Neurocognitive Disorders and Personality Disorders

Introduction
In this unit, you will explore conditions that are more commonly found in older adults, including dementia and other neurocognitive disorders. In addition, you will review personality disorders.
Neurocognitive Disorders
When working with older adults, it is important to establish a trusting and empathic relationship that provides both support and structure for the information collection process. In addition to understanding the older client’s current psychological issues, it may be necessary to gather information about other factors that may be impacting his or her emotional well-being, including medical conditions, pain, environmental conditions, and social support systems. It can be challenging to identify cognitive impairment in older people who come from diverse social, cultural, and educational backgrounds. Other assessment instruments, such as the mental status examination (MSE), can be incorporated into the assessment process to provide additional measures. Although neurocognitive disorders are generally diagnosed later in life, they are not limited to older adults. Likewise, older adults also experience all of the other disorders described in the Abnormal Psychology text and the DSM-5.
Personality Disorders
Personality disorders represent ongoing patterns of thinking, feeling, and behaving that are demonstrated across time and situations since late adolescence or early adulthood. A general definition of the criteria included in personality disorders can be seen on page 645 of the DSM-5. Sociocultural context has a significant impact on the development of personality, as well as what is considered to be a normal, expected range of behaviors within the culture. It is important to take a client’s sociocultural background into consideration during the assessment process. Specific information about cultural, age, and gender features within personality disorders is included in the description of each of the specific personality disorders in that section.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Nolen-Hoeksema, S. (2014). Abnormal psychology (6th ed.). New York, NY: McGraw-Hill.
Objectives
To successfully complete this learning unit, you will be expected to:
1. Formulate a DSM-5 diagnosis for a personality disorder.
2. Discuss the contributions of gender, culture, and relationship dynamics in the diagnosis and treatment of personality disorders.
3. Discuss treatment issues for clients who are diagnosed with personality disorders.
Learning Activities
Unit 9 Study 1
Readings Studies
Use your Abnormal Psychology text to complete the following:
• Read from Chapter 10, the section “Major and Mild Neurocognitive Disorders,” pages 304–315.
• Read Chapter 9, “Personality Disorders,” pages 250–281.
DSM-5 Review
Review the main diagnoses of the following chapters from Section II:
• “Neurocognitive Disorders,” pages 591–643.
• “Personality Disorders,” pages 645–684.
Use the library to read one of the following articles:
• Bockian’s 2006 chapter, “Depression in Dependent Personality Disorder,” from Personality-Guided Therapy for Depression, pages 227–246.
• Links, Stockwell, and MacFarlane’s 2004 article, ” Is Couple Therapy Indicated for Patients With Dependent Personality Disorder?” from Journal of Family Psychotherapy, volume 15, issue 3, pages 63–79.

Optional – Readings
Refer to Optional Readings for Principles of Psychopathology for a list of additional articles about the mental disorders and current issues regarding assessment, diagnosis, and treatment you are studying in this unit.
Unit 9 – Neurocognitive Disorders, Personality Disorders, and Paraphilic Disorders
Articles
Busuttil, W. (2004). Presentations and management of post traumatic stress disorder and the elderly: A need for investigation. International Journal of Geriatric Psychiatry, 19(5), 429–439.
McCray, L. W., Bogner, H. R., Sammal, M. D., & Gallo, J. J. (2007). The role of patient personality in the identification of depression in older primary care patients. International Journal of Geriatric Psychiatry, 22(11), 1095–1100.
Nehls, N., & Sallmann, J. (2005). Women living with a history of physical and/or sexual abuse, substance use, and mental health problems. Qualitative Health Research, 15(3), 365–381.
Polanski, P. J., & Hinkle, J. S. (2000). The mental status examination: Its use by professional counselors. Journal of Counseling and Development, 78(3), 357–364.
Qualls, S. H., & Anderson, L. N. (2009). Family therapy in late life. Psychiatric Annals, 39(9), 844–850.
Qualls, S. H. (2000). Therapy with aging families: Rationale, opportunities, and challenges. Aging and Mental Health, 4(3), 191–199.
Smith, H. M. (2007). Psychological service needs of older women. Psychological Services, 4(4), 277–286.
Dimaggio, G., & Norcross, J. C. (2008). Treating patients with two or more personality disorders: An introduction. Journal of Clinical Psychology, 64(2), 127–138.
Kaylor, L. (1999). Antisocial personality disorder: Diagnostic, ethical and treatment issues. Issues in Mental Health Nursing, 20(3), 247–258.
Links, P. S., Stockwell, M., & MacFarlane, M. M. (2004). Is couple therapy indicated for patients with dependent personality disorder? Journal of Family Psychotherapy, 15(3), 63–79.

Rivas, L. A. (2001). Controversial issues in the diagnosis of narcissistic personality disorder: A review of the literature. Journal of Mental Health Counseling, 23(1), 22–35. – unit 9
Silverstein, M. L. (2007). Diagnosis of personality disorders: A case study. Journal of Personality Assessment, 89(1), 82–94.
Skodol, A. E., & Bender, D. S. (2003). Why are women diagnosed borderline more than men? Psychiatric Quarterly, 74(4), 349–360.
Ziegenbein, M., Calliess, I., Sieberer, M., & Machleidt, W. (2008). Personality disorders in a cross-cultural perspective: Impact of culture and migration on diagnosis and etiological aspects. Current Psychiatry Reviews, 4(1), 39–47.
Zweig, R. A. (2008). Personality disorder in older adults: Assessment challenges and strategies. Professional Psychology: Research and Practice, 39(3), 298–305.

Books

Strong, M. (1998). A bright red scream: Self-mutilation and the language of pain. New York, NY: Penguin Books. (Self-mutilation.)

Unit 9 Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Personality Disorder Diagnosis
Listen to the media The Vignette of Annie. Below for reading.
Based on the information presented, address the following questions:
1. What diagnosis would you give this client? Provide the rationale for your choices, linking the client’s symptoms to specific DSM-5 criteria.
2. How might age, gender, ethnicity, and relationship dynamics contribute to the symptoms and issues this client is presenting?
3. How is neurocognitive functioning impacted by a personality disorder? How might a personality disorder be exacerbated by neurocognitive problems?
4. What factors would you need to consider when developing a treatment plan for this client?
5. How would a personality disorder diagnosis impact the client-counselor relationship, goals of therapy, and interventions you might choose?
Support your ideas with references to the course texts, articles from this learning unit, articles from the Optional Readings for Principles of Psychopathology list, or articles from peer-reviewed journals that you locate in the library.

The Vignette of Annie
Annie is a 47-year-old Chinese-American woman who has come to therapy because of difficulties she is having with her husband. Since her last child left home for college, Annie has felt increasingly lonely and has been asking her husband to spend more and more time with her. His response has been to become angry and critical, saying her expectations are unreasonable and that she needs to find other ways to fill up her time.
For over two years, Annie has felt sad most of the day. She has low energy, poor concentration, and often feels a sense of hopelessness. Annie is in good health and does not use alcohol or drugs. She has not felt this “low” before in her life.
Annie does admit that she has always felt a lack of confidence in herself, even as a child, and has relied on friends and family to provide guidance and direction. She remembers a reluctance, dating back to elementary school. to disagree or express a different opinion for fear of losing friends. She has looked to her son and husband to make all of the important decisions in the family, and has counted on her two daughters for continual reassurance.
Annie hates to be by herself and cannot imagine being able to face life on her own. She is terrified that her husband may leave her and has been clinging more to her friends, calling them frequently and asking them for advice. Lately her friends have been less available for her however, and suggested that she should really be talking to a therapist about these things. This has made Annie feel even more frightened and unhappy.

 

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