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Chapter 14 Personality Disorders
Epidemiology
Types of Personality Disorders
Cluster A Personality Disorders
Cluster B Personality Disorders
Cluster C Personality Disorders
Assessment
Nurse, Patient, and Family Resources
Part III Psychiatric Crises
Chapter 15 Grieving
Theory
Anticipatory Grief
Grieving
Complicated Grieving
Nurse, Patient, and Family Resources
Chapter 16 Suicide
Epidemiology
Risk Factors
Assessment
Nurse, Patient, And Family Resources
Chapter 17 Crisis Intervention
Types of Crises
Phases of Crisis
Assessment
Nurse, Patient, and Family Resources
Chapter 18 Anger, Aggression, and Violence
Responses to Anger, Aggression, and Violent Behavior
Nurse, Patient, and Family Resources
Chapter 19 Family Violence
Assessment
Self-Assessment
Nurse, Patient, and Family Resources
Chapter 20 Sexual Violence
Assessment
Nurse, Patient, and Family Resources
Part IV Psychopharmacology
Chapter 21 Attention-Deficit/Hyperactivity Disorder Medications
Stimulants
Nonstimulants
Managing Aggressive Behaviors in Attention-Deficit/Hyperactivity Disorder
Chapter 22 Antipsychotic Medications
First-Generation Antipsychotics
Second-Generation Antipsychotics
Injectable Antipsychotics
Over-the-Counter Sleep Aids
Herbal and Dietary Supplements for Insomnia
Chapter 27 Substance Use Disorder Medications
Alcohol Cannabis
Opioids
Hallucinogens
Inhalants
Sedatives, Hypnotics, and Benzodiazepines
Amphetamines
Nicotine
Chapter 28 Neurocognitive Medications
Cholinesterase Inhibitors
N-Methyl-D-Aspartate Receptor Antagonist
Medications for Behavioral Symptoms of Alzheimer's Disease
Part V Nonpharmacological Approaches
Chapter 29 Psychotherapeutic Models
Cognitive–Behavioral Therapy
Dialectical Behavior Therapy
Eye Movement Desensitization and Reprocessing Therapy
Interpersonal Therapy
Behavioral Therapy
Milieu Therapy
Group Therapy
Chapter 30 Brain Stimulation Therapies
Electroconvulsive Therapy
Repetitive Transcranial Magnetic Stimulation
Magnetic Seizure Therapy
Vagus Nerve Stimulation
Deep Brain Stimulation
Light Therapy
References
Appendix A Patient-Centered Assessment
General Information
Presenting Problem, Strengths, Goals, and Coping
Relevant History
Psychiatric History
Medication (Including Over-the-Counter)
Alcohol/Substance Use
Sleep Pattern
Appearance
Attitude
Behavior
Mood
Affect
Speech
Copyright
3251 Riverport Lane
St. Louis, Missouri 63043
Varcarolis' Manual of Psychiatric Nursing Care Planning, Edition 6
ISBN: 978-0-323-47949-3
Copyright © 2019 by Elsevier, Inc. All rights reserved.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission and further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Although for mechanical reasons all pages of this publication are perforated, only those pages imprinted with an Elsevier Inc. copyright notice are intended for removal.
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2015, 2011, 2006, 2004, 2000
International Standard Book Number: 978-0-323-47949-3
Senior Content Strategist: Yvonne Alexopoulos
Content Development Manager: Lisa Newton
Senior Content Development Specialist: Danielle M. Frazier
Publishing Services Manager: Julie Eddy
Project Manager: Mike Sheets
Design Direction: Patrick Ferguson
Printed in the United States of America
Dedication
This book is dedicated to people who are living with and recovering from mental illness and to the nursing students and registered nurses who focus on supporting this recovery.
Reviewers
Leslie A. Folds Ed D.; PMHCNS-BC; CNE
Associate Professor of Nursing School of Nursing
Belmont University
Nashville, TN
Phyllis M. Jacobs RN, MSN
Assistant Professor Emeritus School of Nursing
Wichita State University
Wichita, Kansas
Susan Justice MSN, RN, CNS
Clinical Assistant Professor
College of Nursing
University of Texas at Arlington College of Nursing and Health
Innovation Arlington, Texas
Chris Paxos PharmD, BCPP, BCPS, BCGP
Pharmacotherapy Specialist
Department of Pharmacy
Cleveland Clinic Akron General Akron, Ohio
Associate Professor of Pharmacy Practice
Department of Pharmacy Practice
Northeast Ohio Medical University, College of Pharmacy
Rootstown, Ohio
Associate Professor of Psychiatry
Department of Psychiatry
Northeast Ohio Medical University, College of Medicine
Rootstown, Ohio
Acknowledgments
Thanks to my Elsevier family for coordinating and completing another successful project. Kudos go out to Yvonne Alexopoulos, senior content strategist, for providing feedback and supporting my ideas for this sixth edition. Yvonne is a brilliant person with thoughtprovoking comments along with a humorous take on thorny issues. As always, cheers go out to Lisa Newton, our content development manager. This is a woman who responds to emails within an hour, sends positive greetings, and adds a personal touch to nearly all of our communications.
As a senior content development specialist, Danielle Frazier moved the publishing process along while tirelessly re-uploading files to the electronic management system. Big thanks to Mike Sheets, project manager, for pulling all the details together, ensuring consistency, and producing a reader-friendly edition for students and clinical nurses.
Moving from NANDA-I based nursing care plans to a patient problem approach was a big move. Other nurse editors have pioneered and already adopted this method in their popular textbooks. I am especially grateful to editors Donna Ignatavicius and Pamela Swearingen for taking the lead in this endeavor and helping me through the process.
Finally, I'd like to acknowledge Elizabeth (Betsy - the real wizard) Varcarolis. Betsy developed a leading undergraduate psychiatric nursing textbook, Foundations of Psychiatric-Mental Health Nursing, and later added the Manual of Psychiatric Nursing Care Planning. Together, Betsy and I went on to introduce the popular Essentials of Psychiatric Mental Health Nursing, a more condensed version of Foundations. Countless psychiatric nursing students have read her words and been
prepared for the NCLEX based on her knowledge of this discipline. I am sincerely grateful to have been (and still am) Betsy's apprentice. I will always be indebted to her.
Peggy Halter
The Nursing Process
The basis of psychiatric–mental health nursing is the therapeutic relationship. It is within this relationship that care is provided to address healthcare problems, both actual or potential. These problems occur in the context of or as the result of psychiatric disorders, also known as mental illness or mental disorders. A common language for nurses, physicians, social workers, psychologists, and other professionals who work in the mental health system facilitates patient care.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the official publication of the American Psychiatric Association (APA) for categorizing medical diagnoses in the United States. The DSM provides clinicians, researchers, insurance companies, pharmaceutical firms, and policy makers with standard criteria for the classification of psychiatric disorders. Clinicians use this publication as a guide for planning care and evaluating patients' treatments.
First published in 1952, the current manual is the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) (APA, 2013). The Manual of Psychiatric-Mental Health Nursing Care Planning uses the DSM-5 for organizing the order of clinical chapters and for describing psychiatric disorders.
clinical expertise and patient/family preferences and values for delivery of optimal health care.
Quality improvement: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decisionmaking.
QSEN Institute. (n.d.). QSEN competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas
provide a history. Charts from previous hospitalizations or electronic medical records are extremely helpful. Laboratory reports also provide important information.
The use of a standardized nursing assessment tool facilitates the assessment process. Appendix A contains a patient-centered assessment tool. Most healthcare facilities provide patient assessments in either paper or electronic form. Although these tools are integral for gathering essential data, they can feel impersonal. With practice, nurses become proficient in gathering information in a less formal fashion, with the nurse clarifying, focusing, and exploring pertinent data with the patient. This method allows patients to state their perceptions in their own words and enables the nurse to observe a wide range of nonverbal behaviors. A personal style of interviewing congruent with the nurse's personality develops as comfort and experience increase. Box 1.2 presents the factors that are typically assessed.
Box 1.2
Common Assessment Areas
Previous psychiatric treatment
Educational background
Occupational background
Employed? Where? How long?
Special skills
Social patterns
Describe family.
Describe friends.
With whom does the patient live?
To whom does the patient go in times of crisis?
Describe a typical day.
Sexual patterns
Sexually active? Practices safe sex? Practices birth
control?
Sexual orientation
Sexual difficulties
Interests and abilities
What does the patient do in his or her spare time?
What sport, hobby, or leisure activity is the patient good at?
Medications
What medications does the patient take? How often? How much?
What herbal or over-the-counter drugs does the patient take? How often? How much?
What psychotropic drugs does the patient take or use? How often? How much?
How many drinks of alcohol does the patient take per day? Per week?
What recreational drugs does the patient take or use? How often? How much?
Does the patient identify the use of drugs as a problem?
Coping abilities
What does the patient do when he or she gets upset?
To whom can the patient talk?
What usually helps to relieve stress?
What did the patient try this time?
Issues for Which Referral May Be Indicated
Patients may be referred to social services and might need further investigation when planning long-term care. This is especially important in the case of severe mental illness, if any of the following issues are noted:
• Problems
with
primary support (death, illness, divorce, sexual or physical abuse,
