the personality disorder is not the focus of attention; rather, the client may be seeking treatment for a physical condition. Most people with personality disorders are treated in group or individual therapy settings, community support programs, or self-help groups. Others will not seek treatment for their personality disorder, but may be treated for a major mental illness. Mental Health Promotion The treatment of individuals with a personality disorder often focuses on mood stabilization, decreasing impulsivity, and developing social and relationship skills. In addition, clients perceive unmet needs in a variety of areas, such as self-care (keeping clean and tidy), sexual expression (dissatisfaction with sex life), budgeting (managing daily finances), psychotic symptoms, and psychological distress. Typically, psychotic symptoms and psychological distress are often the only areas addressed by health care providers. Perhaps dealing with those other areas in the treatment of a client might result in a greater sense of well-being and improved health. Children who have a greater number of “protective factors” are less likely to develop antisocial behavior as adults. These protective factors include school commitment or importance of school, positive peer relationships, parent or peer disapproval of antisocial behavior, functional family relationship, and effective parenting skills. Interestingly, the study found that children at risk for abuse and those not at risk were less likely to have antisocial behavior as adults if these protective factors were present in their environment. Children lacking these protective factors are much more likely to develop antisocial behavior as adults. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyUR… 1/2 11/27/23, 3:34 AM Realizeit for Student BEST PRACTICE: Treatment of Schizotypal Personality Disorder Since schizotypal personality disorder can later lead to schizophrenia in some clients, effective early identification and treatment of this personality disorde that second-generation antipsychotics (mainly risperidone) are most often used to treat schizotypal personality disorder. However, evidence of efficacy is b to make evidence-based treatment recommendations. The next step would be clinical trials in sufficient number and scope to determine whether second-generation antipsychotics can, in fact, decrease conve disorder to schizophrenia. Adapted from Kirchner, S. K., Roeh, A., Nolden, J., & Hasan, A. (2018). Diagnosis and treatment of schizotypal personality disorder: Evidence from a syste 4(1), 20. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyUR… 2/2