Personality Disorder Flashcards
(32 cards)
1
Q
What are central traits?
A
- Openness - appreciation of a variety of experiences
- Conscientiousness - planning ahead rather than being spontaneous
- Extroversion - sociable, energetic and talkative
- Agreeable - kind, sympathetic and happy to help
- Neuroticism - worry, vulnerable, temperamental
2
Q
How are personality disorders diagnosed?
A
Generally diagnosed by long lasting inflexible, pervasive traits, behaviours and thoughts which cause serious problems and impairment to the functioning of those affected. PDs are seen as traits that deviate from the expectations of the culture of the individual. Diagnosis takes time and gathering lots of history.
3
Q
What are the ICD-10 diagnostic guidelines for personality disorder?
A
Conditions not directly attributable to gross brain damage or disease or to another psychiatric disorder, meeting the following criteria:
- Markedly disharmonious attitudes and behaviour involving usually several areas of functioning e.g. affectivity, arousal, impulse control, ways of perceiving/thinking/style relating to others
- Abnormal behaviour pattern is enduring of long standing and not limited to episodes of mental illness
- Abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations
- The above manifestations always appear during childhood or adolescence and continue to adult
- Disorder leads to considerable personal distress but may only become apparent late in its course
- Disorder is usually, but not invariably, associated with significant problems in social and occupational settings
4
Q
What are the types of EUPD?
A
- Impulsive type
- Borderline type
5
Q
What are the causes of PD?
A
- Classic case of complex biological/psychological social factors
- Nature and nurture (epigenetics)
- Genetic predisposition
- Parents often have development disturbances, so patients are exposed to substance misuse, erratic parenting, marital discord, abuse
- Childhood trauma
- Possible brain injury/cognitive dysfunction
6
Q
What is the treatment for PD?
A
- Biological: treat co-morbidities
- Psychological: DBT (CBT + unstructured psychodynamic therapies) + balint groups (reflection groups for key workers)
- Social: support, structure and crisis management
7
Q
What is Dialectical Behavioural Therapy (DBT)?
A
- Developed for difficulties with treatment of PD e.g. EUPD
- DBT is not suicide prevention, it is trying to balance acceptance with change and build a life for yourself
- Promoting behavioural change
- Common initial targets include: thinking of suicide/SH, restricting meals, binging/purging, drug/alcohol abuse, risky sexual behaviour, reckless driving, physical aggression, shoplifting
- 3-4hr/week
8
Q
What is the WEIRD type of PD?
A
‘odd’ ‘eccentric’
- Paranoid (distrust, suspicious)
- Schizoid (detached emotionally, relationships)
- Schizotypal (magic, odd beliefs)
9
Q
What is the WILD type of PD?
A
‘dramatic’ ‘emotional’ ‘erratic’
- Antisocial (inconsiderate, legal issues)
- Borderline (unstable relationships/emotions, self-image, impulsive)
- Histronic (attention seeking/display lots of emotion)
- Narcissistic (big ego, need admiration, can’t handle criticism)
10
Q
What is the WORRIED type of PD?
A
‘anxious’ ‘fearful’
- Avoidant (inhibited, avoid situations, dependent, submissive, clingy)
- Obsessive Compulsive Personality Disorder (order, perfectionist, in control)
11
Q
What are the primitive defence mechanisms?
A
- Denial
- Regression (reversion to earlier stage of development)
- Acting out
- Projection
- Splitting (when person cannot tolerate that there are positive and negative aspects to everyone)
- Identification
- Projective identification
12
Q
What are less primitive defence mechanisms?
A
- Intellectualisation: overemphasis on thinking when confronted with unbearable emotion e.g. parents of terminal child seeking all possible fruitless medical procedures
- Rationalisation: e.g. after not getting into school you want saying “It was rubbish school anyway”
- Undoing: the attempt to take back an unconscious thought that is unacceptable e.g. after having lustful thoughts about someone, telling partner you love them
13
Q
What are mature defence mechanisms?
A
- Sublimation: channeling of unacceptable impulses, thoughts and emotions into more acceptable ones e.g. sport, humour, fantasy
- Compensation: understanding that you may not be good at one thing but are good at something else
- Assertiveness: respectfully expressing thoughts and emotions without being passive or aggressive
14
Q
How is psychotherapy used with defence mechanisms?
A
It aims to provide a safe, supportive but challenging relationship (attachment) in which people can learn to be more aware of when they are using less constructive mechanisms and develop mature ones.
15
Q
What aspects need to be covered in an overdose history?
A
- Intro, empathise with patient, reassure, confidentiality
- Explore events leading to overdose
- Exploration of signs and symptoms
- Exploration of alcohol use/symptoms of dependency
- Return to exploration of signs and symptoms
- Exploration of self-harm and overdose act
- RISK ASSESSMENT
- Exploration of psychotic symptoms
16
Q
What is the criteria for dependence syndrome?
A
3 of these together within a 12 month period:
- Craving of the substance
- Using the substance in preference of doing other things in your life (salience)
- Increasing tolerance to the substance
- Narrowing of your repertoire of substances used
- A feeling that you have lost control of your substance use
- Withdrawal symptoms
- Reinstatement after a period of abstinence despite knowing it is harmful
17
Q
What are the biological investigations for overdose?
A
ALWAYS compare to previous results for tests
- Full physical examination - self-harm scars, BP, HR, weight
- Bloods - FBC, LFTS (+ GGT), TFTs, U+E’s, paracetamol and salicylate levels
- Urine (MSU for infection and drug screen)
- ECG (check QTc interval as some antidepressants and antipsychotics can prolong this)
18
Q
What are the psychological investigations for overdose?
A
- MSE exam - insight (psychologically minded)
- Risk assessment
- Assess for dependence
19
Q
What are the social investigations for overdose?
A
- Gather more info from family/school/carers
- Might need long-term strategy to help them build up their attachments - allocation of care coordinator and use of CPA
20
Q
What are the symptoms of EUPD/BPD?
A
- Efforts to avoid renal or imagined abandonment
- Unstable interpersonal relationships which alternate between idealisation and devaluation
- Unstable self-image
- Impulsivity in potentially self-damaging area e.g. spending, sex, substance abuse
- Recurrent suicide behaviour
- Affective instability
- Chronic feelings of emptiness
- Difficulty controlling temper
- Quasi psychotic thoughts (resembling psychotic thoughts, but not psychotic level)
21
Q
What are the main management points for EUPD?
A
- Treat co-morbidities - anxiety/depression with antidepressants
- Develop a therapeutic relationship with the patient
- DBT (delivered by team of therapists, 1-to-1 sessions, psychoeducational groups and telephone support)
22
Q
What is the biological treatment for EUPD?
A
- Treat co-morbidities - anxiety/depression with antidepressants
- No psychiatric drug is specifically licensed for the management of EUPD, some can be used for individual symptoms etc
- Potential dietician/nutrition involvement if ED
- Paediatric patient - liaison with paediatric team to manage physical symptoms
23
Q
What is the psychological treatment for EUPD?
A
- Develop a therapeutic relationship with the patient
- CBT (anxiety, depression)
- DBT
- Family/carer therapy
- Exposure therapy for rituals
24
Q
What is the social treatment for EUPD?
A
- Close links with social services and care co-ordinator
- CPA
- Support at work/school/college
- OT
- Social groups (people with similar conditions)
25
What are the different factors to evaluate in a patient formulation?
- Predisposing the patient to suffer from these particular conditions
- Precipitated this particular deterioration at this particular time
- Perpetuation of the condition
26
What is a Care Programme Approach?
- Package of care used by secondary mental health services (CMHS, EIT, crisis tems) - care plan and co-ordinator
- All care plans must include a crisis plan
- CPA for those with wide range of needs from different services or high risk
- Carers can help with: medicines, therapy, physical health problems, money/housing, alcohol/drugs
- CPA will stop if the MH team believe you no longer need this level of support
27
What will the care co-ordinator arrange before the CPA ends?
- Assessment of your needs
- Handing over care to another professional - GP or psychiatrist
- Sharing info with professionals and carer if you want them to know
- Writing plans for review, support and follow-up if needed
- Telling you what to do and who to contact if health gets worse
28
How do you diagnose anorexia nervosa (AN)?
- Body weight 15% below expected
- Self-induced weight loss by avoidance of foods
- Body image distortion - overvalued idea of fear of fatness
- Endocrine disorder - amenorrhea in women
- Atypical ED: most but not all features of AN
29
What would signs/symptoms in a history would indicate ED?
- Intentional vs unintentional weight loss
- Exercise - extreme amount
- Hiding food intake amount
- Vomit/making self vomit after food
- Laxative medication
- Binging or purging
- Regularly weighing self
- Amenorrhea
30
What are the physical complications of eating disorders?
- CV: low BP/HR, HF, anaemia
- GI: constipation
- Skin: lanugo hair, bruising, thin skin, cold extremities
- Renal: kidney stones, kidney failure, electrolyte imbalance
- MSK: reduced muscle mass, osteoporosis, restricted growth
- Gyanecological: irregular/absent periods, subfertility
31
What are the differential diagnoses for weight loss?
- Organic causes e.g. malignancy, thyroid dysfunction, coeliac disease
- Mood disorder e.g. depression
- OCD
- ED e.g. anorexia nervosa, atypical ED
- ASD
- Personality disorder
32
What are the differential diagnoses for weight loss?
- Organic causes e.g. malignancy, thyroid dysfunction, coeliac disease
- Mood disorder e.g. depression
- OCD
- ED e.g. anorexia nervosa, atypical ED
- ASD
- Personality disorder
