Personality disorders (diagnosis and management)

Question 1

What is personality?

Answer 1

A cluster of relatively predictable patterns of thinking, feeling and behaving that is generally consistent across time, space and context

Question 2

What are the components of the 5 factors model of personality?

Answer 2

OCEAN; 
Openness 
Conscientiousness
Extraversion 
Agreeableness 
Neuroticism

Question 3

What is a personality disorder according to ICD10?

Answer 3

Individuals characteristic and enduring patterns of inner experience and behaviour deviate markedly as a whole from the culturally expected and accepted range
PERVASIVE behaviour that is inflexible, maladaptive or dysfunctional
Personal distress and/or adverse impact on the social environment

Question 4

What are personality disorders manifested in?

Answer 4

Cognition
Affectivity
Impulse control
Interpersonal functioning

Question 5

At what age can you diagnose a personality disorder?

Answer 5

18

Question 6

What differentiates personality traits from personality disorders?

Answer 6

Only a disorder IF;
Pervasive
Causes distress
Cause impairment of functioning in most areas

Question 7

What rating scales are used in personality disorder diagnosis?

Answer 7

Zanarini Rating Scale for BPD
Personality Assessment Schedule
Personality Disorder Questionnaire
Minnesota multiphasic personality inventory
Borderline personality questionnaire
International personality disorder examination (IPDE)

Question 8

What proportion of the general population have a personality disorder?

Answer 8

10.6%

Question 9

Cluster A personality disorders?

Answer 9

Paranoid
Schizoid
Schizotypal

Question 10

Cluster B personality disorders?

Answer 10

Antisocial
Emotionally unstable; impulsive or borderline
Histrionic
Narcissistic

Question 11

Cluster C personality disorders?

Answer 11

Avoidant
Dependent
Obsessive-Compulsive

Question 12

Differences between ICD10 and DSM5 in terms of personality disorder classification?

Answer 12

Narcissistic and schizotypal NOT present in ICD10

Question 13

Diagnostic criteria for paranoid personality disorder?

Answer 13

4 of:
Excessive sensitivity to setbacks
Tendency to bear grudges
Suspicious and tendency to misconstrue the neutral/ friendly actions of others as hostile/ contemptuous
Combative and tenacious sense of personal rights out of keeping with actual situation
Recurrent suspicious, without justification, regarding sexual fidelity of partner
Persistent self-referential attitude, associated particularly with excessive self-importance
Preoccupation with unsubstantiated conspiratorial explanations of events in the world at large

Question 14

Diagnostic criteria for schizoid personality disorder?

Answer 14

4 of:
Few activities provide pleasure
Emotional coldness, detachment, or flattened affectivity
Limited capacity to express warm feelings for others as well as anger
Indifferent to either praise or criticism of others
Little interest in having sexual experiences with another person
Almost always chooses solitary activities
Excessive preoccupation with fantasy/ introspection
Neither desired not has any close friends or confiding relationships
Marked insensitivity to prevailing social norms

Question 15

Diagnostic criteria for schizotypal personality disorder?

Answer 15

5 or more of:
Ideas of reference
Odd beliefs or magical thinking inconsistent with subcultural norms
Unusual perceptual experiences, including bodily illusions
Odd thinking and speech (vague, circumstantial, metaphorical, elaborate or stereotyped)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behaviour or appearance that is odd, eccentric or peculiar
Lack of close friends or confidants other than 1st degree relatives
Excessive social anxiety

Question 16

Diagnostic criteria for dissocial personality disorder?

Answer 16

3 of:
Callous unconcern for feelings of others
Irresponsible and disregard for social norms/ rules/ obligations
Incapacity to maintain enduring relationships, though no difficulty to establish them
Very low tolerance to frustration and low threshold for aggression/ violence
Incapacity to experience guilt, or to profit from adverse experience, particularly punishment
Marked proneness to blame others

Question 17

Is dissocial personality disorder the same as psychopathy?

Answer 17

NO

Question 18

Diagnostic criteria for impulsive emotionally unstable personality disorder?

Answer 18

3 of;
Tendency to act unexpectedly, without consideration of consequences
Quarrelsome behaviour and conflicts with others, especially when impulsive acts are thwarted/ criticized
Liability to outbursts of anger or violence
Difficulty in maintaining any course of action that offers no immediate reward
Unstable mood

Question 19

Diagnostic criteria for borderline emotionally unstable personality disorder?

Answer 19

Meets criteria for impulsive PLUS 2 of;
Disturbances in and uncertainty about self-image, aims and internal preferences
Intense and unstable relationships; leading to emotional crises
Excessive efforts to avoid abandonment
Recurrent threats or acts of self-harm
Chronic feelings of emptiness

Question 20

Diagnostic criteria for histrionic personality disorder?

Answer 20

4 of:
self-dramatization, theatricality or exaggerated expression of emotions
Suggestilbe
Shallow/ labile affectivity
Continually seeks excitement and activities in which the subject is centre of attention
Inappropriately seductive in appearance or behaviour
Overly concerned with physical attractiveness

Question 21

Diagnostic criteria for narcissistic personality disorder?

Answer 21

5 of:
Grandiose logic of self-importance
Fixation with fantasies of infinite success, control, brilliance, beauty of idyllic love
A credence that he/she is extraordinary and exceptional and can only be understood by, or should connect with, other extraordinary or important people
Desire for unwanted admiration
Sense of entiltement
Interpersonally oppressive behaviour
No form of empathy
Resentment of others
Display of egotistical and conceited behaviour

Question 22

Diagnostic criteria for anankastic (OCD) personality disorder?

Answer 22

4 of:
Excessive doubt and caution
Preoccupation with details, rules, lists, order, organization or schedule
Perfectionim that interferes with task completion
Excessive conscientiousness
Undue preoccupation with productivity to the exclusion of pleasure/ interpersonal relationships
Pedantic, excessive adherence to social conventions
Rigidity and stubbornness
Unreasonable insistence that others submit to exactly his or her way of doing things

Question 23

Diagnostic critera for anxious personality disorder?

Answer 23

4 of:
Persistent pervasive feelings of tension/ apprehension
Belief that oneself is socially inept/ inferior to others
Excessive preoccupation about being criticized/ rejected in social situations
Unwillingness to get involved with people unless certain of being liked
Restrictions in lifestyle because of need to security
Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection

Question 24

Diagnostic criteria for dependent personality disorder?

Answer 24

Encouranging or allowing others to make most of one’s important life decisions
Subordination of one’s own needs to those of others on whom one is dependent, and undue compliance with their wishes
Unwillingness to make even reasonable demands on the people one depends on
Feeling uncomfortable or helpless when alone
Preoccupation with fears of being left to take care of oneself
Limited capacity to make everyday decisions without an excessive amount of advice/ reassurance

Question 25

Is there good quality evidence for treatment of personality disorders?

Answer 25

No; treat co-morbidities

Question 26

Is pharmacological treatment of personality disorders recommended?

Answer 26

No; not recommended by NICe or licenced

Question 27

In what personality disorders can antipsychotics be used?

Answer 27

Paranoid, schizoid and schizotypal
Reduce suspiciousness
Borderline; if paranoid or hearing voices

Question 28

What antipsychotics are used in personality disorders?

Answer 28

Quetiapine
Olanzapine
Haloperidol

Question 29

When are ADs used in personality disorders?

Answer 29

Mood and emotional difficulties in cluster B (dissocial, emotionally unstable, histrionic and narcissistic)
Can help impulsivity and aggression in borderline and dissocial
Reduce anxiety in cluster C (anankastic, avoidant and dependent)

Question 30

When are mood stabilisers used in personality disorders?

Answer 30

Unstable mood and impulsivity in people with emotionally unstable or borderline personality diisorders

Question 31

What mood stabilizer is used in personality disorders?

Answer 31

Lamotrigine

Question 32

When and what will BZD are used in PDs?

Answer 32

Short term sedative as part of a larger care plan
Diazepam
Zopiclone (sleep)

Question 33

Specific treatment for avoidant personality disorder?

Answer 33

Social skills training

Evidence for ADs

Question 34

What psychological treatment is used in emotionally unstable personality disorders?

Answer 34

Dialectical Behavioural Therapy (DBT)

Question 35

Goal of DBT?

Answer 35

Learning to accept and regulate emotions

Balance between self acceptance and making positive changes in life

Question 36

How long does DBT last?

Answer 36

6 months - 1 year

Question 37

4 principles of DBT?

Answer 37

Mindfulness
Regulation of emotions
Distress tolerance
Interpersonal effectiveness

Question 38

Goal of mentalization based therapy?

Answer 38

To better understand and control your impulses, emotions and behaviours and improve relationships

Question 39

What is STEPPS?

Answer 39

CBT based skills training programme
Focus on stabilisation
20 weeks; includes homework

Question 40

When should you consider inpatient care in those with personality disorders?

Answer 40

Management of an acute increased suicide risk
Changes to medication cannot be managed in community
Clarification and treatment of comorbid diagnosis

Question 41

Which medications have an evidence base for treatment of EUPD?

Answer 41

Lamotrigine
Topiramate; anger and aggression
ADs
Olanzapine and haloperidol