Treatments for Anti-Social Personality Disorder
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Delusional disorders:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient’s mistaken beliefs. Treatment may also include mobilizing a support system for the isolated elderly patient.
Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.
A patient’s history of medication response is the best guide when selecting treatment. The lowest dose should be started initially and increased slowly based on the patient’s response. If the symptoms don’t improve during a 6-week trial, other classes of antipsychotics may be tried. Haloperidol, fluphenazine decanoate, and fluphenazine enanthate are depot formulations that are implanted I.M. to release the drug gradually over a 30-day period, improving compliance. Usually, however, this type of treatment isn’t necessary. Pimozide may be particularly effective in delusional disorders.
Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.
However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures. Agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia, may also occur. Routine blood monitoring is essential to detect the estimated 1% to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Personality disorders:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Personality disorders are difficult to treat. Successful therapy requires a trusting relationship in which the therapist can use a direct approach. The type of therapy chosen depends on the patient’s symptoms. Family and group therapies are usually effective. Cognitive and self-help groups have also been beneficial.
Drug therapy is effective in some types of personality disorders; for example, pimozide has been successfully used to reduce paranoia ideation in some patients with paranoid personality disorder. Antipsychotic drugs (olanzapine or risperidone) may be used to treat severe agitation or delusional thinking. Selective serotonin reuptake inhibitors, such as fluoxetine, may be used to treat irritability, anger, and obsessional thinking. Antianxiety drugs may be used to treat severe anxiety that interferes with normal thinking.
Hospital inpatient milieu therapy can be effective in crisis situations and possibly for long-term treatment of some disorders. Inpatient treatment is controversial, however, because most patients with personality disorders don’t comply with extended therapeutic regimens; for such patients, outpatient therapy may be more helpful.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Photosensitivity reactions:
Treatment
(Professional Guide to Diseases (Eighth Edition))
For many patients, treatment involves a sunscreen, protective clothing, and minimal exposure to sunlight while the patient continues on the drug. For others, progressive exposure to sunlight can thicken the skin and produce a tan that interferes with photoallergens and prevents further eruptions.
Withdrawal of the causative agent and treatment with oral steroids usually provides relief. The patient should be advised not to use the causative agent again if it’s known, even though this may limit the patient’s treatment options.
Antimalarial drugs, beta-carotene, and PUVA (psoralen and UVA) may be used to treat PMLE. Treatment for solar urticaria may also require PUVA. Although hyperpigmentation usually fades in several months, hydroquinone preparations can hasten the process.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Delusional disorders:
Treatment
(Handbook of Diseases)
Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient’s mistaken belief system. Treatment may also include mobilizing a support system for the isolated elderly patient.
Antipsychotic drug therapy
Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation.
Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.
High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents.
Haloperidol, fluphenazine , and fluphenazine are depot formulations that are implanted I.M. They release the drug gradually over a 30-day period, improving compliance.
Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.
However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures as well as agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia.
Routine blood monitoring is essential to detect the estimated 1%to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Personality disorders:
Treatment
(Handbook of Diseases)
Personality disorders are difficult to treat. Successful therapy requires a trusting relationship in which the therapist can use a direct approach. The type of therapy chosen depends on the patient’s symptoms.
Drug therapy is ineffective but may be used to relieve acute anxiety and depression. Family and group therapy usually are effective.
Hospital inpatient milieu therapy can be effective in crisis situations and possibly for long-term treatment for borderline personality disorders. Inpatient treatment is controversial, however, because most patients with personality disorders don’t comply with extended therapeutic regimens; for such patients, outpatient therapy may be more useful.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Agitation:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Orient the patient with agitation to the unit and its procedures and routines. Provide reassurance and emotional support. Explain the need to reduce stressors and maintain a quiet environment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Agitation:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Because agitation can be an early sign of many different disorders, monitor the patient's vital signs and neurologic status while the cause is being determined.
▪ Eliminate stressors, which can increase agitation.
▪ Provide adequate lighting, maintain a calm environment, and allow the patient ample time to sleep.
▪ Ensure a balanced diet, and provide vitamin supplements and hydration.
▪ Remain calm, nonjudgmental, and nonargumentative.
▪ Avoid using restraints, unless absolutely necessary, because they tend to increase agitation.
▪ If appropriate, prepare the patient for diagnostic tests, such as a computed tomography scan, skull X-rays, magnetic resonance imaging, and blood studies.
Patient teaching
▪ Orient the patient to the unit and its procedures and routines.
▪ Explain stress-reduction measures.
▪ Offer reassurance and emotional support.
▪ Explain all tests and procedures, the underlying cause, and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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