PERSONALITY DISORDERS/SOMATIC/PSYCHOTIC

Question 1

What is a personality trait?

Answer 1

Repetitive pattern or perceiving, relating to, and thinking about the environment and oneself

If a person has one or two components of a disorder that is effecting their life

Question 2

What is a personality disorder?

Answer 2

Inflexible, maladaptive manner by which the world is viewed, which originates in adolescence

Must have 5 out of the 9 components of the disorder

Question 3

Are personality disorders easy to diagnose?

Answer 3

NO – patient is unaware of their condition and often feel persecuted by society as a result (aka ego-syntonic).

BUT ALWAYS RULE OUT A MEDICAL CONDITION (even r/o drug use like bath salts)

Question 4

Is there really any way to treat personality disorders?

Answer 4

No; meds can be used for symptoms (not the actual disorder); also behavioral therapy for borderline personality disorder

Question 5

At what age can you diagnose a borderline disorder?

Answer 5

Age 18

Question 6

If a person seems to lack trust, believing the motives of others are malicious. This person makes a mountain out of a mole hole and will cause character assassination (resulting in extreme suspicion) – what type of personality disorder do they have?

Answer 6

Paranoid

Question 7

If a person lives alone and is constantly starting lawsuits & persecutions of the other tenants - what type of personality disorder do they have?

Answer 7

Scan their brain! Personality disorders are present by age 20 (and get less as they age)

Question 8

If a person has complete absence of emotional dependence on other people (AKA a blunted affect), with no desire to make friends; and no outside interest, and may come across as very hard to read – what type of personality disorder do they have?

Answer 8

Schizoid type

Question 9

A patient works as a night watchman, doesn’t interact with others, and ignores all invites from coworkers. They go to work, come home and repeat every day. Along with eat the same thing everyday - what type of personality disorder do they have?

Answer 9

Schizoid

Question 10

If a person has to rely on what they “feel” is right or that they are “seers” and may be highly intuitive – what type of personality disorder do they have?

Answer 10

Schizotypal

Question 11

What can schizotypal personality disorder lead to?

Answer 11

Schizophrenia

Question 12

If a person feels the need to be the center of attention, very dramatic, and are easily swayed by fads, overly trusting, and my interact in inappropriate sexual manners (AKA act very seducing) – what type of personality disorder do they have?

Answer 12

Histrionic

Question 13

A 30 year old woman is detained by police after becoming highly disruptive while getting in an argument with her husband. She is provocatively dressed and is known by friends as being difficult to work with - what type of personality disorder do they have?

Answer 13

Histrionic

Question 14

If a person believe in their superiority, views themselves as a glory seeker, or that they better than you. They often get incredibly jealous. – what type of personality disorder do they have?

Answer 14

Narcissistic

Question 15

Is it easy to treat a narcissist?

Answer 15

Nope

Question 16

What type of personality disorder involves being very unstable in self-image and interpersonal relationships. They believe relationships are polarized (black & white) and can fill their feelings of emptiness with sex or drugs. They often fluctuate wildly (happy and sad) and appear to be bipolar?

Answer 16

Borderline

Question 17

If a patient is a cutter for therapeutic relief of the pain in their head’s - what type of personality disorder do they have?

Answer 17

Borderline

Question 18

How do you treat borderline disorder?

Answer 18

Dialectical behavioral therapy (a form of cognitive therapy)

Question 19

If a patient has no respect for position with very little regard for the feelings of others, responsibility (always someone else’s fault), and participate in unlawful activities and lack remorse for those – what type of personality disorder do they have?

Answer 19

Antisocial

Question 20

If a patient burns animal, or scams the elderly out of their money and they feel no remorse - what type of personality disorder do they have?

Answer 20

Antisocial

Question 21

If a patient appears to be easily hurt if they feel you are criticizing or disapprove of them. They want friends, or would like to go to the party but are terrified to deal with something that will occur (thus they interact with others as little as possible) – what type of personality disorder do they have?

Answer 21

Avoidant

Question 22

If a patient has difficulty making decisions, overly reliant on others. They feel the need to be cared for and when their significant other leaves they have separation anxiety – what type of personality disorder do they have?

Answer 22

Dependent

Question 23

If a patient is very focused on details, strive for perfection, preoccupation with details, rules, lists, and organization. They are often inflexible – what type of personality disorder do they have?

Answer 23

Obsessive Compulsive

Question 24

How do you treat personality disorders?

Answer 24

Cognitive behavioral therapy (can you medication therapy as an adjunct)

Question 25

What personality disorders fall is Cluster C – Anxious?

Answer 25

Avoidant, dependent, OCD

Question 26

What personality disorders fall is Cluster B – Moody?

Answer 26

Historionic, borderline, antisocial, and narcissistic

Question 27

What personality disorders fall is Cluster A – Odd?

Answer 27

Paranoid, schizoid, and schizotypal

Question 28

If a person is extremely anxious and they have diarrhea – what is it?

Answer 28

Psychosomatic disorder

Question 29

What’s it called when the doctor is reminded of his ex-wife with the patient and therefore treats them poorly?

Answer 29

countertransference

Question 30

If a patient has one or more organ systems that they complain of constantly (months to years), and therefore see multiple doctors for (lots of meds and possibly multiple surgeries)?

Answer 30

Somatic symptom disorder

Question 31

If a patient ALWAYS seems to have a variety of different disorders, they doctor shop, and “have a checkerboard abdomen” and want serious medical evaluation despite medical evidence for the need, what diagnosis?

Answer 31

illness anxiety disorder (hypochondriasis)

Question 32

If a patient got a call that their son died and now have paralysis or blindness – what diagnosis?

Answer 32

Conversion disorder

Question 33

What is different about somatic disorders & some diagnostic clues?

Answer 33

Complaints are dramatic and CHANGING; history is vague; peculiar indifference to significant medical complains; PE & labs are inconsistent The patient is NOT faking this (appear as an unconscious stressor)

Question 34

If a patient IS faking complaints, with intent for secondary gain (money, time off work, etc). They are often non-compliant with treatment – what diagnosis?

Answer 34

Malingering

Question 35

If a patient likes to assume the sick role to get medical attention; for PRIMARY gain (often falls into the Boy Who Cried Wolf)– what diagnosis?

Answer 35

Factitious disorder (Munchausen or Munchausen syndrome by proxy [done to a child or elderly])

Question 36

If a patient has gross impairments in the ability to assess reality, and behave coherently – what diagnosis?

Answer 36

Psychosis

Question 37

Who needs to be referred to a psychiatrist in order to control them acutely and is then often maintained in the PCP setting?

Answer 37

Psychosis

Question 38

What’s the major diagnosis of psychosis? How do you diagnosis it?

Answer 38

Schizophrenia For 6+ months; must have 2 or more sxs (delusions, hallucinations, disorganized speech, catatonic behavior, or negative symptoms – diminished emotional expression, avolition – no social interests) PLUS postmorbid decline (occupational, social, or self-care AKA it HAS to affect your daily life)

Question 39

Do you have to have hallucinations to diagnose schizophrenia?

Answer 39

Nope

Question 40

What should you DDX include with visual hallucinations?

Answer 40

Picks, lewy body dementia, frontal tumor, schizophrenia, or autism

Question 41

What should we remember about how schizophrenia presents?

Answer 41

They are fine throughout their early life in their late teens to 20’s then they develop – Disintegration

Question 42

How do you compare the diagnosis timeline of schizophrenia; schizophreniform; and brief psychotic disorder?

Answer 42

>6 months = schizophrenia Schizophreniform disorder: 1 month to 6 months Brief psychotic disorder: 1 day to 1 month

Question 43

If a patient has mania, hypomania, depression, or mixed states that is separated by 2 week period with the absence of mood symptoms and just psychotic symptoms?

Answer 43

Schizoaffective Disorder

Question 44

If a patient has delusions about plausible events such as being persecuted, having serious illness, or having a secret relationship with another person BUT functioning in society is NOT impaired – what diagnosis?

Answer 44

Delusional disorder