Personality/Somatoform/Psychotic DO Lecture Flashcards by Cassidy Ruocco

an enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself

Personality trait

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a pervasive, inflexible, maladaptive manner by which the world is viewed, which originates in adolescence or earlier (some even cite from the first 2 years of life!), and alters how the patient views the world

Personality disorder

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Dysfunctional characteristics of a person’s personality that are incongruent with social norms

Personality disorder

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With this type of psychiatric diagnosis, there is conflict betwen the person and the world

*these pts are aware of their condition

ie..a depressed person realizes he/she is depressed

Ego-dystonic

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With this type of personality disorder,
there is no conflict between the person and the way they view the world

*they rarely see difficulty with how they act and rarely seek help. they therefore tend to have maladaptive lives riddled with legal and psychosocial dysfunction

Ego-syntonic

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Individuals with this type of personality disorder…

are “unaware” of their condition and ofteen feel perscuted by society as a result of this

Ego-syntonic

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There are 10 personality disorders that are broken up into _____ clusters

*must have 5 of 9 traits to have disorder

three clusters! (A, B, C)

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“weird, wacky, odd/eccentric”

Paranoid
Schizoid
Schizotypal

..what cluster?

Cluster A

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“Dramatic, emotional, erratic, wild”

Antisocial
Borderline
Histrionic
Narcissistic

..what cluster?

Cluster B

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“Anxious, fearful, worried”

Dependent
Obsessive-Compulsive
Avoidant

what cluster?

Cluster C

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This disorder is marked by intense distrust due to assuming the motives of others are malicious

Because of the preoccupation with unjustified doubts, a person with this disorder may perceive even an innocuous interaction as a character assassination.

The result of this is extreme suspicion and strained interpersonal relationships and the ability to interact becomes stilted.

Paranoid

(part of Cluster A personality D/O)

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Blunted affect (expressionless) associated with feelings of detachment

*desire relationships to be distant, often choose to be solitary

do NOT show much emotion, they are often perceived as emotionally cold

Schizoid

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Think of the night watchman: Happy being alone, do not want friends and wont think anything of not having friends, seem emotionally cold

“Goes to work comes home goes to work comes home… same thing everyday”

Schizoid

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Inability to interact with others due to discomfort, which arises from the actual act of having to interact (NOT due to negative self image)

*they may also demonstrate cognitive distortions, odd speaking patterns, and experience strange perceptual occurrences influencing their behavior

(magical thinkers, link to schizophrenia D/O)

Schizotypal

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“GET FACT”

*G**rudges help for long periods of time
*E**xploitation expected (without a sufficient basis)
*T**rustworthiness of others doubted
*F**idelity of sexual partner question
*A**ttacks on character are perceived
*C**onfides in others rarely, if at all
*T**hreatening meanings read into events

Paranoid Personality Disorder

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“SIR SAFE”

*S**olitary lifestyle
*I**ndifferent to praise or criticism
*R**elationships of no interest
*S**exual experiences not of interest
*A**ctivities not enjoyed
*F**riends lacking
*E**motionally cold and detached

Schizoid Personality Disorder

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“UFO AIDER”

*U**nusual perceptions
*F**riendless except for family
*O**dd beliefs, thinking and speech
*A**ffect- inappropriate, constricted
*I**deas of reference
*D**oubts others- suspicious
*E**ccentric appearance/behavior
*R**eluctant in social situations, anxious

Schizotypal Personality D/O

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Paranoid, Schizoid and Schizotypal are all what cluster of personality DOs?

Cluster A

(they are strange)

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Antisocial
Borderline
Histrionic
Narcissistic

..what cluster of personality DOs?

Cluster B

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pervasive pattern of disregard for and violation of the rights of others.

Very impulsive and show disregard for the safety and welfare of others and of themselves. They fail to conform to social norms, participate in unlawful activities, and lack remorse for those they have wronged.

MC= Men, Diagnosis @18y

Antisocial

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instability in self-image and interpersonal relationships.

Impulsivity may lead to self-harm, such as drug abuse and promiscuous sex, and relationships are often polarized (black-white, love-hate) such that a pattern of extreme valuation-devaluation is expressed.
This can lead to efforts to avoid real or imagined abandonment and feelings of emptiness.

MC= Women; Cutting, 18

Borderline

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What type of personality D/O….

Young woman who cuts herself or harms herself but is not trying to actually kill herself

*Commit acts for attention, not trying to kill self

Borderline

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emotionality and attention seeking behavior is expressed, and are not happy unless they are the center of attention.

In order to gain attention, they often are swayed by fads, become overly trusting, and even may interact in inappropriately sexual manners.

Displays of emotion are often theatrical and overly dramatic, yet are superficial and can change immediately

Histrionic

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prone to grandiose fantasies, with the need for admiration.

Generally lacking empathy, these people are arrogant and feel a sense of entitlement.

They expect others to acknowledge their supposed superiority and feel overly jealous when others receive praise.

Narcissist

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Avoidant Dependent Obsessive-Compulsive ..what cluster of personality DOs?

Cluster C

**They want friends**, **but do not know how to obtain them** \*dysfunction in ability to act interpersonally _due to discomfort._ They have self-inadequacy (compare to schizoid). Because of their fear of shame, ridicule, or rejection, they choose to interact with others as little as they possibly can. New activities are rarely attempted and new relationships are seldom formed. **MC in Women, related to abuse**

Avoidant

**excessively clingy and have a pervasive need to be cared for** They are prone to experience separation anxiety, and _jump from relationship to relationship when one ends._ They have trouble making everyday decisions on their own, and they go out of their way to make sure others have responsibility to make major decisions. MC in Women

Dependent

**inflexible and rigid strive for perfection (“Type A Personality; “Anal-Retentive”);** rigidity is to the point that projects and tasks cannot be completed on time because they are not perfect enough. The preoccupation with details, rules, lists, and organization can be very invasive to the point that it affects interpersonal functioning.

Obsessive-compulsive

Are there FDA approved medications to treat any personalty DOs?

What is largely the mainstay of treatment for personality disorders?

Psychotherapy

relationship between psychological events and physical health has been recognized for a long time, but the precise nature of this relationship is unclear

Psychosomatic theory

Something internally (ie depression) causes something physical/externally to happen (ie migraine, diarrhea)

Psychosomatic problems

Mental disorders characterized by physical symptoms but without physical cause **symptoms NOT intentionally produced (unconscious)** More common in women ie.. Somatic symptom D/O, Illness anxiety D/O, Conversion D/O

Somatoform disorders

Variety of complaints in one or more organ system(s) lasting for months to years **Associated wth excessive, peristent thoughts about symptoms** May co-occur with medical conditions

Somatic symptom disorder

Preoccupatin with and **fear of having a serious medical illness** despite medical evidence and reassurance to the contrary **\*\*often have CHECKERBOARD abdomen from so many surgeries\*** Need to make these ppl feel understood but also rationalize how insurance will only pay for so much

Illness anxiety disorder (hypochondriasis)

Sudden loss of sensory or motor function (paralysis, blindness, mutism,etc) often **following an acute stressor** patient is **aware of but sometimes indifferent** to the symptoms **\*\*LA BELLE INDIFFERENCE** More common in females, young adults, adolescents

Conversion disorder

A condition in which a person is unconcerned with symptoms **caused by a conversion disorder** \*inappropriate lack of emotion or concern

La Belle Indifference

Presenting complaints may be: **dramatic, multiple, peculiar** Can have extreme anxiety or profound lack of anxiety **History often vague and complex**. multiple past work ups with inconclusive findings **Lab studies are often inconsistent** with medical complaints

Diagnostic clues to **somatoform disorders**

What is the difference between a **somatoform D/O** vs. **malingering and factious D/O**?

Somatoform= unconscious, NOT intentional Malingering and factious disorder= CONSCIOUS! there is incentive for this person

The intentional/conscious production of false or grossly exaggerated physical or psychological symptoms that is **motivated by _external incentives_**

Malingering

"Faking" or exaggerated symptoms to obtain a specific **secondary gain** \*POOR compliance! Complaints cease after gain

Malingering

Involves the intentional/conscious production or feigning of physical or psychological illness based primary upond a **desire to assume the _sick role_ and get medical attention**, not as a response to external incentives \***INVOLVES _PRIMARY_ GAIN**

Factitious disorder

Which intentional/conscious decision to fake or exaggerate and illness is for **primary gain?** which one is for **secondary gain?**

Primary gain= Factitious disorder (medical attention) Secondary gain= Malingering (ie financial gain)

Munchausen syndrome and Munchausen syndrome by proxy are examples of?

Factitious disorders

Chronic factitious disorder with predominantly physical signs and symptoms, characterized by a history of multiple hospital stays and willingness to receive invasive procedures

Munchausen Syndrome

When illness in a child or elderly patient is caused by the caregiver Motivation is to assume the sick role by proxy

Munchausen syndrome by proxy (this is a form of child/elder abuse\*)

Which 2 of the following are psychiatric disorders: Malingering Factitious Disorder Somatization

Factitious and Somatization are psychiatric disorders (Malingering is NOT)

Which 2 of the following are deliberate and conscious decisions? Malingering Factitious Disorder Somatization

Malingering Factitious D/O (Somatization is NOT deliberate)

Syndrome characterized by gross impairments in the ability to assess reality, and behave coherently

Psychosis

Defined if 1 or more of the following is present: Hallucinations Delusions Disorganized speech Disorganized behavior Disorganized motor behavior Negative symptoms

Psychosis

Cognitive disorders, such as delirium and dementia Mood disorders Autistic disorder Psychotic disorders ...all of these disorders incorporate \_\_\_\_\_\_\_

psychosis

sensory impressions that occur without external stimulation of the relevant sensory organ

Hallucinations

fixed, false beliefs even in the presence of evidence to the contrary. The beliefs are firmly held and do not waver.

delusions

Diminished emotional expression and avolution are examples of..

negative symptoms (seen with psychosis)

Presenting complaints of auditory and/;or visual hallucinations, bizarre beliefs, unusual suspiciousness, change in social behavior, marked decrease in motivation or self-care, and peculiar behaviors or mannerisms physical exam often unremarkable

Psychosis

Mental status examination shows hallucinations, delusions, disorganized speech or behavior, peculiar psychomotor activity

Psychosis

Disorder characterized by psychosis and disintegration of abilities to think logically and maintain normal social behavior ## Footnote **pts have both positive and negtive symptoms (plus other sxs)**

Schizophrenia

Examples of **positive** symptoms seen in schizophrenia

Hallucinations Delusions

Examples of **negative** symptoms seen in schizophrenia?

* *Affectal blunting** (decreased intenstiy of emotional response) * *Avolition** (decreased motivation to do purposeful activities) * *Alogia** (lack of speech) * *Social withdrawal**

Examples of **disorganized sxs** in schizophrenia?

Illogical/incoherent speech Aimless or pecuilar motor behavior

Examples of **cognitive sxs** in schizophrenia?

Impaired attention Impaired ability to plan, organize, sequence activity Impaired memory

Depressed mood Substance abuse Sleep disturbances

Other symptoms associated with schizophrenia

Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms: decreased emotional expression, avolition ...how many of these are required for a schizophrenia dx?

2 or more

Post morbid decline (ie..occupation, social, self care) 6+ month duration

Other requirements for a schizophrenia dx

Serotonin and dopamine antagonists (SDAs), aka atypical antipsychotics, are **first line treatment** for?

Schizophrenia (Clozapine is second line because it can cause agranulocytosis)

Typical neuroleptic and antipsychotic meds with dopamine antagonist activity (haloperidol, chlorpromazine, thioridazine, loxapine, flupheazine) are best for the management of _______ symptoms in schizophrenia

positive!

Second generation antipsychotics or atypical neuroleptics with SDA activity (risperidone, paliperidone, asenapine, olanzapine, aripiprazole, ziprasidone, quetiapine) are generally used in the treatment of _________ symptoms in schizophrenia

negative

For a schizophrenia dx, the symptoms must last longer than...

6 months

Schizophreniform disorder has virtually the same symptoms as schizophrenia but has a different timeline what is the timeline for schizophreniform?

1 month to 6 months

What is the timeline for brief psychotic disorder (which has pretty much the same symptoms as schizophrenia)

1 day to 1 month

A disorder with baseline psychosis with inter-episode mood symptoms, with at least a 2 week period with the absence of mood symptoms and just psychotic symptoms

Schizoaffective disorder

Baseline psychosis with mixed episodes of mood symptoms, with a 2 week period that is just psychotic symptoms

Schizoaffective disorder

This disorder meets the criteria for major depressive episode, manic episode, or mixed episode, during which criteria for schizophrenia are also met **there is a mixture of psychotic and mood symptoms** **\*\***delusions or hallucinations lasting for 2 weeks without mood disorder symptoms help to differentiate\*\*\*

Schizoaffective disorder

Disorder involving delusions about plausible events, such as being persecuted, having a serious illness, or having a secret relationship with another person often not overly bizarre thought process generally organized **functioning is NOT markedly impaired**

Delusional disorder

Present to clinical attention when: Anxiety overtakes them about their delusion Discovery by a relative, friend or found upon medical examination Threats or illegal activity related to delusion

Delusional disorder

* *Erotomanic** (belief another person is in love with the pt) * *Somatic** (delusions of a physical defect or medical condition) * *Jealous** (delusions of sexual partner's infidelity) * *Persecutory** (delusion of mistreatment or persecution) * *Grandiose** (inflated self worth, power, knowledge)

Subtypes of Delusional Disorder (tx= same as schizophrenia)

Alcohol Illicit drugs Medications (anticholinergics, antidepressants, hallucinogens, psychostimulants) CNS disease Endocrinopathies Vitamin deficiency HIV/AIDS SLE ..can all cause?

psychotic disorders

Paranoid Disorganized Catatonic Undifferentiated Residual

Types of schizophrenia

MC type of schizophrenia?

Paranoid schizophrenia

Rare subtype of schizophrenia Must have at least 2 of the following: Extreme negativism or mutism Motor immobility Excess motor activity without purpose Pecuilary voluntary movement (bizarre posture, "waxy flexibility") Echolalia Echopraxia

Catatonic schizophrenia

Good pre-morbid functioning Later age at onset Acute onset Obvious precipitating factors Presence of positive symptoms

**more favorable prognosis** of schizophrenia

3 phases of schizophrenia?

1. prodromal phase 2. psychotic phase 3. residual phase

Precedes first psychotic break by month or years subtle behavioral changes, functional decline, social withdrawal, irritability

Prodromal phase of schizophrenia

What phase of schizphrenia... Delusions, hallucinations, disorganized speech, bizarre behavior, thoughts and content

Psychotic phase

What phase of schizphrenia.. Occurs between psychotic episodes Blunted affect, odd thinking/behavior and other negative symptoms

Residual phase

Personality/Somatoform/Psychotic DO Lecture Flashcards

(85 cards)