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Y4 Psychiatry > 5 - Personality Disorders > Flashcards

5 - Personality Disorders Flashcards

1
Q

When doing a psychiatric exam what is important to think about?

A

Why has this person got this disorder at this time?

Positive AND Negative symptoms

Could this be organic?

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2
Q

What hallucinations can LSD give people?

A

Visual!! Think organic cause or LSD if visual hallucinations

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3
Q

What is a personality and what shapes a personality?

A

Individual differences in characteristics thinking, feeling and behaving

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4
Q

What is a personality disorder?

A

An individual differs significantly from the average person in terms of how they think, feel, perceive and relate to others

Maladaptive pattens of behaviour, cognition and inner experience exhibited across a wide range of contexts and deviated largely from those accepted by the individual’s culture

They develop early, are persistent and cause significant distress

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5
Q

What are some of the aetiologies of personality disorders?

A
  • Childhood development – insecure childhood attachments, childhood trauma, inconsistent parenting
  • Genetic
  • Psychodynamic theories – maladaptive or primitive defence mechanisms
  • Cognitive-behavioural theories – development of maladaptive core beliefs derived from early experiences
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6
Q

What are some characteristics of having a personality disorder? (3 P’s)

A

1 Markedly disharmonious attitudes and behaviour, involving usually several areas of functioning, eg affectivity, arousal, impulse control, relationships

2 Prevailing, chronic, abnormal behaviour patterns, not limited to discrete episodes

3 Present in a broad range of personal and social situations

4 Start before 18 years old and continue into adulthood

5 Personal distress caused by these patterns of behaviour

6 Associated with significant problems in occupational and social performance

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7
Q

People have traits of a personality disorder, when does this become a ‘disorder’?

A

When it interferes with normal everyday functioning

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8
Q

What are the three clusters of personality disorder?

A

Mad, Bad and Sad

Group A: Odd or Eccentric (Paranoid, Schizoid, Schizotypal)

Group B: Dramatic or Emotional (Dissocial, Emotionally Unstable, Narcissistic, Histrionic)

Group C: Anxious or Avoidant (Anankastic, Anxious, Dependent)

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9
Q

What are Group A personality disorders and how do they present?

A

Paranoid

  • Irrational suspicion and mistrust of others (no delusions)
  • Hypersensitive to criticism
  • Reluctant to confide and preoccupied with perceived conspiracies against themselves

Schizoid

  • Lack of interest in others, apathy and a lack emotional breadth
  • Have few friends, do not form relationships, prefer solitary activities

Schizotypal

  • Eccentric odd behaviours
  • Unconventional beliefs
  • Can go on to develop Schizophrenia
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10
Q

Emotionally unstable is a Group B personality disorder. What are the two types and the characteristics of these?

A

More common in females

Often outburst of emotion and inability to control these emotions

Borderline: Feeling of ‘emptiness’, unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self-harm/suicide, impulsivity, pseudohallucinations, fear of abandonment

Impulsive: Inability to control anger or plan, unpredictable affect and behaviour

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11
Q

Dissocial (Antisocial) is another Group B personality disorder. How does it present?

A
  • Disregard for social obligations, and unconcern for the feelings of others
  • Behaviour not readily by adverse experience, including punishment
  • Low tolerance to frustration and discharge of aggression, including violence
  • Tendency to blame others or offer plausible rationalizations for the behaviour
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12
Q

Apart from Emotionally stable (Borderline) and Antisocial, what are the other personality disorders in Group B and how do they present?

A

Narcissistic:

  • Grandiose, need for admiration of others and a lack of empathy
  • Has sense of entitlement and will take advantage of others to achieve own wants
  • Arrogant and preoccupied by their own fantasies and desires

Histrionic:

  • Over-dramatize
  • Self-centred
  • Shallow affect/Superficial emotionality
  • Labile mood
  • Seeks attention and excitement
  • Manipulative behaviour
  • Seductive
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13
Q

What are Group C personality disorders and how do they present?

A

Anankastic (Obsessive Compulsive)

  • No intrusive thoughts or ritual, obsessions are pleasurable
  • Rigid, stubborn, perfectionism
  • Preoccupied with rules

Anxious (Avoidant)

  • Persistent anxiety self-conscious, insecure
  • Fearful of negative evaluation by others
  • Desires to be liked

Dependent

  • Feels helpless when not in relationship
  • Fear of abandonment
  • Need for reassurance
  • Need others to make decisions for them
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14
Q

What is the ICD-10 diagnostic criteria for dissocial personality disorders?

A

Needs 3 of:

  1. callous unconcern for the feelings of others
  2. gross and persistent attitude of irresponsibility and disregard for social rules
  3. incapacity to maintain relationships, though no difficulty in establishing them
  4. very low tolerance to frustration and aggression
  5. incapacity to experience guilt and to profit from experience, particularly punishment
  6. marked proneness to blame others, or to offer plausible rationalizations, for the behaviour
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15
Q

What is the prognosis with personality disorders?

A
  • Risk of suicide
  • Issues with interpersonal relationships
  • May switch from one disorder to another e.g B to C
  • Prevalence declines with age as older adults tend to be less impulsive and aggressive or may get better at hiding traits
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16
Q

What questionnaire can you use for personality disorders?

A

PDQ-4

17
Q

How do personality disorders develop?

A
  • Genetics
  • Environment (early parenting, attachment trauma, loss)
18
Q

Which personality disorder are more likely to self-harm and why?

A

Borderline Personality Disorder

Coping strategy for overwhelming emotions

19
Q

What is the Hamilton Boundary Seesaw model?

A
20
Q

How can we manage personality disorders?

A

Disruption in attachment so need to restore attachment

  • Boundaries
  • Help manage crises
  • Treat comorbid conditions e.g depression, substance abuse, harm minimisation
  • Group interventions
  • Dialectical behavioural therapy (DBT): individual and group therapy using mindfulness, CBT and Eastern philosophy
  • No role for medication unless co-morbid condition
  • Reflective practice MDT
21
Q

How can we manage self-harm in BPD?

A
  • Harm minimisation e.g elastic bands
  • Treatment contract: patient has obligation to get self-harm medically attended to and staff have obligation to be non-critical when treating
22
Q

How can you set boundaries with someone with BPD?

A
  • Clear in explaining expectations of a service
  • Consistent and reliable in doing what they say they are going to do
23
Q

What children are at risk of developing conduct (antisocial) disorders so need to be monitored by CAHMS?

A
  • Parents with other mental health problems, or with significant drug or alcohol problems
  • Mothers younger than 18 years, particularly those with a history of maltreatment in childhood
  • Parents with a history of residential care
  • Parents with significant previous or current contact with the criminal justice system.
24
Q

How prevalent are personality disorders?

A

1 in 20 people have them

25
Q

What is the Lang’s three system model?

A

Used to describe anxiety disorders

Fear -→ Arousal (Physiological) and Avoidance (Behavioural)

26
Q

What is the Clark model?

A

Model of panic

27
Q

What are the three characteristic cluster symptoms of PTSD?

A
  • Reexperiencing
  • Avoidance
  • Hyperarousal

ALWAYS EXPLORE PAST PSYCHIATRIC HISTORY

28
Q

What are some secondary psychological disorders that can develop from PTSD?

A
  • Depression
  • Substance misuse
  • Panic disorder
  • Somatisation
  • Other anxiety disorder
29
Q

What is the best treatment for PTSD?

A

Psychological

Trauma-focused CBT or EMDR, or CPT, or NET

30
Q

What type of trauma leads to the development of personality disorders?

A

Repeated complex trauma!!! Poor attachment

Isolated trauma usually leads to PTSD

31
Q

What factors do you need to consider before giving NAC treatment for a paracetamol OD?

A
  • Amount taken (paracetamol blood test)
  • Staggered OD?
  • Any other drugs or alcohol taken?
32
Q

If someone takes an OD what questions can you ask to determine the level of suicidality?

A
  • Ask the patient their intentions
  • Ask how long this was planned for or whether it was impulsive
  • Preparations put in place for the suicide attempt – e.g. stockpiling medications
  • Final acts - e.g writing a will, arranging care of dependants/pets
  • Help seeking – did they seek help proactively?
  • History of suicidal acts.
  • Do they have any feelings of regret?
  • Were they intoxicated?
  • How do you about the future?
  • Do you feel relieved you didn’t die?
33
Q
A
  • Intense and unstable relationships
  • Unclear sense of identity
  • Impulsivity
  • Unpredictable affect
  • Thoughts, threats or acts of self harm
  • Unpredictability
34
Q

What is DASH?

A

DASH (Domestic abuse, stalking and Honour based violence risk assessment model) which may lead to a referral to MARAC (Multi Agency Risk Assessment Conference)

35
Q
A

Conduct disorder

36
Q
A
  • Lack of remorse/guilt for what has happened
  • Lack of concern for the feelings of Jake/staff
  • Low tolerance for frustration
37
Q

Should personality disorders be treated as inpatients?

A

NO

Only use in crisis or for brief pre-determined time period

Admit as voluntary patient not under the MHA

38
Q
A
39
Q
A

Y4 Psychiatry (17 decks)

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