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Health Differences Across the Lifespan 2 Study Guide • Cluster B disorders: antisocial, borderline, histrionic, and narcissistic; be patient when emotional and erratic behavior is displayed; provide a consistent and structured milieu to avoid manipulation and power struggles; safety is always first priority of care, protect patient from suicide and self-mutilation until they can protect themselves; set limits as necessary to help patient maintain impulse control to protect both the patient and others from injury; help the patient recognize and discuss fear of abandonment; help the patient recognize presence of dichotomous thinking or splitting, in which self and others are perceived as all good or all bad; encourage direct communication to minimize attention seeking through use of dramatic, seductive behavior • Cluster C disorders: avoidant, dependent, and obsessive compulsive; point out avoidance behaviors and related losses and secondary gains; provide problem solving and assertiveness training to increase self-confidence and independence; encourage expression of feelings to decrease rigidity and need for control; help patient acknowledge and discuss sense of inadequacy and fear of rejection Treatment • Psychopharmacology: Antipsychotic agents may be prescribed on a short-term basis to alleviate psychotic symptoms. SSRIs may be prescribed to diminish rapid mood swings and impulsive, aggressive, or self-destructive behavior associated with borderline personality disorder. • Individual and group therapy: This is based on the patient’s level of function and specific needs. Behavioral therapy involves impulse control training designed to support patient safety by decreasing the risk of suicide or self-mutilation through use of antihero contracts. It involved setting limits to discourage a tendency to test and manipulate others, behavioral modification to include social skills for patients who are helpless and dependent, and anxiety reduction. • Crisis intervention: Prevention is the key to successfully moving people through a crisis with fewer associated behavioral disorders and reactions later in life. This process stems from the work of Gerald Caplan. Here we encounter the term debriefing. Debriefing involves one or more therapists coming together with a small group of people who have experienced a crisis. The therapists encourage these people to share their reactions to this crisis. Other forms of crisis intervention have evolved from this. They include telephone-based interventions, such as suicide prevention, poison control, and crisis pregnancy, as well as on-site interventions like those provided by Red Cross at major disasters. • Community mental health programs: One form of a community-based program is day treatment programs. These programs allow people to live at home or in a sheltered environment while coming to a hospital or clinic during the day for individual and/or group therapy. There are different types of day treatments for different types of psychosocial and medical needs. Another aspect of day treatment programs is that they can allow the caregiver some needed relief to help avoid caregiver role strain associated with long term care of a mentally ill person. Sheltered workshops also offer respite to care givers but they are aimed at giving the affected person a safe environment to work. They provide people with mental disabilities a place to work and even earn income. Persons with Down’s Syndrome may benefit greatly from this type of program.

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