1- Mental health conditions (Personality disorders) Flashcards
define personality
individual differences in characteristic patterns of thinking, feeling and behaving
factors shaping personality
- Biological
o Genes: temperament, physical appearance/characteristics, IQ, disability - Psychological
o Early attachment and environment
o Sibling
o Peer relationships
o Schooling
o Traumas (loss, life events) - Social
o Socioeconomic status
o War/peace
o Social media
o Culture
o Climate
o Immigration
RF for PD
Prevalence of PD
- 4-13%
- 20% of GP attendees who are adults suffer from PD
- Most prevalent
o Dissociative
o Histrionic
o Paranoid
PD clusters
MAD BAD SAD
features of PD
3 Ps
- Persistent
- Problematic
- Pervasive
define PD
Conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others
or
A deeply ingrained and enduring pattern of inner experience and behaviour that deviates markedly from expectations in the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment
personality types
- 10 diff types, usually groups around 3 clusters: A, B, C
- Common to have more than 1 types of personality disorder
- People may present with traits of one type rather than the full disorder
- Scoring high on severity and across different types is a sign of increasing complexity
Cluster A PD
paranoid
schizoid
schizotypal
paranoid
present as suspicious and mistrustful, misinterpreting events as persecutory, bearing grudges, strong sense of personal right
schizoid
present as detached, solitary, aloof, little interest in people and sex, indifferent, lacking close friends
schizotypal
present as eccentric, odd behaviour and thinking, unconventional beliefs
cluster B PD
Borderline (EUPD)
Narcissistic
Antisocial/dissocial
Histrionic
borderline
(emotionally unstable personality disorder)- presents with emotional instability, impulsivity, parasuicidal acts, chronic feelings of emptiness, intense and unstable relationships, fear of abandonment
narcissistic
presents as grandiose, self-important, degrading others
antisocial/dissocial
presents with unconcern for the feelings of others, disregard for rules, impulsivity, low tolerance to frustration, failure to take responsibility (criminals)
histrionic
- presents as theatrical, dramatic, exhibit superficial emotionality, seductiveness, suggestibility
cluster C PD
Anankastic
Dependent
Anxious-avoidant
anakastic
obsessive compulsive- present as rigid, stubborn, perfectionistic, preoccupied with rules, order and routine, have a higher sense of morality
dependent
needing others to make decisions for them, fear abandonment, unable to cope alone, need reassurance
anxious avoidant
presents with persistent anxiety, sensitive to rejection, tend to avoid relationships unless acceptance is guaranteed
diagnosis/ investigations for PD
1) history
2) MSE
3) Risk assessment
4) Investigations
history
- ‘Are you ever concerned about other people in your life?’, ‘Can you rely on friends and
- ‘How do you think your friends and family would describe your personality?’
- (open question)
family?’, ‘How do you view your relationship with family?’ (paranoid) - ‘Do you work well with others?’, ‘What activities do you enjoy?’, ‘Would you say you have many close friends?’ (schizoid)
- ‘How would you describe your relationships with the people in your life?’, ‘Do other people ever say you have a temper?’, ‘Do you ever feel life is not worth living?’, ‘Do you have any worries about being alone?’ (emotionally unstable)
- ‘Have you ever got into serious trouble, for instance with the police? If so, was it your fault?’, ‘Do people ever tell you that you have a temper?’, ‘Do you like to think things through properly before carrying out an act?’ (dissocial)
- ‘Do you feel that you are easily influenced by your friends?’, ‘Do you like to be the life and soul of a party?’ (histrionic)
- ‘Is there anything you worry about or fear?’, ‘Do you struggle to make an important decision?’, ‘Place yourself on a scale ranging from very shy to confident.’ (dependent)
- ‘Tell me about your social circle’, ‘Do you ever take risks or partake in brand new activities?’, ‘Do you feel contented with yourself?’ (anxious)
- ‘Do you feel that you are a perfectionist?’, ‘Do you spend more time working or relaxing?’, ‘Do you find you are struggling to meet deadlines at work?’ (anankastic)
- A reliable collateral history is imperative: to determine the course of the symptoms, as well as identifying characteristic features which the patient may not have disclosed.
Risk assessment
suicide
self harm- esp EUPD
risk to others
investigations for PD
a. Questionnaires e.g. personality diagnostic questionnaire, Eysneck personality questionnaire
b. Psychological testing e.g. Minnesota multiphasic personality inventory (MMPI)
c. CT head/MRI – frontal lobe tumour
Differentials for PD
- Mood disorders: Mania, depression.
- Psychotic disorders: Schizophrenia, schizoaffective disorder.
- Substance misuse.
management of PD general
- Co-morbid psychiatric illness and substance misuse are common in patients with PD. Their recognition and treatment are essential.
- Risk assessment is crucial, particularly in cases of emotionally unstable PD, where patients may be suicidal. Potential stressors that induce crises should be identified and reduced.
- Several psychosocial interventions exist in the treatment of PD.
- Pharmacological management will not resolve the PD, but may be used to control symptoms. Low-dose antipsychotics for ideas of reference, impulsivity
and intense anger. Antidepressants may be useful in emotionally unstable personality disorder. Mood stabilizers can also be given. All of these are off-licence indications for prescribing. - Give the patient a written crisis plan. At times of crisis, if dangerous and violent or if there is a suicide risk consider the Crisis Resolution Team and detention under the Mental Health Act.
- The management of people with PDs can be outlined using the bio-psychosocial approach
Borderline personality disorder
A personality disorder characterized by severe mood swings, impulsive behaviour, and difficulty forming stable personal relationships.
pathophysiology theories for BPD
- Attachment in childhood ‘attachment theory’: the emotional bond between parent and child is crucially important for child survival. Experience of a consistent and responsive caregiver in childhood gives a person the sense that the world is safe and they are lovable.
- Attachment in adults: repeated experiences of care and affection help babies interact with the world in a trusting and flexible way, gives them a model of relating, increases their confidence and their capacity to tolerate and resolve conflict
- Watch Still face experiment - mother is playing with baby with lots of different interaction and expression. Then she pulls a very neutral face and doesn’t react to mother for 2 mins. Baby becomes very upset and is confused
- When babies have an experience of a world which is unsafe and abusive, they may grow up to become adults who cannot trust others. They do not have the necessary brain connections and chemicals to help them manage their feelings which tend to overwhelm them
presentation of BPD
o Abandonment fear
o Mood instability
o Suicidal/ self harm- VERY COMMON
o Unstable relationships
o Intense relationships
o Control of anger poor
o Impulsivity
o Disturbed sense of self
o Emptiness
example features of all PD
which PD is this patient likely to have
- Borderline personality disorder/ emotionally unstable personality disorder
