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Course 2F - The Quiz



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TABLE 1 - DSM-IV-TR AXIS II DISORDERS: Research suggests that .....
borderline personality disorder and antisocial personality disorder may be the most commonly occurring personality disorders among HIV-infected substance-using patients.
among noninfected patients with personality disorders, those with borderline personality disorder and antisocial personality disorder are at higher risk for becoming infected with HIV.
Both of the above
Neither of the above
The clinical diagnosis of personality disorders is primarily derived from ....
the patient’s description of symptoms to assist diagnosis.
observation of the patient’s behavior and style of interacting with others.
Both of the above
Neither of the above
How many personality disorders are there in the DSM-IV-TR?
In comparison with the general population ... patients belonging to an HIV-risk-behavior group (such as injection drug users) may be more likely to have a personality disorder which is in
Cluster A, either Paranoid or Schizoid or Schizotypal
Cluster B, particularly borderline personality disorder or antisocial personality
Cluster C, either avoidant or dependent
DIFFERENTIAL DIAGNOSIS FOR PERSONALITY DISORDERS: An HIV/AIDS patient initially presents with some maladaptive behaviors and traits of Personality Disorder, e.g., he's disruptive with unwarranted anger and hostility, or avoidant and excessively emotional, or guarded and avoidant. Which action below is NOT APPROPRIATE AT THE POINT OF INITIAL PRESENTATION?
Staff should first recognize that some patients may try to mask their inability to process information due to low or borderline intelligence or other cognitive impairments, with behaviors that look like a Personality Disorder.
Staff should first recognize that disruptive behaviors may be symptoms of HIV dementia and may also mimic symptoms of personality disorders.
Staff should first recognize that victims of domestic violence may appear inhibited, avoidant, excessively emotional, or submissive, until they feel safe.
He or she should be diagnosed with an Axis II Personality Disorder, based upon the presenting behaviors.
For purposes of DIFFERENTIAL DIAGNOSIS _________________ by asking patients to explain in their own words what the clinician has told them.
clinicians can assess level of paranoia
clinicians can assess how patients process information that is given to them,
clinicians can assess the level of narcissism,
Delirium, Dementia, Metabolic Disorders, and other medical disorders of the Central Nervous System (CNS)
Mood Disorders, domestic violence, Anxiety Disorders, Psychotic Disorders
Low or borderline intelligence, malingering, substance use or withdrawal
all of the above
only the first and third answers
If the maladaptive personality traits and behaviors persist after other treatable disorders have been excluded or adequately addressed,
they may be attributed to the psychophysiological effects of HIV-AIDS
they may be attributes of an underlying personality disorder.
Neither of the above
MANAGEMENT OF PATIENTS: Patients with Personality Disorders may exhibit a range of personality traits and behaviors that seriously interfere with their ability to interact effectively with clinicians and staff. Which action below is NOT appropriate in the management of such patients?
A particular staff member may be better-suited for handling a certain personality disorder, trait, or behavior; therefore, clinicians should determine who among his/her staff should be the primary person to interact with a particular patient.
Screen out the most severely dysfunctional and refer to settings which are not saturated with AIDS/HIV patients.
Ensure consistency in care, continuity of care, ease of access to care, and shorter periods of waiting will help diminish waiting room anxieties and displays of disruptive behaviors.
If waiting room times cannot be shortened, it is important that patients have activities that will help prevent anxiety and disruptive behavior. Educational videos, discussions with patient educators, printed materials, refreshments, and games help to create an environment that addresses the difficulty that some patients with anxiety disorders experience during wait times.
Per information in Section IV, which statement is NOT true?
The diagnosis of a specific personality disorder may not be as important as identifying and focusing on specific personality traits that make treatment planning and provision of health care difficult.
The Intake Staff must arrive at a definitive diagnosis before actual work with the patient begins.
The medical staff’s principal objective should be to help patients maximize health-oriented behaviors.
Effective communication is the cornerstone of good patient care. For patients with personality disorders and associated maladaptive personality traits and behaviors, establishing adequate communication ....
is oftentimes impossible to achieve and thus we must work around this roadblock.
is not only necessary but may also be sufficient to prevent or alleviate disruptive behavior.
Listen carefully to identify the patient’s agenda; avoid abrupt movements; communicate in an unhurried manner
Maintain eye contact and use body language that conveys support and respect
Use humor to lighten the mood if the patient becomes agitated or anxious
Offer choices and options whenever possible; this will involve the patient and help share responsibilities of care
MORE ABOUT EFFECTIVE COMMUNICATION: Staff members can prevent the potential chaos that these patients may create by maintaining appropriate boundaries and providing structure. Which action below is NOT an example of maintaining boundaries and providing structure?
When a patient first arrives for his/her office visit, a staff member may explain the schedule and the role of each staff member involved.
Say to the patient, 'We'll just need to hang loose today. The doctor is backed up. We're not sure how long the wait's going to be.'
Say to the patient, 'Your doctor will see you first, although you may have to wait 15 to 30 minutes because he/she is a bit backed up today.'
Say to the patient, ' After your office visit with your doctor, he/she may then want you to speak to the nurse to review your medications, or go to the lab for blood work.'
Patients are often unaware of the impact of their behavior on others and may react defensively with anger or withdrawal when confronted about the negative effect of their behavior. To lessen patients’ sense of feeling criticized ....
clinicians should avoid upsetting the patient with comments about his behavior if at all possible.
clinicians should be supportive and offer patients alternative, more adaptive ways of interacting and behaving.
The importance of using a TEAM APPROACH with patients with personality disorders _________________
may need to be placed on the back burner when staffing patterns are stretched extremely thin.
cannot be overemphasized.
If all members of the treatment team are doing their jobs effectively, you will not see a situation in which the feelings evoked in one staff member contradict the experience of a different staff member, or where staff feel frustrated and isolated from each other.
True False
By definition, patients with personality disorders often evoke intense feelings that are difficult for the people around them to process. A procedure that allows staff to call on a colleague for substitution or supervision can enable team members to regroup and avoid feeling overwhelmed when stress is high.
True False
Some patients with severe personality disorders may have _________________ that could foster conflict among patients, clinicians, and other staff.
physical health problems
a peer network
styles of interaction
A team approach that relies on _________________ is essential to prevent conflict among patients, clinicians, and other staff.
a clear chain of command
supportive, effective communication among everyone involved in the patient’s treatment
annual review of employee rules of conduct
TREATMENT PLANNING: Which statement is not true, per this section?
Treatment planning may occur in a team meeting and may require a comprehensive conversation among all members of the treatment team.
The treatment plan should clearly delineate the goals of treatment and expected behaviors for staff and patients alike.
It may take the form of a treatment contract between staff and patient.
Because patients with Personality Disorder can be quite argumentative, it is not necessary for the patient to be part of the treatment planning process.
The focus of goals should be on health and behavior, such as adhering to medications, keeping appointments, and arriving to appointments on time, rather than on general demands and feelings of the patient.
Looking at the approach to good treatment planning, select the best answer below: .
Behaviors that are unacceptable should be clearly delineated, along with corresponding consequences for the behavior.
Staff members should be consistent in their response to unacceptable behavior and should avoid specifying consequences with which the staff is unwilling or unable to follow through
Staff should suggest alternatives to behaviors that are damaging to the patient or clinic. For example, if a patient becomes verbally aggressive or threatening and is unable to modify his/her behavior, he/she will be asked to leave the office
Treatment plans should help both staff and patients feel more secure and in control, because the limits of safe behavior are known and agreed upon by everyone.
All of the above.
Patients who refuse psychiatric referral
cannot be safely treated in an HIV/AIDS clinic setting.
may accept consultation with a 'treatment planning consultant' who is a mental healthcare professional, such as a psychiatrist, social worker, or nurse practitioner.
APPROACH TO SPECIFIC PATIENT TYPES: Looking at 'Cluster A - Odd or Eccentric Patients' who tend to be 'guarded, suspicious, and argumentative'..... These patients are doubtful of others’ intentions and motives. They may be openly or covertly suspicious of interventions. To the extent that they are convinced that others intend to harm them, they may also be hostile or menacing. Clinicians should maintain a respectful, professional distance from patients. Which line of communication below represents this type of approach?
May I see that article you have on HIV treatment? [Clinician reviews the article, following with] This is helpful. Can I keep a copy in the file? Now, for the next month, can you try [clinician offers treatment recommendation]?
I understand your reasons for not wanting to take medications. If you change your mind, please let me know. I would like to continue to work with you and help you do the things that will keep you as healthy as possible for as long as possible.
Your home remedies have kept you healthy so far. These medications won’t mix with one of the home remedies. Can we find a replacement for only that specific remedy to make sure that it does not take away the treatment action of your medications? What other remedy might work for you with these medications?
The _________________ patient may appreciate a clinician who is more formal and 'business-like'. Thus maintain a respectful, professional distance; acknowledge the patient’s perception of the world, without debate or agreement, and try to focus his/her attention on healthcare treatment.
Cluster B - Sociopathic
Cluster A - Guarded, suspicious, argumentative
Cluster C - Orderly, controlled, and controlling
With the _________________ patient, set limits on interactions with the patient to prevent excessive and unrealistic demands from him/her. Refer the patient, if needed, to programs that extend his/her social and healthcare support networks.
Cluster C - Anxiously dependent and clinging
Cluster B - Dramatic, dependent, and overdemanding
Cluster A - Idiosyncratic or eccentric
With the _________________ patient, recognize and support the patient’s strengths and achievements, and show interest in the patient’s opinions. Demonstrate competence without challenging the patient’s need to feel superior.
Cluster B - Superior
Cluster A - Idiosyncratic or eccentric
Cluster C - Orderly, controlled, and controlling
With the _________________ patient, set realistic limits on patient visits; never tolerate aggressive behavior or any other behavior that creates an unsafe environment. Consider a mental health consultation, which may help with development of an appropriate treatment plan.
Cluster A - Aloof or uninvolved
Cluster C - Orderly, controlled, and controlling
Cluster B - Sociopathic
With the _________________ patient, consider providing more frequent but briefer appointments; scheduling interactions with the patient may help minimize his/her excessive demands at inconvenient times. Forewarn him/her of change, such as vacations and other absences.
Cluster C - Anxiously dependent and clinging
Cluster B - Dramatic, dependent, and overdemanding
Cluster A - Idiosyncratic or eccentric
With the _________________ patient, demonstrate a supportive attitude toward the patient. Maintain professional boundaries to prevent the patient from provoking unhelpful responses.
Cluster C - Anxiously dependent and clinging
Cluster B - Dramatic, emotionally involved, seductive, and captivating
Cluster A - Guarded, suspicious, argumentative
TREATMENT OF PERSONALITY DISORDERS: The primary psychiatric treatment of personality disorders and maladaptive traits consists of psychotherapeutic and social interventions, sometimes used in combination with adjunctive pharmacotherapy. Which statement in this regard is NOT true?
Psychotropic medications alone are rarely useful for the treatment of patients with personality disorders, but it is important to treat comorbid Axis I disorders, such as mood and anxiety disorders.
Clinicians should also be aware of symptoms in these patients that suggest a comorbid psychotic disorder
Evidence suggests that selective serotonin reuptake inhibitor (SSRI) antidepressants ARE INEFFECTIVE in relieving the depressed, anxious, and impulsive presentations in patients with personality disorders.
Evidence suggests that selective serotonin reuptake inhibitor (SSRI) antidepressants CAN BE EFFECTIVE in relieving some of the depressed, anxious, and impulsive presentations in patients with personality disorders.


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