Personality Disorders + Schizophrenia

Question 1

Cluster A PDs

Answer 1

Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder

Question 2

Cluster B PDs

Answer 2

Borderline Personality Disorder
Narcissistic Personality Disorder
Histrionic Personality Disorder
Antisocial Personality Disorder

Question 3

Cluster C PDs

Answer 3

Avoidant Personality Disorder
Dependant Personality Disorder
Obsessive-Compulsive Personality Disorder

Question 4

Definition of PD

Answer 4

Chronic maladaptive behaviour + interpersonal problems
>2:
- cognition
- affectivity
- interpersonal function
- impulse control

Question 5

General management

Answer 5

Clearly establish limits such as appt length
Look for medical + psych diagnosis with new symptoms
Limit use of benzos
Reflect + acknowledge own emotional responses
Address behaviours in a direct but non-threatening manner, co-create realistic goals, establish and maintain boundaries, continue relationship unless there is a risk

Question 6

Sx management of anxiety, hostility + sensitivity

Answer 6

mesoridazine (phenothiazine)
haloperidol (APs)
thiothixene (APs)

Question 7

Sx of Paranoid

Answer 7

SUSPECT
Spousal infidelity
Unforgiving
Suspicious of others
Perceives attacks
Enemy
Confiding in others is feared
Threats perceived

Question 8

Sx of Schizoid

Answer 8

DISTANT
Detached
Indifferent
Sexual experiences of little interest
Tasks done alone
Absence of friends
Meither desires or enjoys relationships
Takes pleasure in few activities

Question 9

Sx of Schizotypal

Answer 9

ME PECULIAR
Magic thinking/ odd beliefs
Experiences unusual perceptions
Paranoid ideation
Eccentric behaviour
Constricted affect
Unusual thinking/ speech
Lacks close friends
Ideas of reference
Anxiety in social situations
R/O psychotic

Question 10

Sx of Antisocial

Answer 10

CORRUPT
Conforming to law lacking
Obligations ignored
Reckless disregard for safety
Remorseless
Underhanded
Planning insufficient
Temper

Question 11

Sx of Histrionic

Answer 11

ACTRESS
Appearance focused
Centre of attention
Theatrical
Relationships considered more intimate than they are
Easily influenced
Seductive behaviours
Shallow emotions
Speech (vague)

Question 12

Sx of Borderline

Answer 12

AM SUICIDE
Abandonment
Mood instability
Suicidal
Unstable/ intense relationships
Impulsivity
Control of anger
Identity disturbance
Dissociative
Emptiness

Question 13

Sx of Narcisstic

Answer 13

SPEEECIAL
Special
Preoccupied with fantasies
Envious
Entitlement
Excess admiration required
Conceited
Interpersonal exploitation
Arrogant
Lacks empathy

Question 14

Sz of Avoidant

Answer 14

AVOIDER
Avoids social type of work
Views self as inept
Occupied with fear or criticism
Inhibited in new relationships
Don’t get involved when uncertain of being liked
Embarrassment prevents new activities
Restraint within intimate relationships

Question 15

Sx of Dependent

Answer 15

RELIANCE
Reassurance required
Expressing disagreement difficult
Life responsibilities assumed by others
Initiating projects difficult
Alone
Nurturance - needs support
Companionship sought
Exaggerated fears of being left alone

Question 16

Sx Obsessive compulsive

Answer 16

OBSESSOR
Obsessed over details
Both miserly with self and others
Shows perfectionism that interferes with task completion
Excessively devoted to work
Super consciousness
Supervision required for delegated tasks
Object hoarder
Rigidity

Question 17

Ix for psychosis

Answer 17

Hemoglobin
White Blood Cell Count
Platelets
Creatinine
Fasting/Random Glucose
Blood Urea Nitrogen
Sodium
Potassium
Calcium
Albumin
Magnesium
TSH
AST
ALT
Alkaline Phosphotase
GGT
Vitamin B12
Ferritin
PTH
Urine Toxicology
Serum Toxicology
Fasting Lipids (if considering starting antipsychotic medications)

Question 18

DSM-V criteria schizophrenia

Answer 18

> 2 symptoms present for 1 month
- delusions
- hallucinations
- disorganized thinking/ speech
- negative symptoms
- disorganised or catatonic behaviour

Question 19

Complications of schizophrenia

Answer 19

Decreases lifespan by 15 years
Increased risk of CAD, DM, HTN, emphysema
Suicide risk
45% have SU disorder

Question 20

Ix of schizophrenia

Answer 20

CBC, lytes, renal, liver, TSH, FBG, lipids
Hepatitis, syphilis, HIV

Question 21

Monitoring for schizophrenia

Answer 21

Every 3 months
S+S
Functional impairment
Suicidal/ aggressive thoughts
SU
FBG, lipids, BMI + BP

Question 22

Management of schizophrenia

Answer 22

Family intervention
CBT offered to those that have not responded to AP
Social skills training
AP trial for min 2 weeks - once improvement seen, hold dose
Offer maintenance at lower dose for 2-5 years

Question 23

Ongoing management for schizophrenia

Answer 23

Positive + negative sx
Function + ADLs
Ideation of harm to self or others
Med compliance + SE
Substance use
Capacity
Psychosocial supports

Question 24

Approach to psychotic pts

Answer 24

Clearly communicate limits of confidentiality
Enquire about substance use
Ensure early treatment + FU
Determine if they meet criteria for involuntary treatment

Question 25

Sx control for lability, rejection, impulsivity, self-mutilation

Answer 25

SSRI

Question 26

Sx control for behavioural dyscontrol

Answer 26

carbamazepine

Question 27

Sx control for aggression

Answer 27

lithium

Question 28

Sx control for explosive behaviour

Answer 28

oxazepam

Question 29

1st episode of schizophrenia

Answer 29

2nd gen AP, maintain for 18mo, treat comorbid depression w/ SSRI, offer housing, family counselling, vocational rehab, financial support, admission, detox, referral to SW, check bHCG

Question 30

Negative sx of schizophrenia

Answer 30

flat affect, social withdrawal, anhedonia, avolition, poverty of speech

Question 31

Rx for NMS

Answer 31

stop offending med, IV NS, cooling blankets, ice packs, DVT prophylaxis

Question 32

Classes of meds to treat NMS

Answer 32

benzos for agitation, skeletal muscle relaxant (dantrolene), dopamine agonist (bromocriptine)