10. Personality Disorders Flashcards
(30 cards)
1
Q
Describe: Personality Disorders (4)
A
- PDs are an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture; they are manifested in two or more of cognition, affect, interpersonal functioning, and impulse control.
- They are often inflexible and pervasive across a range of situations.
- Usually at least age 18 yr for Dx, but pattern well established by adolescence or early adulthood
- Associated with many complications, such as depression, suicide, violence, brief psychotic episodes, multiple drug use, and treatment resistance
2
Q
PDs are often a product of what? (1)
A
an intricate interaction of psychological (e.g., stress), social (e.g., homelessness), and biologic factors (e.g., genetics).
3
Q
Name 3 clusters
A
- Cluster A: Eccentric (Odd) and ‘‘Mad’’
- Cluster B: Dramatic (Impulsive/Emotional) and ‘‘Bad’’
- Cluster C: Anxious and ‘‘Sad’’
4
Q
Name general DX criteria of PD (5)
A
- Behavior deviates markedly from individual’s cultural expectations. Inflexible and pervasive across a broad range of personal and social situations, manifesting in ≥2 of:
- Cognition (perception and interpretation of self, others, and events)
- Affect (range, intensity, lability, and appropriateness of emotional response)
- Interpersonal functioning
- Impulse control
- Often leading to clinically significant distress or impairment in social, occupational, or other important areas of functioning
- Stable and of long duration with onset tracing back to at least adolescence or early adulthood
- Not better accounted for by other psychiatric disorders
- Not due to direct physiologic effects of a substance or a GMC such as head injury
5
Q
Name PD of cluster A (3)
A
- Paranoid PD (0.5%–3%)
- Schizoid PD (2%–7%)
- Schizotypal PD (3%–5.6%)
6
Q
Name criterias for Paranoid PD (7)
A
4 diagnostic criteria from “SUSPECT”
- S: Spouse fidelity suspected
- U: Unforgiving and bearing grudges
- S: Suspicious of others
- P: Perceives attack on his or her character not apparent to others and reacts quickly
- E: Enemy or friend (suspects associates and friends)
- C: Confides in others feared
- T: Threats perceived in benign events
7
Q
Name criterias for Schizoid PD (8)
A
4 diagnostic criteria from “SOLITARY”
- S: Shows emotional coldness to others
- O: Omits from social events
- L: Lacks friends
- I: Involved in solitary activities
- T: Takes pleasure in few activities
- A: Appears indifferent from praises and criticisms
- R: Restricts from close relationship
- Y: Yanks himself or herself from social interactions
8
Q
Name criterias for Schizotypal PD (10)
A
≥5 diagnostic criteria from “ME PECULIAR”
- M: Magical thinking or odd beliefs
- E: Experiences unusual perceptions
- P: Paranoid ideation
- E: Eccentric behavior or appearance
- C: Constricted (or inappropriate) affect
- U: Unusual (odd) thinking and speech
- L: Lacks close friends
- I: Ideas of reference
- A: Anxiety in social situations
- R: Rule out psychotic disorders and pervasive developmental disorder
9
Q
Name PDs of cluster B (4)
A
- Antisocial PD (3% in males; 1% in females)
- Borderline PD (2%–4%)
- Histrionic PD (1.3%–3%)
- Narcissistic PD (2%)
10
Q
Name criterias: Antisocial PD (7)
A
3 diagnostic criteria from “CORRUPT”
- C: Conformity to law lacking
- O: Obligations ignored
- R: Reckless disregard for safety of self or others
- R: Remorse lacking
- U: Underhandedness (deceitful, lies, cons, others)
- P: Planning deficit (impulsive)
- T: Temper (irritable and aggressive)
11
Q
Name criterias: Borderline PD (9)
A
5 diagnostic criteria from “AM SUICIDE”
- A: Abandonment
- M: Mood instability
- S: Suicidal and/or self-harming behaviors
- U: Unstable and intense relationships
- I: Impulsivity (self-damaging areas)
- C: Can’t control anger
- I: Identity disturbance
- D: Dissociative symptoms
- E: Emptiness
12
Q
Name criterias: Histrionic PD (8)
A
5 diagnostic criteria from “PRAISE ME”
- P: Provocative or sexually seductive behavior
- R: Relationships considered more intimate than they are
- A: Attention (uncomfortable when not the center of attention)
- I: Influenced easily
- S: Style of speech (impressionistic, lacks details)
- E: Emotional liability and shallowness
- M: Make up (physical appearance used to draw attention to self)
- E: Exaggerated emotions (theatrical)
13
Q
Name criterias: Narcissistic PD (7)
A
5 diagnostic criteria from “SPECIAL”
- S: Special (believes he or she is special and unique), Status (“high”)
- P: Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- E: Entitlement (strong sense), Envious
- C: Conceited (grandiose sense of self-importance)
- I: Interpersonal exploitation
- A: Arrogant (haughty)
- L: Lacks empathy
14
Q
Name PDs in cluster C (3)
A
- Avoidant PD (0.5%–1.6%)
- Dependent PD (1.6%–6.7%)
- Obsessive-compulsive PD (3%–10%)
15
Q
Name criterias: Avoidant PD (7)
A
4 diagnostic criteria from “AVOIDER”
- A: Avoid occupational activities
- V: View self as inept, unappealing, or inferior
- O: Occupies with fear of rejection or criticism in social situations
- I: Inhibits from new interpersonal relationships
- D: Difficulty initiating new projects due to lack of self-confidence
- E: Embarrassment prevents new activity or taking personal risks.
- R: Restraints in intimate relationships due to fear of being shamed
16
Q
Name criterias: Dependent PD (9)
A
5 diagnostic criteria from “DEPENDENT”
- D: Difficulty in making everyday decisions without advice and reassurance from others
- E: Excessive length to obtain nurturance and support
- P: Preoccupies with thoughts of taking care of self
- E: Exaggerated fears of being left to care for self
- N: Needs others to assume responsibility for most major areas of his or her life
- D: Difficulty in expressing disagreement
- E: Ending one relationship immediately and seeking urgently for another
- N: Not able to initiate projects due to lack of self-confidence
- T: Take care of me is his or her motto
17
Q
Name criterias: Obsessive-compulsive PD (8)
A
4 diagnostic criteria from “LAW FIRMS”
- L: Loses point of activity due to preoccupation with details
- A: Ability to complete tasks compromised by perfectionism
- W: Worthless objects unable to discard
- F: Friendships and leisure activities excluded due to a preoccupation with work
- I: Inflexible, scrupulous, overly conscientious on ethics, values, or morality, not accounted for by religion or culture
- R: Reluctant to delegate unless others submit to exact guidelines
- M: Miserly toward self and others
- S: Stubbornness and rigidity
18
Q
How to differentiate PD from other psychiatric disorders? (6)
A
- Onset: early onset (late adolescent to early adulthood)
- Duration: chronic for life, long-enduring patterns of behavior
- Natural history: non episodic, non fluctuating
- Functioning:pervasive across all functioning in life, affecting social, occupational, and interpersonal functioning
- Insight: usually little because the disorder is egosyntonic (i.e., they have no concerns with the symptoms)
- Avoid medications that can be abused (benzodiazepines, opioids) or can be fatal in overdose (TCA)
19
Q
Describe history: PD (14)
A
- History of presenting illness
- Onset (often starts in young adults)
- Symptoms
- Duration (long-standing vs. intermittent)
- Other mood or psychotic symptoms
- Substance use
- Eating disorder, self-harm
- Interpersonal stressors
- Social history
- Early attachments
- Living arrangements
- Relationships
- Educations
- Trauma
- Level of functioning
- Assess for degree of impairment and functioning
20
Q
Describe physical exam: PD (3)
A
- Neurologic exam
- Look for signs of self-harm (cuts, burns, etc.)
- Mental Status Exam
- Grooming, tattoos, style of clothing, behavior during assessment, labile mood or unstable affect, fixed patterns or beliefs, thought patterns, grandiosity, paranoia, psychotic symptoms
21
Q
Describe investigations: PD (5)
A
- Only needed if the clinician is seriously concerned about ruling out symptoms of another medical condition
- Routine blood work: CBC + differentials, thyroid function test (TSH, T3/T4), electrolytes, magnesium, calcium, phosphates, renal function test (creatinine, BUN), fasting glucose, HbA1c, liver function test (AST, ALT, ALP, albumin, INR, biliru- bin), lipid profiles (LDL, HDL, TG), ESR, folate, vitamin B12
- Urine drug screen
- Additional screening: neurologic consultation, CXR, ECG, EEG, CT/MRI of head
- CT head should be considered if there has been an abrupt change in pattern of behavior.
22
Q
Describe management: PD (7)
A
- PDs improve at much faster rate with psychotherapy compared with the natural course of illness.
- Psychoeducation
- Psychotherapies
- DBT (especially for borderline PD)
- Social skills training (for schizotypal and dependent PD)
- Substances and alcohol abuse counseling (for antisocial PD)
- Pharmacotherapy: low-dose antipsychotics (for schizotypal and borderline PD), low-dose antidepressants, low-dose anxiolytics. Note: medications are treating clinical symptoms, not the PD.
23
Q
Describe: Brief therapy (1)
A
Emphasizes on a specific problem with direct intervention
24
Q
Describe: Cognitive behavioral therapy (CBT) (3)
A
- Modifies cognitions, assumptions, beliefs, and behaviors, with the aim of influencing disturbed emotions
- with behavioral component including systemic desensitization, flooding, positive reinforcement, negative reinforcement, extinction, and punishment
- and with cognitive component including theory, goal setting, and thought record
25
Describe: Dialectical Behavior Therapy (DBT) (4)
* One of the best researched therapies for one of the most common PDs (borderline PD).
* It focuses on four areas: mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance.
* There are two components of the therapy: individual and group component.
* DBT is longer than most other manual-based therapies (\> 1 yr)
26
Describe: Family/couple therapy (1)
* Works with families and couples in intimate relationships to nurture change and development with structural focus of here and now by reestablishing parental authority, strengthening normal boundaries, rearranging alliances, and emphasizing family relationships as an important factor in psychological health
27
Describe: Group therapy (1)
Develops goals of self-understanding, self-acceptance, increasing social skills, and creating a micro- cosm of society
28
Describe: Insight-oriented therapy (1)
Involves intensive analysis of the unconscious aspects of psychology, emotions, and behaviors, exploring the inner conflicts caused by childhood loss or trauma, providing understanding and insight into ways of dealing with loss and conflict, and developing more appropriate coping mechanisms
29
Describe: Interpersonal psychotherapy (IPT) (1)
Brief psychological treatment for depression to improve the quality of the patient’s relationships, to focus on unresolved grief and conflicts in his or her life that differ from his or her expectations, and to overcome social isolation
30
Describe: Psychodynamic psychotherapy (2)
* Interpersonal and relational intervention used to help patients in problems of living, increasing individual sense of well-being, and reducing subjective discomforting experience
* based on experiential relationship building, dialogue, communication, and behavior change are designed to improve the patient’s mental health
