NSG 2271, Psychosocial Nursing, Chapter 22,
Personality and Impulse Control Disorders Test
With Complete Solution
Anti-Social Personality Disorder (ASPD) (Cluster B) - ANSWER is
characterized by a pervasive pattern of disregard for and violation of the
rights of others (occurring since age 15).
psychopath or sociopath - ANSWER a person with a tendency toward
antisocial and criminal behavior with little regard for others; often used to
describe persons with ASPD
Clinical & Diagnostic Criteria for ASPD - ANSWER Individuals display
arrogant, self-centered, privileged and entitled behavior. They are
self-serving and exploit and seek power over others. They can be
interpersonally engaging and charming which is often mistaken for a genuine
sense of concern for others. They lack empathy; are unable to express human
compassion; and tend to be insensitive, callous and contemptuous of others.
Deceit and manipulation for personal profit or pleasure are central features.
They are behaviorally impulsive and interpersonally irresponsible. Many
people with this disorder repeatedly perform acts that are grounds for arrest.
They act hastily and spontaneously, are temperamentally aggressive and
shortsighted, and fail to plan ahead or consider alternatives. They fail to
adapt to ethical and social standard of the community and lack a sense of
personal obligation to fulfill social and financial responsibilities. They lack
remorse.
Twelve month prevalence rates of ASPD are estimated between ___ and ___ %.
- ANSWER 0.2 to 3.3 %
,Risk Factors for ASPD - ANSWER A) Males with alcohol use disorder and
those released from substance abuse clinics, prisons, or other forensic
settings
B) Those with adverse socio-economic or socio-cultural factors
(to be diagnosed the individual must be at least 18 and have exhibited one or
more childhood behavioral characteristics of conduct disorder before age 15
such as aggression to people or animals, destruction of property,
deceitfulness or theft, or serious violation of rules)
Comorbidity of ASPD - ANSWER It is associated with several other psychiatric
disorders, including mood, anxiety, and other personality disorders. Strongly
associated with alcohol and drug use, but is not warranted if the behavior
occurs only in the context of substance abuse.
Etiology of ASPD - ANSWER Biologic Theories - studies show changes
associated with personality disorders or characteristics, but there is no
evidence that these changes caused the disorder. Early MRI studies showed
that persons with ASPD failed to activate the limbic-prefrontal circuit during
fearful situations. These findings support neural basis of fearlessness in these
individuals. Impairment in moral judgment is associated with dysfunction of
the prefrontal cortex. Emotional distance, aggression, and impulsivity are
consistently associated with neural dysfunction.
Psychosocial Theories:
a) Temperament - scientist believe temperament is neurobiologically
determined and is central to understanding personality disorders. Two
behavioral dimensions of temperament are activity spectrum with varies
from intense to passive, and the adaptability spectrum which varies from
,having a positive attitude about new stimuli with high flexibility to
withdrawal from new stimuli with minimal flexibility in response to change. A
strong relationship is found between difficult temperament and ASPD.
b) Attachment - unsatisfactory attachments in early relationships lead to
antisocial behavior in later life. Risk factor for developing dysfunctional
attachment include parental abandonment or neglect, loss of a parent or
caregiver, physical or sexual abuse. Parents who lack secure attachments in
their own childhood may be unable to form secure attachments with their
children.
c) Family Issues - Individuals with ASPD may come from chaotic families in
which alcoholism and violence are the norm. Individuals who are victims of
abuse and neglect, live in foster homes, or had several primary caregivers are
more likely to be victimized by antisocial behavior, especially aggression.
Treatment goals for patients with ASPD - ANSWER to develop a nurturing
sense of attachment and empathy for other people and situations and to live
within the norms of society
Evidenced Based Nursing Care for Patients with Antisocial Personality
Disorder (ASPD) - ANSWER Mental Health Nursing Assessment - key areas of
assessment are determining the quality of relationships, impulsivity, and the
extent of aggression.
Nursing Diagnosis - Common diagnosis is Risk for Other Directed Violence,
Dysfunctional Family Processes, also Ineffective Role Performance,
Ineffective Individual Coping, Impaired Communication, Impaired Social
Interactions, low Self-esteem, and Risk for Violence.
Outcomes - should be short-term and relevant to a specific problem.
, (Evaluate outcomes in terms of management of specific problems).
Therapeutic Relationship - goal should be to identify dysfunctional thinking
patterns and develop new problem-solving behaviors.
Interventions include:
1) Facilitating Self-Responsibility - encouraging patient to assume
responsibility for personal behavior.
2) Enhancing Self-Awareness - exploring and understanding personal
thoughts, feelings, motivations and behaviors.
3) Teaching the patient about positive health care practices, impulse control,
and anger management by engaging the individual in discussion bout the
issues then direct the topic to the major teaching points
4) Group Interventions are more effective than individual modalities.
Example: problem solving groups that focus on identifying a problem and
developing solutions are helpful because patient self-responsibility is
reinforced when patients remind each other of better alternatives.
5) Milieu Interventions - it is important to provide a structured environment
with rules.
6) Anger Management - because the expression of anger and aggression
develops during a lifetime, these individuals can benefit from anger
management techniques.
7) Social Support - helping the patient build new support system after new
skills are learned is necessary.
8) Interventions for Family Members - family members usually need help in
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