Personality Disorders Flashcards
(24 cards)
What are personality traits?
enduring patterns of perception, thinking and relating to self and environment
What is a personality disorder?
persistently inflexible, maladaptive traits which are stable over time and cause significant personal distress or functional impairment
How do PD patients present?
a range of problems - self harm, depression, anxiety, violence, disorderly conduct, PTSD
may be concurrent with psychiatric illness - schizophrenia
diagnosis requires consistent features over time, which make it hard at time at crisis
concrete diagnosis is hard to achieve despite definitions
What should the assessment of PD focus on?
sources of distress comorbid mental illness specific impairments of functioning - work home social? education and work criminality relationships sexual behaviour
reliable collateral history is essential
What are the different categories of PD?
Acquired
Specific
Dimensional approach
Categorical approach (cluster A, B, C)
What is acquired PD?
Organic: insult e.g. brain damage or disease
i.e. frontal lobe lesion social disinhibition, behavioural changes
Or following a catastrophic event or the development of severe psych illnesses
What is specific PD?
Difficult to find any links between an insult and the PD, causation is possibly down to genetic and environmental factors.
Usually start in adolescence or early adulthood
What is the ‘dimensional approach’ classification of PD?
PD is part of a spectrum of behaviour that merges with normality – measured by personality inventories e.g. MMPI
What is the ‘categorical approach’ to classifying PD?
ICD-10, DSM-IV assume that there are distinct types of PD
Cluster A, B, C
What is the Cluster A PD?
“odd, eccentric”
Paranoid, schizoid or schizotypal
What is the Cluster B PD?
“dramatic, emotional, erratic”
Borderline (emotionally unstable), antisocial, histrionic, narcissistic
What is Cluster C PD?
“anxious, fearful”
Dependent, avoidant, obsessive-compulsive
How does PD effect people and their lives?
- Significantly increased mortality and physical/psychiatric morbidity
- Affects relationships
- Strong association between some types and healthcare and criminal justice service involvement
- M/F relatively equal, higher prevalence in 25-44 y/o.
- Prevalence in prison sample groups is 50-80%
- Cluster A is more common in relatives of schizotypal patients
- Adverse social circumstances are associated with cluster B
What is the general management for a PD patient?
- Gain an open trusting relationship with patient
- Take care to minis distress
- Crisis Mx Plan with patient, family, emergency care etc.
- short term meds or crisis or symptoms that can be medically treated
- psychological therapy to address and modify maladaptive traits
What psychological therapies can be used in PD?
o Dialectical behaviour therapy (DBT) o Mentalisation-based therapy (MBT) o CBT o Cognitive Analytical Therpay (CAT) for borderline PD o Therapeutic communities
What are the hallmarks of a problem caused by dysfunctional PD?
- Pervasive - occurs in all/most areas of life
- Persistent - evidence from adolescence and continues into adulthood
- Pathological - causes distress to self or others; impairs function (occupation/social/relationships)
Describe the aetiology of a PD?
Genetics
Childhood temperament - emotional difficulties in childhood may impact PD
Childhood experience - link between neglect, trauma and abuse in childhood and PD
Neurochemical imbalance - links between impulsive behaviour and serotonin have been noted
How is PD assessed in clinic?
History, MSE, physical exam, differential diagnosis, risk assessment, management plan
Ask questions about how long it has been a problem/how it affects relationships etc.
Screen for comorbidities - anxiety/depression/PTSD/sybstance misuse
How can you find out more about the type of PD?
Ask about:
o Religious belief/morals
o How do you deal with stress/pressure
o Hobbies/interest/favourite books/films
What is the short term management for a PD patient?
- Think about ongoing risks suicidal? Self harm? Overdose? Drugs/drink?
- Take history and consider comorbidity
- Risk assessment, the assess whether care is to be delivered as an outpatient/Inpatient
What is the long term management?
- Strategies CBT, Dialectical Behavioural Therapy (DBT), Cognitive Analytical Therapy (CAT), therapeutic communities
- Good engagement from patient is vital
- Social interventions may also be appropriate stigma, social inclusion activites, finance, housing
What should you be aware of when managing a PD patient?
- PD patients are challenging to manage and can provoke negative reactions in health care professionals
- Set clear boundaries
- Know your limits
- Beware of transference and counter transference
- Patients may need to take responsibility for their actions
- Beware of the admission trap can be counter productive, foster dependence and disempower indivduals from adopting safer coping strategies
What is the prognosis of PD?
- PD, particularly cluster B, are linked to a higher rate of suicide, as a result of impulsivity and emotional instability
- Cluster B tends to be less common with increasing age
How should medications be used in PD?
NICE do not recommend pharmacological treatment for PD
• Antipsychotics can be used to treat psychotic experiences, reduce impulsivity and agitiation
• Antidepressants for comorbid illnesses such as anxiety and depression
• Mood stabilisers for mood instability
