Troubles de la personnalité

Question 1

Cluster A

Critères TP Paranoïaque?

Answer 1

Nécessite 4/7 (“MENACES”):

1. Menaces/significations cachées perçues
2. Epouse infidèle (doute sur)
3. Ne pardonne pas (rancunier)
4. Attaques perçues et réactions promptes
5. Confidences craintes
6. Exploité/trompé (s’attend à)
7. Suspicieux vs loyauté des proches/amis

Question 2

Which of the following is correct?
1.
PD diagnosis is more strongly negatively related to quality of life than any other variable
2.
Etiology of personality disorder is primarily environmental with minimal genetic heritability
3.
Avoidant, schizotypal and borderline personality disorder, have the least functional impairment of all PD’s
4.
PD diagnosis are stable over time

Answer 2

1

Question 3

Cluster A

Critères TP Schizoïde?

Answer 3

Nécessite 4/7 (“DISTANT”):

1. Détachement de l’affect/froideur
2. Indifférent aux éloges/critiques
3. Sexe (pas d’intérêt)
4. Tâches/activités solitaires
5. Absence d’amis proches
6. Ne désire pas/n’aime pas relations
7. “Tente pas” –> peu de plaisir/intérêt pour activités

Question 4

Cluster A

Critères TP Schizotypique?

Answer 4

Nécessite 5/9 (“SCHIIZZOO”):
1. Social le rend anxieux
2. Comportement ou aspect bizarre/excentrique
3. Hallucinations quasi (perceptions inhabituelles)
4. Idées de référence
5. Idées persécutoires
6. biZarres croyances/pensée magique
7. biZarre pensée et langage
8. O affect
9. O amis

Question 5

Cluster B

Critères TP Antisociale?

Answer 5

Nécessite 3/7 (“CRIMINE11”) :
1. Conformité aux règles absente
2. Responsabilité 0
3. Impulsivité
4. Mépris de la sécurité
5. Irritabilité/agressivité
6. No remords
7. Escroqueries/tromperies/mensonges

18 ans minimum
15 ans (trouble des conduites avant cet âge)

Question 6

Cluster B

Critères TP Limite?

Answer 6

Nécessite 5/9 (“SVICIDAIR”):
1. Suicidaire (gestes/menaces/idées/automutilation)
2. Vide chronique
3. Interpersonnel instable/intense
4. Colère incontrôlée
5. Identité instable
6. Dissociation ou idéation persécutoire
7. Abandon réel/imaginé (efforts pour éviter)
8. Impulsivité dommageable (au moins 2 domaines)
9. Réactivité marquée de l’humeur et instabilité affective

Question 7

Cluster B

Critères TP Histrionique?

Answer 7

Nécessite 5/8 (“ACTRISSS”):
1. Apparence utilisée pour attirer l’attention
2. Centre de l’attention (mal à l’aise si ne l’est pas)
3. Théatral
4. Relations plus intimes qu’en réalité
5. Influençable/suggestible
6. Séduction/provocation inadaptée
7. Superficiel et changeant dans expression émotionnelle
8. Subjectif mais pauvre en détail dans façon de parler

Question 8

Cluster B

Critères TP Narcissique?

Answer 8

Nécessite 5/9 (“GRENDIOSE”):
1. Grandiose (sens de sa propre importance)
2. Relations utilitaires/exploite l’autre
3. Envieux des autres et croit être envié
4. Narguer (arrogant/hautain)
5. Dû (tout lui est)
6. Idéal (fantaisies de succès illimité, pouvoir, splendeur, etc.)
7. Observé (besoin excessif d’être admiré)
8. Spécial/unique et compris seulement par des gens spéciaux
9. Empathie = manque

Question 9

Cluster C

Critères TP Évitante?

Answer 9

Nécessite 4/7 (“S’INHIBE”):
1. S‘implique avec autrui seulement si certain d’être aimé
2. Intimité réservée car craint honte/ridicule
3. No risque personnel/nouvelles activités car crainte de l’embarras
4. Hauteur (ne se sent pas à) donc inhibé dans situation interpersonnelles
5. Inférieur aux autres/sans attrait/socialement incompétent (se voit comme)
6. Boycotté (craint d’être critiqué ou rejeté) dans situations sociales
7. Evite activités sociales professionnelles par crainte d’être critiqué/désapprouvé/rejeté

Question 10

Cluster C

Critères TP Dépendante?

Answer 10

Nécessite 5/8 (“DR IDA a des DRS”):
1. Décision difficile sans être rassuré/conseillé de façon excessive
2. Responsabilités doivent être assumées par autrui
3. Initiative absente si seul
4. Désaccord avec autrui impossible à exprimer par peur de perdre soutien
5. Autonomie effrayante : préoccupé de manière irréaliste à l’idée de se débrouiller seul
6. Désagréable (endure volontairement) pour obtenir soutien/appui
7. Relation recherchée de manière urgente lorsqu’une se termine
8. Seul = se sent impuissant/mal à l’aise par crainte exagérée d’être incapable de se débrouiller

Question 11

Cluster C

Critères TP Obsessionnelle-Compulsive?

Answer 11

Nécessite 4/8 (“PARFAITE”):
1. Perfectionnisme qui entrave achèvement des tâches
2. Accumule objets/incapable débarasser même sans valeur sentimentale
3. Rigide/têtu
4. Focus sur détails/règles/organisation jusqu’à perdre de vue but de l’activité
5. Avare pour soi et autrui
6. Investit travail/productivité de façon excessive
7. Travaille seul (réticence à déléguer) ou à sa manière
8. Éthique/morale trop rigide

Question 12

En lien avec TP schizoid : which of the following is most likely to be correct
a)
It is unusual that MrT has not sought treatment for his difficulties before now.
b)
MrT possibly has family members who have schizophrenia or who are introverted
c)
MrT’s diagnosis is most likely schizophrenia given that he has psychotic symptoms
d)
MrT’s social isolation is likely due to persistent depressive disorder and he would benefit from a day hospital program

Answer 12

b

Question 13

When developing a course of treatment pour Schizotypique, which of the following statements are correct?
A.
There is 30% chance that Ms R will develop schizophrenia
B.
Psychodynamic psychotherapy is contraindicated
C.
Ms R will likely improve with time, with symptoms improving more than function
D.
Effective treatment will need to involve actively interpreting Ms R’s odd beliefs and magical thinking

Answer 13

c

Question 14

In your treatment of MR avec TP parano which of the following statements is most correct
A.
It will be important to patiently challenge each of MrM’s attacks of you and others
B.
It is helpful to remember that MrM was likely to have been an eccentric child with poor peer relationships
C.
Any degree of paranoia is pathological
D.
MrM’s attacks/criticism of others are likely motivated by an underlying belief that he is superior to others

Answer 14

b

Question 15

In psychodynamic therapy witha TP dependant , which of the following is true?
a.
To prevent boundary crossings it is important from the start of treatment to consistently refuse requests for extra sessions
b.
Idealization of the therapist is concerning and likely to result in regression outside of therapy
c.
Dependent transference must be addressed in a way that promotes emotional growth
d.
The therapist needs to be aware of and actively resist the development of dependent transference

Answer 15

c

Question 16

In your treatment withTP évitant which of the following is most correct:
a)
SSRI’s are indicated for management of MrS’s fears of intimacy
b)
MrS’s maladaptive avoidance has likely developed as a defense against shame, embarrassment and failure
c)
Psychodynamic psychotherapy is more effective than CBT for avoidant personality disorder
d)
As regular social contact with others is likely unattainable for MrS it is not a goal of treatment.

Answer 16

b

Question 17

When planning treatment for Ms TPOC which of the following approaches is most correct
1.
Offer MsM psychodynamic therapy or CBT, emphasize that CBT may be better than psychodynamic psychotherapy
2.
Highlight that perfectionism, orderliness, need for control likely developed as a response to parental neglect and inadequacy
3.
Goals of therapy include MsM’s ability to see her perfectionism as resulting from the belief that she is superior to others and a recognition of her lack of empathy for others
4.
DSM 5 Section II requires that the preoccupation with details, rules, lists, order, organization, schedules occur to the extent that the major point of the activity is lost

Answer 17

4

Question 18

If you are considering a career working with people with BPD the MOST important thing you should do is:
a)
Run…hide…consider another career
b)
Learn mindfulness…go to a month long retreat (and then reconsider!)
c)
Learn a structured empirically based therapy
d)
Ensure that you have liberal access to support and consultation

Answer 18

d

Question 19

Effective psychotherapies for BPD include all of the following features except
a.
Adverse effects of self injurious behaviourare identified
b.
Therapist is quiet, distant and does not get too involved
c.
Focus of treatment is to establish connection between actions and feelings
d.
Therapists pay careful attention to, have access to consultation, in order to manage countertransference.
e.
Here and now focus

Answer 19

b

Question 20

*
In treatment of histrio mme which one of the following is correct
a.
Expect functional impairment will be similar to patients with BPD
b.
Use self disclosure, give advice regularly and monitor for idealization with eroticized transference.
c.
Limit expectations for response to psychodynamic psychotherapy
d.
Anticipate that symptoms will improve with time

Answer 20

d

Question 21

In the treatment of individuals with NPD which of the following is most correct
1.
The presence of narcissistic personality traits is an indicator of severe functional impairment
2.
In psychodynamic psychotherapy a positive therapeutic alliance develops quickly
3.
Therapists need to be careful not to limit expectations in order to avoid enhancing grandiosity
4.
Suicidalityin NPD can at times have a protective effect and at other times puts the individual at risk

Answer 21

4
*
Suicidalityin NPD:

NPD has elevated risk suicide, suicide attempts, high lethality suicide attempts.
“Vulnerable” subtype at highest risk Pincus2009, Ansell 2015

For some individuals SI and fantasies can serve a narcissistically useful function –helps the person to maintain a sense of control over unbearable feelings

Question 22

Enfant 13a difficultés dans plrs domaines ds les 3 derniers mois suite à séparation des parents. S’est fait arrêter (shoplifting) plrs fois, ment à école + aux parents, facilement irritabile, un peu truant, a été dans plrs batailles. Le dx le plus probable?
a)TP antisocial
b)Tr adaptation
c)Dépression
d)Tr opposition
e)Tr des conduites

Answer 22

Tr adaptation

Question 23

Personnalité à travers le temps / lifespan… Ce qui est vrai..
a)Traits restent stable
b)Devient + rigide avec le temps
c)MMPI nécessite différentes normes

Answer 23

A : Traits restent ‘‘RELATIVEMENT’’ stables

Question 24

Le MMPI *Minnesota Multiphasic Personality Inventory, lequel est V :
a)A une haute consistance interne
b)Est un test de personnalité projectif
c)Mesure introversion sociale
d)Mesure le QI

Answer 24

c)Mesure l’introversion social

Faible consistance interne, questionnaire OBJECTIF

Question 25

Lequel est Vrai p/r aux Tb personnalité chez les vieux ?
a)TP NS est l’un des tb mentaux les plus fréquent
b)USage de substance est parfois comorbide avec les TP
c)Sx empirent avec le temps
d)Plus fréquent que chez les populations plus jeunes

Answer 25

B)

Question 26

Lequel est V en lien avec TP chez les vieux?
a)Prévalence des TP restent idem
b)Sévérité des TP restent idem
c)Sx humeur comme colère et solitude restent idem
d)Sx reliés à impulsivité restent idem

Answer 26

c

Question 27

La conception classique de ‘‘character’’ n’est PAS réflété dans quel énoncé?
A)Character réfère au mode habituel de la personnalité à s’ajuster aux tensions internes & au monde externe
B)Dans les types de ‘‘character’’ sublimatory, l’énergie instinctive est maintenue ss contrôle par une mesure contre-cathectique qui forme en partie le trait
c)Caractère réactif se manifeste parfois en attitude d’évitement
d)Caractère réactif sont gnrlmt égosyntones car intimement lié aux processus de défenses
e)Traits de Caractère sublimatoire ne sont gnrlmt pas subdivisés davantage en ss types

Answer 27

B

Question 28

The best predictor of adult antisocial personality disorder is
A)Family discord
B)Childhood behavior
C)Loss or separation at an early age
D)Psychosocial deprivation
E)Absence of a father figure

Answer 28

b

Question 29

Common countertransference reactions to the patient with antisocial personality disorder include all of the following EXCEPT:
A) Therapeutic nihilism (condemnation)
B) Helplessness and guilt
C) Devaluation and loss of professional identity
D) Assumption of psychological complexity
E) Sexual infatuation

Answer 29

D

Question 30

Previous names for borderline personality disorder included all of the following
EXCEPT:
A)“As if” personality
B)Residual schizophrenia
C)Pseudoneurotic schizophrenia
D)Ambulatory schizophrenia psychotic character disorder

Answer 30

B

Question 31

Otto Kernberg notes which of the following as an indicator of poor prognosis in the psychoanalytic psychotherapy of borderline personality disorder?
A)Splitting
B)Projective identification
C)Antisocial features
D)Non specific ego weakness
E)Introspection

Answer 31

D
(NON SPECIFIED EGO WEAKNESS =represented
especially by a lack of anxiety tolerance , a lack
of impulse control , and a lack of developed
sublimatory channels.

Need modified approach of psychoanalysis
due to risk of severe acting out)

Question 32

According to Linehan, identify the best choice of therapeutic priorities (in decreasing order) in your interview when dealing with borderline personality patients, in the first phase of treatment.
patient arriving late
drug use by the patient
exaggerated expenses by the patient
the therapist considering the patient as fragile
suicidal thoughts of the patient

Answer 32

1.suicidal thoughts of the patient
2.patient arriving late
3.the therapist considering the patient as fragile
4.drug use by the patient
5.exaggerated expenses by the patient

Pyramide : Interférence avec VIE - Thérapie - QoL

Question 33

Narcissistic personality disorder is characterized by
A) Interpersonal exploitation
B) Impulsivity
C) Affective instability
D) Interpersonal instability
D) Efforts to avoid abandonment

Answer 33

A

Question 34

Which of the following is true regarding a person with avoidant personality
disorder?
A)They have no desire for social interaction
B)They are reluctant to get into relationships unless they are certain of beingliked
C)They have no empathy for others
D)They have chronic feelings of emptiness

Answer 34

b

Question 35

Which Type A personality characteristic is most associated with an increased
risk for cardiovascular disease?

Answer 35

Anger/hostility

Question 36

Which of the following features best distinguishes avoidant personality disorder
from dependent personality disorder?
A)Low self esteem
B)Fear of social embarrassment
C)Limited social relations
D)Self doubt

Answer 36

B

Question 37

3year old girl adopted from orphanage with poor conditions. Can’t seem to play appropriately when separated from parents, and when reunited, seems to want contact but also angry and not consolable. What type of attachment?
A)Normal response due to age
B)Secure attachment
C)Insecure - ambivalent
D)Insecure-disorganized

Answer 37

C

Question 38

Which attachment style most associated with dissociation?
A)Disorganized
B)Ambivalent
C)Anxious

Answer 38

A

Question 39

Patient with what sounds like bpd. What to do with family?
A. Set therapeutic boundaries
B. Tell them diagnosis
C. Tell them not to talk about self harm
D. Tell them medications are necessary

Answer 39

B

Question 40

Young man incarcerated for 18 months with history of ASPD behaviourand conduct disorder. Seen after incarceration by you. His explanation was they “got the wrong guy.’ Charming, upbeat, positive personality. Best therapy?
a. Group CBT
b. Mindfulness
c. individual Insight-oriented
d. group IPT

Answer 40

A

NICE guidelines discuss CBT in ASPDbut some studies have recommended against group therapy in people with the ASPD/NPD/CD cluster.