Psychiatric Nursing

Psychiatric Nursing

Boyd,00, M. A. (2012). “Psychiatric Nursing: Contemporary Approach (5^th edition).” Aptara, Inc.: Wolters Kluwer,. Print.        426-446.

This book should be used as it outlines the nursing interventions that are commonly used in psychiatric nursing, including self – care skills, anger management, symptom and medication management. The book also explores family-based assessment and intervention while taking into consideration the changing structure. Contemporary parental roles in the family setting are also taken into account. The book also explores the effects of mental wellness on family functioning. The author advises that during the family assessment, the nurses should focus on developing relationships with the family by establishing credibility. While establishing credibility, the nurse should demonstrate their skills and knowledge and project a professional image. During family assessment, nurses can create genograms which are multigenerational schematic depictions of legal, biological and emotional relationships across generations. The genograms helps the nurse explore relations and patterns of illness.

2. Dubovsky AN, Kiefer MM: Borderline personality disorder in the primary care setting. Med Clin North Am 2014; 98:1049–1064

This article should be used as it describes borderline personality disorder’s epidemiology, remission, clinical characteristics, comorbidity, pathophysiology, treatment and its management in primary care settings. The author also provides a real-life case of borderline personality disorder. The prevalence of the disease is presented as well as the risk factors. Remission rates are described as high with an increase in age, although relapses can occur. The article also highlights that suicidal rates among personas borderline personality disorder is 50% above the general population average. Critical characteristics are identified as unstable interpersonal relationships, disturbed cognition, affective dysregulation and impulsivity. Comorbidity is identified as psychiatric disorders, substance abuse, cardiovascular diseases and obesity. The pathophysiology includes genetics, brain abnormalities, neurohormones and environmental factors such as negative childhood experiences such as abuse and trauma. The article explains that psychotherapy and psychopharmacology as the main types of treatment. Management within the primary care entails setting clear boundaries for treatment, setting regular scheduled appointments and communicating with all the providers that are involved with the patient. Therefore the article should be used as it has a comprehensive coverage of borderline personality disorder’s epidemiology, remission, clinical characteristics, comorbidity, pathophysiology, treatment and its management in primary care settings.

3. Gulanick, M., & Myers, J.L (2014). “Nursing Care Plans: Diagnoses, interventions, and outcomes (8 th edition).” Elsevier: Mosby, Elsevier: Mosby, Philadelphia, PA.

This book should be used as it offers nurses with a systematic method of developing individualized care plans. For each care plan, the book begins with a comprehensive definition of the diagnosis, including prevalence, overview of common management and the setting where the diagnosis can occur. Each problem is accompanied by cross-references. Further for each diagnosis, the common risk factors, related factors and expected outcomes and collaborative and independent interventions are provided. Nursing care plans focus on risk factor management and health promotion. The book is also useful in identifying outcome criteria during the creation of monitoring tools and quality improvement projects. Specifically, the book identifies bipolar disorder, including its defining characteristics, common expected outcomes, ongoing assessment and their rationale. It also highlights the various therapeutic interventions for bipolar disorder and the rationale behind them.

4. Sanislow CA, Grilo CM, Morey LC, et al: Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the collaborative longitudinal personality disorders study. Am J Psychiatry 2002; 159:284–290

This article should be used as it involves a study that evaluated the effectiveness of the DSM –IV criteria for assessing borderline personality disorder. The DSM –IV criteria includes instability, anger, impulsivity, unstable relationships, and feelings of emptiness, paranoia, identity disturbance, self-injury and abandonment fears. The initial study involved conducting diagnostic interviews on many participants (n =668) from different regions over an extended period of time. Confirmatory factor evaluation was conducted after two years a subset of (498) using three-factor model that comprised of affective dysregulation, behavioral dysregulation and disturbed relatedness. The second test was conducted by independent assessors who were blinded to the findings of the earlier test. The results from the second test indicated a high internal consistency for both follow-up and baseline assessments. However, the researchers advanced that the three-factor model provided a considerably better fit.

5. Gunderson JG, Lyons-Ruth K: BPD’s interpersonal hypersensitivity phenotype: a gene-environment-developmental model. J Pers Disord 2008;

This article is relevant as it explores how borderline personality disorder emerges in children’s early interpersonal relationships and how the reactions evolve to instability in interpersonal relations that is evident in borderline personality disorder patients. The paper provides a theory that children with genetic-based hypersensitivity to interactions with other persons can have difficulty with interpersonal relationships later in life. The later interpersonal strategies are occasioned by borderline interpersonal disorders such as being fearful and needy. The psychobiological disposition for poor interpersonal relationships is also linked to parents as they are also likely to have such maladaptive responses. Development pathways that lead to disorganized attachments are also considered. The developmental pathways that are identified include controlled attachments with their caregiver. Overall, understanding the genetic causes the illness can lead to a deeper understanding of borderline personality disorder’s etiology.

6. Skodol, A. (2017). Borderline personality disorder: Epidemiology, clinical features, course, assessment, and diagnosis. In: UpToDate,Stein,
7. B. (Ed.).

This article should be used as it provides a clear description of borderline personality disorder as well as a review of the illness’s epidemiology, diagnosis, clinical features and differential diagnosis. With regards to epidemiology, the article explains that the disease has a prevalence of 1.4% with females affected at a rate three times higher than males and higher rates among Hispanics compared to African Americans and Caucasians. The pathogenesis identifies psychosocial, biological and genetic causes. Clinical features include imparted interpersonal relationships, impulsivity and affective dysregulation. Comorbidities include eating disorders, substance use and anxiety. The authors explain that 8-12% of borderline personality disorder patients commit suicide. Patients also engage in self harming behavior, including cutting themselves. Diagnosis includes self-reporting, information from friends and family and the clinician’s observations. The article identified nine dimensions that form the diagnostic criteria, including instability, anger, impulsivity, unstable relationships, and feelings of emptiness, paranoia, identity disturbance, self-injury and abandonment fears. The differential diagnosis involves distinguishing other disorders from the borderline personality disorder.

Meta-analysis of treatment.

One of the methods used to treat borderline personality disorder is psychotherapy. Dubovsky and Kiefer (2014) explain that four types of psychotherapy are often used including transference- focused psychotherapy, mentalization-based therapy, dialectic behavior therapy and general psychiatric management. All the four methods are highly structured, and the patient and therapist follow a treatment manual during the entire treatment period making it easier for therapists to assess adherence. Additionally, they require the therapist to take extensive training. Psychotherapy requires the therapist to develop self-awareness and continuously consult with colleagues so that they can avoid burnout. Dialectic behavior therapy focuses on helping the patient regulate their emotion and learn reality testing. The method has been effective in reducing suicide and self-harm. Mentalization-based therapy focuses on assisting patients in understanding their mental states so that they can think before they react. Transference focused psychotherapy focuses on projecting the feelings of the patient onto the therapist, whereas general psychiatric management centres on the patients interpersonal relationships. General Psychiatric management can also involve family therapy and pharmacotherapy.

References

Boyd, M. A. (2018). Psychiatric nursing: Contemporary practice. LWW.

Dubovsky, A. N., & Kiefer, M. M. (2014). Borderline personality disorder in the primary care setting. Medical Clinics of North America, 98(5), 1049-1064. https://doi.org/10.1016/j.mcna.2014.06.005

Gulanick, M., & Myers, J. L. (2010). Nursing care plans: Diagnoses, interventions, and outcomes. Elsevier Health Sciences.

Gunderson, J. G., & Lyons-Ruth, K. (2008). BPD’s interpersonal hypersensitivity phenotype: A gene-environment-Developmental model. Journal of Personality Disorders, 22(1), 22-41. https://doi.org/10.1521/pedi.2008.22.1.22

Sanislow, C. A., Morey, L. C., Grilo, C. M., Gunderson, J. G., Tracie Shea, M., Skodol, A. E., Stout, R. L., Zanarini, M. C., & McGlashan, T. H. (2002). Confirmatory factor analysis of DSM-IV borderline, schizotypal, avoidant and obsessive-compulsive personality disorders: Findings from the collaborative longitudinal personality disorders study. Acta Psychiatrica Scandinavica, 105(1), 28-36. https://doi.org/10.1034/j.1600-0447.2002.0_479.x

Skodol, A. (2017). Borderline personality disorder: Epidemiology, clinical features, course, assessment, and diagnosis. In: UpToDate, Stein,

1. B. (Ed.).