B3.062 Personality Disorders in Psychiatry

Question 1

what is personality

Answer 1

way of understanding normal human behavior and information processing
affects cognition, emotion, and behavioral responses
provides stability and tendencies across setting and contexts

Question 2

nature

Answer 2

emphasis on biological factors to predispose people to certain traits or personality features

Question 3

nurture

Answer 3

emphasis on psychological, social, and environmental factors to help express, inhibit, or reinforce underlying predispositions toward tendencies of thinking, feeling and behaving

Question 4

what evidence is there for personality disorders having a strong genetic influence

Answer 4

higher concordances between monozygotic twins than dizygotic twins

Question 5

what is a personality disorder

Answer 5

when personality features are extreme or skewed they can be maladaptive and represent a disorder that requires treatment

Question 6

APA definition of personality disorder

Answer 6

enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of important social and personal contexts, and are inflexible and maladaptive, and cause either significant functional impairment or subjective distress

Question 7

general symptoms of a personality disorder

Answer 7

frequent mood swings
stormy relationships
social isolation
angry outburst
suspicion and mistrust of others
difficulty making friends
a need for instant gratification
poor impulse control
alcohol or substance abuse

Question 8

what types of problems are personality disorders frequently comorbid with

Answer 8

mood disorders
anxiety disorders
adjustment problems
substance abuse
frequent ER visits
social problems
illegal activities
poor, inflexible coping strategies

Question 9

core features of personality disorders

Answer 9

present by adolescence (age 15)
pervasive and inflexible
associated with impaired functioning (social, occupational, or other important area)

Question 10

cluster A disorders

Answer 10

“odd or eccentric”
paranoid
schizoid
schizotypal

Question 11

cluster B disorders

Answer 11

"dramatic, emotional, and erratic"
borderline
narcissistic
histrionic
antisocial

Question 12

cluster c disorders

Answer 12

“anxious, avoidant, fearful”
obsessive-compulsive personality disorder
dependent personality disorder
avoidant personality disorder

Question 13

paranoid personality disorder

Answer 13

characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent

Question 14

schizoid personality disorder

Answer 14

lack of interest and detachment from social relationships, and restricted emotional expression
“autistic thinking”

Question 15

schizotypal personality disorder

Answer 15

a pattern of extreme discomfort interacting socially, distorted cognitions and perceptions, behavioral eccentricities
“magical thinking”
thought to be “akin” to schizophrenia-spectrum disorders

Question 16

what are some common themes among cluster B disorders

Answer 16

commonly seen in emergency settings
externalizing
individuals get in trouble and physical harm due to their choices

Question 17

borderline personality disorder

Answer 17

pervasive pattern of instability in relationships, self-image, identity, behavior and affect often leading to self harm and impulsivity
often mistaken for bipolar mood disorder

Question 18

narcissistic personality disorder

Answer 18

a pervasive pattern of grandiosity, need for admiration, and lack of empathy

Question 19

histrionic personality disorder

Answer 19

a pervasive pattern of attention-seeking behavior and excessive emotions
seduction/manipulation of others

Question 20

antisocial personality disorder

Answer 20

a pervasive pattern of disregard for and violation of the rights of others, lack of empathy
must have history of conduct disorder during childhood (longstanding)

Question 21

obsessive compulsive personality disorder

Answer 21

characterized by rigid conformity to rules, perfectionism and control

Question 22

dependent personality disorder

Answer 22

pervasive psychological need to be cared for by other people

Question 23

avoidant personality disorder

Answer 23

pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation
strong social anxiety

Question 24

personality disorder due to a general medical condition

Answer 24

must be attributable to medical condition

head/brain trauma most common

Question 25

risk factors for personality disturbance

Answer 25

``` temperament problems in childhood adverse environmental events parents with personality disorders low socioeconomic status physical or sexual abuse in childhood psychological and physical neglect chaotic family life conduct problems loss of parents ```

Question 26

% of people w BPD who experienced childhood sexual abuse

Answer 26

40-71%

Question 27

% of people w antisocial personality disorder who have a history of risk factors

Answer 27

childhood physical abuse 42% parental marital abuse 49% poverty 42% foster care 40%

Question 28

discuss the relationship between trauma and childhood brain development

Answer 28

traumatic events have been shown in animal models to sensitize the HPA system sensitization by stress hormones result in altered functioning of the amygdala and limbic connection with the prefrontal lobes in animal models and post-mortem studies repetitious brain exposure to higher levels of neurotransmitters such as noradrenaline affect development of hippocampus (decreased size)

Question 29

function of cortisol

Answer 29

increases excitatory neurotransmission

Question 30

sympathetic nervous system

Answer 30

contributes to arousal | exaggerated startle response

Question 31

limbic system

Answer 31

hippocampus: involved in memory formation, retrieval | anterior cingulate: initial emotional regulation

Question 32

frontal lobe

Answer 32

prefrontal cortex and orbitofrontal cortex - involved in short term memory - problem solving - executive functioning, decision making - automatic and controlled emotional regulation

Question 33

discuss the neuroimaging and anatomical findings associated with BPD and antisocial personality disorder

Answer 33

dysfunction of prefrontal-limbic circuits | lower volume of hippocampus, LPFC, cingulate in BPD

Question 34

discuss the neuroimaging and anatomical findings associated with schizotypal

Answer 34

compromise of the temporal lobe and basal striato-thalamic structures

Question 35

what type of attachments in infancy and childhood lead to more emotional and physical health

Answer 35

secure

Question 36

how do you assess a personality disorder?

Answer 36

clinical interview | psychological testing

Question 37

what are components of a clinical interview when assessing personality disorders

Answer 37

comprehensive history functioning back to childhood and adolescence functioning in multiple domains corroboration from family

Question 38

different types of psychological testing

Answer 38

``` DSM SCID-II MMPI-2 MCMI-III PAI ```

Question 39

how do you treat a personality disorder?

Answer 39

``` no pharma treatment for personality disorders treatment typically symptomatic in nature -antidepressants -anxiolytics -mood stabilizers -atypical antipsychotics reduction in comorbid symptoms psychotherapy ```

Question 40

how is psychotherapy utilized in PDs

Answer 40

primary treatment modality patients respond to structured therapies as well as less structured therapies counseling directed towards problem areas--supportive therapy

Question 41

disorders with greater treatment response to CBT spectrum counseling

Answer 41

BPD OCPD avoidant dependent

Question 42

disorders with less response to therapy

Answer 42

cluster A | antisocial