4 - PSY - Personality Disorders

Question 1

What is personality

Answer 1

set of consistent thoughts, feelings and behaviours across time in a variety of settings

Question 2

3 hallmarks of a problem caused by dysfunctional personality? - P’s

Answer 2

Pervasive - all/most areas of life
Persistent - evidence from adolescence continuing to adulthood
Pathological - causes distress to self or others - impairs function

Question 3

4 factors that may contribute to development of PD

Answer 3

Genetics - all 10 modest/moderate heritable
Childhood temperament - basic disposition to emotional response
Childhood experience - neglect, trauma, abuse as child has links to PD - PTSD is common co-morbidity
Neurochemical imbalance - may explain heritability

Question 4

You start suspecting a PD - 4 initial questions? and why?

Answer 4

1 - how long has this been a problem?
2 - what kind of person were you before this happened? recent/sudden change points away from PD
3 - How does this affect your relationships?
4 - How would your friends describe you? normally evident from relationships

Question 5

Common co-morbid conditions with PD - 5

Answer 5

Anxiety Disorder
Depression
PTSD
Substance and Alcohol misuse
Adjustment disorder/stress reaction

Question 6

What isn’t considered a PD in ICD10 but IS in DSM?

Answer 6

Schiotypal - ICD has schizophrenia, schizotypal and delusional disorders chapter
Narcissistic PD is not in ICD

Question 7

DSM Antisocial PD = ICD…?

Answer 7

Dissocial PD

Question 8

DSM Obsessive-Compulsive = ICD…?

Answer 8

Anankastic

Question 9

DSM Avoidant = ICD…?

Answer 9

Anxoius (Avoidant)

Question 10

8 main ICD PD’s

Answer 10

Paranoid
Schizoid
Dissocial
EUPD
Histrionic
Anankastic
Anxious (avoidant)
Dependent

Question 11

Paranoid PD features

Answer 11

Sensitive
Unforgiving
Suspicious
Possessive + jealous
Excess self importance
Conspiracy theories
Tenacious sense of rights
SUSPECT

Question 12

Schizoid features

Answer 12

ALL ALONE
Anhedonic, limited emotional range, little libido
Apparent indifference to praise/criticism
Lack of close relationships
One player activities
Normal social conventions ignored
Excess fantasy world

Question 13

Dissocial PD features

Answer 13

FIGHTS
Forms but can't maintain relationships
Irresponsible
Guiltless
Heartless
Temper easily lost
Someone else's fault

Question 14

EUPD common features

Answer 14

Affective instability
Explosive behaviours
Impulsive
Anger outbursts
Unable to plan or consider consequences

Question 15

Histrionic features

Answer 15

ACTORS
Attention seek
Concerned with own appearance
Theatrical
Open to suggestion
Racy and seductive
Shallow affect

Question 16

Anankastic features

Answer 16

DETAILED
Doubtful
Excess detail
Tasks not completed
Adheres to rules
Inflexible
Likes own way
Excludes pleasure + relationships
Dominated by intrusive thoughts

Question 17

Anxious/avoidant features

Answer 17

AFRAID
Avoids social contact
Fears rejection/criticism
Restricted lifestyle
Apprehensive
Inferiority
Doesn't get involved unless sure of acceptance

Question 18

Dependent PD features

Answer 18

SUFFER
Subordinate
Undemanding
Feels helpless when alone
Fears abandonment
Encourages others to take decisions
Reassurance needed

Question 19

Strategies to counter the difficulties of managing a PD patient

Answer 19

• clear boundaries
• be reliable and consistent
• know limits
• remember splitting (“best doctor!” - next day - “Worst doctor!”
• beware transference and counter-transference
• beware of “admission trap”

Question 20

Short term PD management

Answer 20

• first, think of ongoing risks
• history and consider co-morbidity
• risk assessment
• where is it safe to manage this patient?

Question 21

Main talking therapies for long term management?

Answer 21

CBT, DBT, CAT (analytical), therapeutic communities

Question 22

When might drug treatment be considered?

Answer 22

AP’s - transient psychotic experiences, reducing impulsivity and agitation
AD’s - co-morbidities - anxiety and depression
Mood stabilisers for unstable mood