What is the community presence of personality disorders?
What is the prison presence of personality disorders?
Does personality disorder have a genetic or environmental aetiology?
Thought to have both
Name some factors that are thought to cause personality disorder (PD)
1) May be due to neurodevelopmental disorders (possibly within the autistic spectrum)
2) Minimal brain damage (maybe associated with EEG changes)
3) Low levels of serotonin (SSRIs can help in some pts)
What is thought to cause borderline PD?
Early adverse social circumstances (physical, sexual or mental abuse) preventing progression through the stages of psychosexual development.
When does your personality become personality disorder?
When traits are persistently inflexible and maladaptive to an extent that it causes personal distress.
What is unusual in the way that PD pts present?
They do not regard their behaviour and coping style as abnormal and therefore will not present with that as their primary complaint. Instead they usually present with a wide range of problems e.g. self harm, depression, anxiety, violence, PTSD, disorderly conduct etc
What % of pts with a psychotic disorder also have PD?
What are the two broadest groups of PD?
1) Acquired PD. Due to brain damage or disease, generally in the frontal lobe. (also pts who have PD from catastrophic event e.g. hostage situation).
2) PD with no obvious cause.
What are the characteristic traits of acquired PD?
1) Sexual inhibition
2) Abnormalities of emotional expression
When does PD (not with an obvious cause) usually develop? (describe the course)
Adolescence or early adulthood (with a steady course)
What are the three main clusters of PD?
Cluster A: ‘odd or eccentric’
Cluster B: ‘dramatic, emotional, erratic’
Cluster C: ‘anxious or fearful’
What are the subtypes in cluster A PD pts?
What are the subtypes in cluster B PD pts?
What are the subtypes in cluster C PD pts?
3) Obsessive compulsive
How generally should PD be managed?
By the MDT using a biopsychosocial approach (still debated exactly how it should be managed)
What medications can be used in PD? (and what are the indications?)
1) Mood stabilisers
Which cluster of PD pts have a higher risk of suicide/ accidental death?
What is the relationship between pts with PD and other psychiatric diagnoses?
Patients with personality disorders often have other psychiatric conditions.
These tend to have a more severe and worse prognosis than if the personality disorder were not present
What is a particular risk with schizotypal PD pts?
They may go on to develop schizophrenia.
Which PD disorders can get better over time and why?
Antisocial PDs may improve with time, particularly if they have formed a relationship with a therapist.
Which PD disorders tend to be stable over time?
Obsessive compulsive PD.
What are somatoform disorders?
Mental disorders with features suggestive of a physical illness but with no detectable cause
BUT the symptoms are NOT under voluntary control (unlike factitious and malingering disorders).
What are the most common somatoform disorders?
1) Somatisation disorder
2) Hypochondrial disorder
What is somatisation disorder?
The main features are multiple, recurrent, frequently changing physical symptoms.
Patients should have numerous symptoms from almost all of the systemic groups, not just a few isolated symptoms.
Give some examples of symptoms common in somatisation disorder.
1) GI disturbances – nausea, vomiting etc
2) Skin problems – itching, burning, numbness etc
3) Sexual or reproductive problems – loss of libido, erectile dysfunction etc
4) Urinary problems – dysuria, frequency, retention, incontinence
5) Neurological problems – paralysis, visual loss, sensory loss etc.
What is the ICD-10 classification of somatisation disorder?
1) At least 2 years of symptoms with no adequate physical explanation found
2) Persistent refusal by the patient to accept reassurance from several doctors that there is no physical cause for the symptoms
3) Some degree of functional impairment due to the symptoms and resulting behaviour
Explain the difference between hypochondrial disorder and somatisation disorder.
In somatisation disorder patients express concern about numerous physical symptoms,
whereas in hypochondrial disorder patients misinterpret normal bodily sensations
and believe that they have a serious and progressive physical disease.
What is the difference in the goals of hypochondrial disorder and somatisation disorder when contacting medical services?
Patients with hypochondrial disorder may ask for investigations to definitely diagnose a specific disease
whereas patients with somatisation disorder will ask for treatment to remove their symptoms
What is body dysmorphic disorder?
A variant of hypochondrial disorder where patients excessively imagine or accentuate a slight defect in their appearance.
What is the new name for Munchausen’s syndrome?
What is the difference between malingering and factitious disorder?
In malingering pts want the secondary external gain of being diagnosed with a disease.
In factitious disorder pts the care seeking behaviour is often a sign of psychological distress.
What is the prevalence of somatisation disorder?
0.2-2% lifetime prevalence
What is the most common period of life to be diagnosed with somatisation disorder?
Usual onset before 25, often in adolescence.
Which gender is somatisation disorder most common in and what is the ratio?
F:M = 10:1
What is the prevalence of hypochondrial disorder?
1-5% lifetime prevalence
What is the most common period of life to be diagnosed with hypochondrial disorder?
Which gender is hypochondrial disorder most common in?
The same in M + F
What is the best management stratergy for pts with malingering and factitious disorders?
Make appointments at fixed intervals rather than seeing patients when requested
Explain what paranoid PD is.
1) Suspecting others of hurting/deceiving them
2) Doubt spouses fidelity.
Explain what schizoid PD is.
1) Emotional coldness
2) Does not desire or enjoy relationships
3) Takes pleasure in few activities
4) Indifferent to praise or criticism.
Explain what schizotypal PD is.
1) Eccentric behaviour
2) odd beliefs or magical thinking
3) social withdrawal
4) unusual perceptual experiences, ideas of reference, circumstantial thinking.
Explain what borderline PD is.
1) Unstable, intense relationships fluctuating between extremes of idealization and devaluation.
2) Unstable self image
3) impulsive (sex, binge eating, substance abuse, spending money)
4) repetitive suicidal or self-harming behaviour
5) efforts to avoid abandonment.
Explain what antisocial PD is.
1) Repeated unlawful or aggressive behaviour
2) deceitfulness, lying
3) reckless, irresponsible
4) lack of remorse or incapacity to experience guilt.
Explain what histrionic PD is.
1) Dramatic, exaggerated expressions of emotion
2) attention seeking seductive behaviour
3) labile shallow emotions.
Explain what narcissistic PD is.
1) Grandiose sense of self-importance
2) need for admiration.
Explain what dependant PD is.
1) Excessive need to be cared for
3) need others to assume responsibility for major life areas
4) fear of separation.
Explain what avoidant PD is.
1) Hypersensitivity to critical remarks or rejection
2) Fears of inadequacy
3) Inhibited in social situations.
Explain what obsessive complusive PD is.
1) Preoccupation with orderliness, perfectionism and control
2) Devoted to work at expense of leisure
3) pedantic, rigid and stubborn
4) Overly cautious.
What are antipsychotics used to treat in PD?
help with: 1) psychotic symptoms
What are antidepressants used to treat in PD?
have general effects in reducing:
What are mood stabalisers used to treat in PD?
3) mood instability