borderline personality disorder and schizophrenia

Question 1

Borderline personality disorder makor symptoms

Answer 1

Chronic feelings of emptiness

Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) - mood swings

Frantic efforts to avoid real or imagined abandonment

Instability in self image

Impulsive behaviour in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)

Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

Pattern of unstable and intense interpersonal relationships characterised by extremes between idealisation and devaluation (also known as “splitting”better or worse than)

Recurrent suicidal behaviour, gestures, or threats, or self-harming behaviour

Transient, stress-related paranoid ideation or severe dissociative symptoms.

Question 2

pattern of abrupt mood swing

Answer 2

borderline personality disorder

Question 3

self harm common and they cannot control their temper and general effect

Answer 3

borderline personality disorder

Question 4

BPD also called

Answer 4

Emotionally unstable personality disorder (EUPD)

Question 5

what is schizophrenia

Question 6

what are the difference between positive and negative symptoms

what are examples

Answer 6

positive symptoms are something adding to a normal person
negative symptoms are something being taken away from a normal person

Positive symptoms:
Auditory hallucination
Thought and speech disorders
Catatonia - abnormal movement
Incongruent affect

Negative symptoms:
Anhedonia - don’t enjoy stuff
Alogia - naturally quiet don’t say much
Avolition - inability to care for personal hygiene or participate in work or recreational activity
Blunting of affect

Question 7

what is psychosis

Answer 7

Psychosis is where you see or hear things that are not there (hallucinations) or believe things that are not true (delusions).

Question 8

what is schneiders first rank symptoms

Answer 8

The index test being evaluated in this review are Schneider’s First Rank Symptoms (FRS), which include: auditory hallucinations; thought withdrawal, insertion and interruption; thought broadcasting; somatic hallucinations; delusional perception; feelings or actions as made or influenced by external agents

Question 9

what is an hallucination

Answer 9

a sensory perception (auditory or visual) – e.g. hearing voices of celebrities

Question 10

what is a delusion

Answer 10

a flase belief contraindicated by reality (e.g. that you work for MI5)

Question 11

ILLUSION

Answer 11

,a distorted vision of reality (e.g. a man with two heads)

Question 12

when does EUPD manifest

Answer 12

early adulthood

Question 13

EUPD more common in

Answer 13

women

Question 14

risk factors for shcizophrenia

Answer 14

Family history
Traumatic events in childhood (e.g. poor maternal affection and bonding, poverty, exposure to natural disasters)
Heavy cannabis use in childhood
Maternal poor health (including malnutrition and infections such as rubella and cytomegalovirus)
Birth trauma (hypoxia and blood loss in particular)
Living in the city
Living in/emigrating to more developed countries

Question 15

diangosis made through what criteria

Answer 15

ICD-10 needs to be present for at least 1 month and be there most of the time

Question 16

what tests might you do to rule out schziphrenia

Answer 16

FTs (alcohol abuse)
Drug screen (amphetamines and cannabis)
Glucose (diabetes)
CT/MRI (look for trauma)
Thyroid function (hypothyroidism can have psychiatric sx)
Screen for HIV (causes mania)

differentials
Substance induced psychotic disorder (commonly drugs of abuse, but can be iatrogenic e.g. steroids)
Organic psychosis caused by infection, brain injury and CNS diseases such as Wilson’s disease
Metabolic disorder such as hyperthyroidism and hyperparathyroidism
Dementia and depression can also co-occur with psychosis

Question 17

treatment for schizophrenia

Answer 17

Risperidone - 1st line

Lorazepam may be used if there is acute behavioural disturbance in the presentation of paranoid schizophrenia, but this is not the first-line treatment and will not improve psychotic symptoms.

Clozapine for children and young people whose schizophrenia has not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks.

Question 18

treatment for EUPD

Answer 18

care programme approach (CPA).

CPA is essentially a way of ensuring that you receive the right treatment for your needs. There are 4 stages:

an assessment of your health and social needs
a care plan – created to meet your health and social needs
the appointment of a care co-ordinator (keyworker) – usually a social worker or nurse and your first point of contact with other members of the CMHT
reviews – where your treatment is regularly reviewed and any necessary changes to the care plan can be agreed

Psychotherapy — also called talk therapy
Focus on your current ability to function
Learn to manage emotions that feel uncomfortable
Reduce your impulsiveness by helping you observe feelings rather than acting on them
Work on improving relationships by being aware of your feelings and those of others
Learn about borderline personality disorde

you can have medications to treat the symtpoms as such like depressipn or anxiety

Dialectical behavior therapy DBT includes group and individual therapy designed specifically to treat borderline personality disorder. teach you how to manage your emotions, tolerate distress and improve relationships.

Schema-focused therapy can be done individually or in a group. It can help you identify unmet needs that have led to negative life patterns.

Mentalization-based therapy MBT is a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and create an alternate perspective on the situation. THINKING BEFORE REACTING

Systems training for emotional predictability and problem-solving (STEPPS). STEPPS is a 20-week treatment that involves working in groups that incorporate your family members, caregivers, friends or significant others into treatment. STEPPS is used in addition to other types of psychotherapy.

Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations.

Good psychiatric management.

Question 19

A young female patient is having a history taken and suddenly stops talking halfway through explaining how she believes she hears voices at night. The silence is prolonged, and when she starts to speak again, she talks about how beautiful the weather is outside.

What type of thought disorder is exhibited?

Thought insertion

Thought blocking

Delusional perception

Thought withdrawal

Thought broadcasting

Answer 19

thought blocking

Question 20

how often does clozapine need to be monitored

Answer 20

Clozapine requires differential white blood cell monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly as part of the clozapine patient monitoring service.

Question 21

risperidone and olanzapine are what

Answer 21

dopmaine receptor antagonists

Question 22

oxytocin impoves empathy and motivation in patietns with BPD - love hormone
,substances that impact glutamate include N-acetylcysteine