Flashcards in Patient with personality disorder Deck (23):
1
Etiology
1. Genetic
Family history->substance misuse, schizophrenia
Temperament
2. Psychoanalytical
Getting "stuck" at stage of development
Anxieties of ego failed defenses
3. Trauma->childhood trauma alters neurotransmitter, hyperarousal, HPA
4. Defenses, attachment
2
Features of personality disorders
Enduring
Pervasive
Stable
Deviate from cultural norm
Maladaptive
Impacts:
1. Cognition->percieving self and others
2. Affect
3. Interpersonal function
4. Impulse control
3
Affect, behaviour and cognition encompass
Neurodevelopment (temperament)
and psychodevelopment
(secure base (age 1-7)+self esteem
(7-12)+self image 12-18)-->
integration and self identity
4
Cluster A
Odd, aloof, bizarre-->
neurodevelopement=
Paranoid
Schizoid
Schizotypal
5
Cluster B
Dramatic
Impulsive
Erratic-->
abandonment
issues
Borderline,
Antisocial
Narcisist,
Histrionic
6
Cluster C
Fearful and anxious-->
inferiority, low self esteem
OCPD, Dependent, AVoidant,
Passive aggressive
7
Attachment theory and personality
Secure vs insecure vs disorganised
Insecure=
1. Anxious-preoccupied
2. Dissmisive/avoidant
3. Fearful-avoidant
Insecure attachment
endures through life-->
unstable, destructive,
inappropriate relationships
cannot reflect on mind and
mind of others
Leads to disturbed sense of
self
8
History
Sources of distress
Comorbidities
Impairment of function
Complete psychiatric assessment
Substance use, suicide risk, relationships, work, legal, family, social
9
Features of schizoid, schizotypal, paranoid
1. Schizotypal:
Interpersonal/social deficits
Reduced capacity for close relationships
Eccenteric
Cognitive/perceptual disturbances
Odd thinking, ideas of reference
Social anxiety
2. Schizoid:
Detachment
Restricted emotional expression/interpersonal relationships
Solitary, indifferent
Affectively detached
3. Paranoid:
Distrustful
Suspscious
Holds grudges
Perceives threats in neutral events
10
Features of narcissistic, antisocial, histrionic
1. Histrionic:
++Emotional
Attention seeking
Discomfort if not COA
Shallow expression of emotion
Draws attention to self physically seductive
2. Narcissitic:
grandiosity
Needs admiration
Lacks empathy
Views self as special
Unwilling to recognise feelings of others
Exploitative
Arrogant
3. Antisocial:
Disregard rights of others
Beginning
11
Features of avoidant, dependant, OCPS
1. Avoidant
Social inhibition
Inadequacy
Hypersensitive to criticism
Reluctant to take risks for fear of rejection
2. Dependant:
Excess need to be taken care of
Submissive
Poor decision making, needs advices
Fears solitude
Clinging behaviour
3. Obsessive/compulsive
Preoccupied with ordiliness
Perfectionism
Lack flexibility, openness, efficiency
Overconscientious
Stubborn
Excessively rigid, devoted to work
12
Management of Cluster A
1. Patient communication and relationship management strategies
2. Antipsychotics
3. Antidepressant
4. Substance abuse treatment programme
13
Cluster B management
1. Patient communication and relationship management strategies
2. Psychotherapy->borderline and anti-social
3. Mood stabilisers->borderline
4. Substance abuse treatment programme
14
Cluster 3 management
1. Patient communication and relationship management strategies
2. Psychotherapy
3. Substance abuse treatment
4. Paroxetine, sertraline, fluoxetine->avoidant
15
Defenses in paranoid, psychiatric risks
1. Projection
2. Identification with the aggressor->taking on aspect of character that causes anxiety
3. Repression
4. Denial
5. Splitting
Fear of dependence and vulnerability to hostility
History of a harsh, punitive parent
1. Delusional disorder
2. Depression
3. Anxiety disorder
4. OCD
16
Schizoid defenses, psychiatric risks
1. Splitting
2. Projection
3. Denial
4. Rationalisation
Apparent self sufficiency, masks both the wish for and fear of closeness
Cold, neglectful parents
1. Delusional disorder
2. Schizophrenia
3. Anxiety disorder
17
Schizotypal defenses, psychiatric risks
1. Denial
2. Projection
3. Acting out
4. Fantasy
1. Depression
2. Anxiety
3. Schizophrenia
4. Delusional disorder
18
Antisocial defenses, psychiatric risk
1. Repression
2. Splitting
3. Denial
Repressing powerlessness and low self worth
Rage denied and split off
Empathetic failure, need for control
Inconsistent parenting, ineffectual or harsh discipline, parental criminality/substance use
1. Substance use
2. Depression
3. Criminality
19
Narcissistic defenses, psychiatric risk
1. Denial
2. SPlitting
3. Projection
4. Rationalisation
5. Intellectualisation
Fear of not being the best
Inability to deal with perceived threats to self and self worth
Emotional neglect, empathetic failure, inability to form meaningful relationships
1. Depression
2. Dysthymic
3. Substance abuse
20
Histrionic defenses, psychiatric risk
1. Projection
2. Splitting
3. Fantasy
Fear of impermanence of relationships, gender identity concerns
History of perceived rejection by same sex parent and identification with opposite sex parent
21
Avoidant personality defenses, psychiatric risk
1. Projection
2. Denial
Conscious desire for closeness with fear of closeness and rejection
Relative stable sense of self although feel worthless
History of parental rejection or severe life threatening/disfiguring illness in childhood
1. Depression
2. Anxiety
22
Dependent defenses, psychiatric risk
1. Denial
2. Repression
Fear of abandonment
Preserved cohesive sense of self
History of separation and losses
1. Anxiety disorders
2. Depression
23