conditions Flashcards
What is an organic illness
Conditions with demonstrable aetiology in CNS pathology
Causes of organic disorders
- substance misuse
- trauma
- inflammation
- degeneration
- infection
- metabolic
Examples of organic disorders
- Delirium
- Dementia
- Lobe syndrome
- Endocrine causes
List some organic causes of diseases
- Neurological
- Endocrine
- Metabolic
- SLE
- Medication
- Drug abuse
- Toxins
Neurological causes of psychosis
- epilepsy
- head injury
- brain tumour
- dementia
Endocrine causes of psychosis
- hyper/hypothyroidism
- cushing’s
- hyperparathyroidism
- addison’s disease
Metabolic causes of psychosis
- uraemia
- sodium imbalance
- porphyria (inherited blood disorder related to a build up in chemicals related to red blood cell proteins
Medications that can cause psychosis
- steroids
- L-dopa
- INH (isoniazid)
- anticholinergics
- antihypertensives
- anticonvulsants
- ritalin
Elicit drugs that can cause psychosis
- cocaine
- LSD
- cannabis
- PCP
- amphetamines
- opioids
Schizophrenia definition
Schizophrenia is the most common form of psychosis. It is a lifelong condition, which can take on either a chronic form or a form with relapsing and remitting episodes of acute illness
Schizophrenia epidemiology
Men are at higher risk of all psychotic disorders, ethnic minorities are at a higher risk of all psychotic disorders
Most commonly develops in adolescence and early 20s
Schizophrenia aetiology
multifactorial - genetic - environmental - social Short-lived illnesses similar to paranoid schizophrenia are associated with cocaine, amphetamines and cannabis
Schizophrenia risk factors
- family history
- intrauterine and perinatal complications eg. premature birth and low birth weight
- intrauterine infection
- abnormal early cognitive/neuromuscular development
- social isolation
- abnormal family interactions eg. hostile or overly critical
Schizophrenia presentation
First rank/positive symptoms
- delusions
- hallucinations
- thought disorder
- lack of insight
Chronic/negative symptoms
- underactivity
- low motivation
- social withdrawal
- emotional flattening
- self-neglect
Appearance and behaviour in schizophrenia
- withdrawal
- suspicion
- stereotypical behaviours eg. repetition of purposeless movements
- mannerisms eg. saluting
Speech in schizophrenia
- interruptions to the flow of thought
- loosening of associations
- loss of normal thought structure
Mood and affect in schizophrenia
- flattened
- incongruous or odd
Abnormal beliefs in schizophrenia
- hallucinations especially auditory
Cognition in schizophrenia
should assess attention, concentration, orientation and memory. Significant impairment suggests delirium or severe dementia
Schizophrenia differential diagnosis
- drug induced psychosis: amphetamine, LSD, cannabis
- temporal lobe epilepsy
- encephalitis
- dementia
- mania
- psychotic depression
- some personality disorders
Schizophrenia investigations
- LFTs and FBC for alcohol abuse
- serological tests for syphilis and AIDs screening
- urine screen for drugs of abuse
Schizophrenia management
Initial
- early assessment and engagement including assessment of social circumstances and involvement of family where possible
- early intervention is important
- antipsychotics can be prescribed. an atypical antipsychotic is normally used
MDT support in schizophrenia
combination of inpatient and outpatient care, hospital consultant, community psychiatric nurses, GPs, crisis support, daycare, home treatment teams, social workers, voluntary organisations and involvement of carers.
Psychological support for schizophrenia
- information and education
- voluntary organisations and support groups
information and support for carer - information and support for carers
- specialist “family interventions in psychosis” teams
- family therapy
- CBT
- art therapy
Drug management for schizophrenia
1st line
- atypical antipsychotics eg. risperidone or olanzapine
If violent or aggressive
- benzodiazepines for rapid tranquilisation
Side effects of antipsychotics
- weight gain
- extrapyramidal symptoms (dystonia, akathisia, parkinsonism, bradykinesia, tremor) are less common with atypical antipsychotics
Schizophrenia prognosis and recovery
- 80% show response to treatment in a year
- 20% have no new psychotic episodes within 5 years
- most live independently outside hospital
- 6.5% suicide risk
- reduced life expectancy by 10-20 years, linked to cardiovascular disease, respiratory disease and cancer
Factors associated with good prognosis in schizophrenia
- absence of family history
- good premorbid function (stable personality and relationships)
- clear precipitant
- acute onset
- mood disturbance
- prompt treatment
- maintenance of initiative and motivation
Factors associated with poor prognosis in schizophrenia
- longer duration of untreated psychosis
- early or insidious onset
- male
- negative symptoms
- family history
- low IQ, low socioeconomic status or social isolation
- significant psychiatric history
- continued substance misuse
What is schizoaffective disorder
A psychiatric condition which contains features of both schizophrenia and mood disorders (eg. depression, bipolar disorder)
Schizoaffective disorder epidemiology
- Less common than schizophrenia
- usually presents in early adulthood and women are more often affected
Types of schizoaffective disorder
- Bipolar type
- Depressive type
- Manic type
- Mixed type
Schizoaffective disorder diagnosis
- delusions or hallucinations must be present for at least two weeks when the mood symptoms are not present
- symptoms of mood disturbance are present for a significant length of the illness
- the disturbance must not be due to other causes eg. organic, substance misuse, medication
Schizoaffective disorder presentation
Can present as:
- major depressive episode
- manic episode
- mixed episode
- schizophrenia
How does a major depressive episode present
5 of the following for at least two weeks. One symptom must either be depressed mood or loss of interest or pleasure
- depressed mood
- decreased pleasure in activities
- weight loss/gain or appetite change
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue
- feelings of guilt or worthlessness
- decreased concentration
- recurrent thoughts of death or suicidal notions
How does a manic episode present
Persistent elevated or irritable mood for at least a week. 3 of following (or four if they have an irritable mood)
- inflated self esteem or grandiosity
- reduced need for sleep
- pressure of speech
- flight of ideas and racing thoughts
- easily distracted
- increase in goal-directed activity with psychomotor agitation
- excessive involvement in high risk activities eg. shopping sprees
How does a mixed episode present
contains features of both manic episode and major depressive episode
- you only need to have the symptoms for a week for diagnosis
Symptoms of schizophrenia for a diagnosis of schizoaffective disorder
2 or more for a month
- delusions (if bizarre, no other symptoms required)
- hallucinations (if in form of running commentary or 2 voices, no other symptoms required)
- speech abnormalities
- behavioural abnormalities eg. disorganised, catatonia
- negative symptoms eg. apathy or lack of emotions
Investigations for schizoaffective disorder
mainly to rule out underlying causes
- bloods eg. FBC, renal and LFT. TFT, HIV test
- urine or plasma toxicology
- CXR to exclude pneumonia in elderly
Schizoaffective disorder complications
- Poor social integration and function
- self-neglect
- difficulties with relationships
- substance misuse
- suicidal behaviour
- homicidal thoughts
Schizoaffective disorder management
- hospital admission, if threat to themselves or others Treatment of acute exacerbation - antipsychotics or atypical antipsychotics eg. risperidone, olanzapine Long term treatment - antipsychotics with psychological treatments Ongoing depressive symptoms - antidepressants - ECT In bipolar type - mood stabilisers Psychological treatments - CBT - family interventions - counselling - art therapy - supportive psychotherapy
Schizoaffective disorder prognosis
Bipolar type has better prognosis than depressive type due to long term mood disturbance
What is bipolar disorder
A chronic episodic illness associated with behavioural disturbances. Characterised by episodes of mania (or hypomania) and depression. Either can occur first, one may be more dominant, but all cases eventually lead to depression
Types of bipolar disorder
Type I: involves depression and mania. The manic episodes are severe, resulting in impaired functioning and frequent hospital admissions
Type II: just involves hypomania (mild form of mania). This has no psychotic symptoms and results in less associated dysfunction. Is often interspersed with depressive episodes
Bipolar disorder epidemiology
- 2.4% lifelong prevalence
- similar in men and women
- more common in 16-24 year olds
- type one slightly more common
- commonly associated with anxiety and substance misuse
Bipolar disorder presentation
- Manic phase
- Hypomanic phase
- Depressive phase
Describe the manic phase of bipolar disorder
- grandiose
- pressure of speech
- excessive amounts of energy
- racing thoughts and flight of ideas
- overactivity
- needing little sleep
- easily distracted
- bright clothes/unkempt
- increased appetite
- sexual inhibition
- recklessness with money
Describe the hypomanic phase of bipolar disorder
Lesser degree of mania
- persistent mild elevation of mood
- increased activity and energy
- no hallucinations or delusions
- no significant effect on functional ability
Describe the depressive phase of bipolar disorder
- low mood
- reduced energy
- no joy in daily activities
- have negative thoughts
- lack facial expressions
- poor eye contact
- tearful and unkempt
- low mood worse in mornings, disproportionate to circumstances
- feelings of despair, low self-esteem and guilt with no apparent reason
- weight loss
- reduced appetite
- altered sleeping pattern
- loss of libido
- in severe cases can be delusions of persecution or illness or impending death
- patients can become unwell through self-neglect
Bipolar disorder diagnosis
at least two episodes in which a person’s mood and activity levels are significantly disturbed (one of which must be mania or hypomania)
Clinical assessment of a patient with bipolar disorder
- detailed history of the episode: symptoms, hallucinations, delusions, collateral history
- previous episodes
- suicidal or homicidal thoughts
- self neglect
- family history
- substance misuse, smoking, alcohol intake
- general physical health
Bipolar disorder non-pharmacological management
- education regarding diagnosis, treatment and side effects
- good communication
- self-help and support groups
- self-monitoring of symptoms
- coping strategies
- psychological therapy eg. CBT
- encouragement of engagement in calming activities
Bipolar disorder pharmacological management
Following an acute episode patients should be followed up once a week for 6 weeks and then every 4 weeks for 3 months
1st manic episode
- liaise with consultant psychiatrist, consider hospital admission
- aims of treatment is to reduce symptoms rapidly and ensure safety of the patient and others
- oral therapy
- use rapid tranquilisers if necessary
- antipsychotics eg. haloperidol. quetiapine, risperidone
Acute depressive episode
- antidepressants (can be less effective in bipolar disorder)
- offer fluoxetine
Long term management
- lithium (add valproate if ineffective) but don’t use valproate in women of child-bearing age
How should patient’s with bipolar disorder be monitored
- once on treatment a patient should be reviewed at least weekly and then annually one stable
- pay attention to lipid levels, plasma glucose, weight, tobacco use, alcohol and other illicit drugs and monitoring of blood pressure
- regularly ask about side effects and suicidal ideation
Mania in pregnancy
- discuss risks about medications affecting foetuses
- drugs such as carbamazepine and lamotrigine should be stopped in pregnancy
- valproate should be avoided in women able to become pregnant
- if a pregnant woman develops mania then low doses of antipsychotics can be used
Bipolar disorder prognosis
- bipolar disorder requires lifelong treatment and management
- natural course usually includes periods of remission with frequent relapse, which occurs more commonly with poor adherence
- on average a person with bipolar disorder will experience 10 episodes in their life (high variation)
Poor prognosis is associated with: - substance dependency
psychotic features - depression symptoms
- interepisode depression
- male
Lithium prophylaxis improves prognosis in 50% patients
People with bipolar disorder are at higher risk of suicidal ideation, leading to poorer prognosis
Depression definition
Negative affect and/or absence of positive affect. Most common psychiatric disorder
Depression diagnosis
At least one core symptom:
- persistent sadness or low mood nearly every day
- loss of interest or pleasure in most activities
At least 3 or 4 of:
- fatigue
- worthlessness, excessive or inappropriate guilt
- recurrent thoughts of death, suicidal thoughts, suicide attempts
- diminished ability to think/concentrate or increased indecision
- psychomotor agitation or retardation
- insomnia/hypersomnia
- changes in appetite + weight
symptoms persistent for at least 2 weeks, not due to a physical/organic factor or illness
Depression classification
Sub threshold depressive symptoms: <5 symptoms
Mild depression: not many more than 5 symptoms, resulting in minor functional impairment
Moderate depression: symptoms or functional impairment are between mild and severe
Severe depression: most symptoms present, which markedly interfere with normal function. Can occur with or without psychotic symptoms
What is persistent depressive disorder
A chronic form of depression. Symptoms usually come and go over a period of years and the intensity can change over time
Depression epidemiology
- 3rd most common reason for consulting a GP
- 5% adults have an episode of depression a year
- Chronic physical illness will increase risk of depression
Depression risk factors
- Female
- Past history of depression or other mental health conditions
Significant physical illness - psychosocial problems eg. divorce, unemployment, poverty
Depression risk factors in children and adolescents
- family discord
- bullying
- physical, sexual or emotional abuse
- comorbid disorders (drug and alcohol use)
- history of parental depression
- ethnic and cultural factors
- homelessness
- refugee status
- living in institutional settings
How to assess for depression
- the patient health questionnaite (PHQ-9)
- the hospital anxiety and depression (HAD) scale
- Beck’s depression inventory II
- Full history and examination, enquiring about suicidal ideas, delusions and hallucinations
- past psychiatric history
- assess patient safety and risk to others
Neurological causes of depression
- CVA
- epilepsy
- parkinson’s disease
- brain tumour
Differential diagnoses to depression
- bipolar disorder
- schizophrenia (depression can co-exist)
- dementia
- seasonal affective disorder
- bereavement
- organic cause
- drug side effects
Investigations in depression to exclude an organic cause
- bloods: U&Es, LFTs, TFTs, calcium levels, FBC, inflammatory markers
- other relevant tests eg. magnesium levels, HIV or syphilis serology, drug screening
- Imaging eg. MRI or CT brain
Depression management
- Assessment
- cognitive enhancement (acetylcholinesterase inhibitors, antioxidants, hormones)
- treat psychosis/agitation (antipsychotics)
- treat depression/insomnia (SSRIs, hypnotics)
- psychological support (to patient and caregiver)
- functional management: encourage independence with self care + assist with communication
- social management: accommodation, financial matters, legal matters
- CBT
- ECT
First line antidepressants
SSRIs (less toxic in overdose and less side effects than TCAs) Start with generic SSRIs eg: - citalopram - fluoxetine - paroxetine - sertraline
How long should patients stay on antidepressants for
- If the patient benefitted from antidepressants, continue for at least 6 months after remission to reduce risk of relapse
- continue for two years if the patient has had 2 or more depressive episodes recently
Complications of depression
- Social difficulties: stigma, loss of employment, marital breakup
- Associated problems: anxiety, substance misuse
- Increased mortality either by suicide or by comorbid conditions eg. coronary heart disease
- Depression exacerbates pain + disability associated with physical conditions
Depression prognosis
- average episode lasts 6-8 months
- > 50% risk of recurrence
- worse prognosis with psychotic symptoms, prominent anxiety, underlying personality disorder or severe symptoms
Risk factors increasing the risk of recurrence of depression
- > 3 major depressive episodes
- high prior frequency of recurrence
- episode in previous 12 months
- residual symptoms during continuation treatment
- severe episodes
- long previous episodes
- relapse after drug discontinuation
- poor self-rated health
Infectious causes of depression
- HIV
- EBV
- Brucellosis
Endocrine and metabolic causes of depression
- hypothyroidism
- Cushing’s
- Addison’s disease
- parathyroid disease
- B12 and folate deficienct
- Porphyria
Cardiac causes of depression
- MI
- CCF
Autoimmune causes of depression
- SLE
- RA
- Cancer
Medications that can cause depression
- analgesics
- antihypertensives
- L-dopa
- anticonvulsants
- antibiotics
- steroids
- OCP
- cytotoxics
- cimetidine
- salbutamol
Drugs of abuse that can cause depression
- alcohol
- benzodiazepines
- cannabis
- cocaine
- opioids
- toxins
What is seasonal affective disorder (SAD)
A seasonal pattern of recurrent depressive episodes in both depression and bipolar disorder. In the northern hemisphere this occurs in January/February (winter depression)
Clinical features of SAD
Mild to moderate symptoms of low self esteem, hypersomnia, fatigue, increased appetite, weight gain, decreased social and occupational functioning
Aetiology of SAD
It is unclear as to whether this is a separate subtype of depressive disorder or if it is a manifestation of atypical depression
What is delirium
A clinical syndrome of confusion, with a variable degree of clouding of consciousness, visual illusions, and/or visual hallucinations, lability of affect, and disorientation
Delirium epidemiology
Common in in-patients Vulnerable groups: - elderly - pre-existing dementia - blind or deaf - very young - post operative - burn victims - alcoholic and benzodiazepine dependent
Causes mortality and morbidity
Clinical features of delirium
- impaired level of consciousness
- reduced ability to direct, sustain and shift attention
- global impairment of cognition with disorientation, and impairment of recent memory and abstract thinking
- disturbance in sleep/wake cycle
- nocturnal worsening of symptoms
- psychomotor agitation and emotional lability
- perceptual distortions, illusions and hallucinations (normally visual)
- speech: rambling, incoherent, thought disordered
- poorly developed paranoid delusions
- rapid onset of clinical features with fluctuations in severity over minutes or hours
Differentials to delirium
- mood disorder
- psychotic illness
- post-ictal
- dementia
Causes of delirium
Normally multifactorial:
- intracranial: CVA, head injury, encephalitis, tumour, raised ICP
- metabolic: anaemia, electrolyte disturbance
- endocrine: pituitary, thyroid, parathyroid or adrenal illnesses
- infective: UTI, chest infection
- substance intoxication or withdrawal: alcohol, benzodiazepines
- hypoxia: secondary to any cause
Delirium risk factors
- age >65
- male sex
- pre-existing cognitive deficit (dementia, stroke)
- severity of dementia
- severe comorbidity
- previous episode of delirium
- operation (hip fracture repair)
- some conditions (burns, AIDSm fracture, infection, low albumin, dehydration)
- drug use
substance misuse - hypo/hyperthermia
- visual/hearing problems- poor mobility
- social isolation
- stress
- terminally ill
- new environment
- ICU admission
- urea/creatinine abnormalities
Most common causes of delirium
- infection
- medication
- drug withdrawal
Subtypes of delirium
- Hypoactive
- Hyperactive
- Mixed (patients vary from hypoactive to hyperactive)
Describe hypoactive delirium
Apathy and quiet confusion present, can be confused with depression
Describe hyperactive depression
Agitation, delusions, disorientation, can be confused with schizophrenia
Supportive management for delirium
- clear communication
- reminders of time of day, time, location, identifiaction of people
- clock available
- have familiar objects around patient (glasses, walking aids, hearing aids)
- staff consistency
- relaxation
Medical management for delirium
manage underlying cause/conditions:
- infection
- constipation
- urinary retention
- dehydration and electrolyte abnormalities
- pain
- medication changes
Pharmacological management for delirium
- using drugs can lead to adverse effects and worsening of delirium
- antipsychotics have beneficial effects in some patients
- haloperidol and olanzapine are preferred, using the lowest possible dose
- benzodiazepine if caused by alcohol withdrawal
Common drugs that cause delirium
- benzodiazepines
- narcotic analgesics
- first generation antihistamines
- antispasmodics
- warfarin
- furosemide
- statins
- steroids
- beta blockers
Complications of delirium
- HAP eg. clostridium difficile and MRSA
- pressure sore
- fracture (hip)
- residual psychiatric and cognitive impairment
Prevention of delirium
- awareness of high risk patients and close observation for delirium
- MDT approach
- assess patients within 24 hours of admission
- identify and correct hypoxia
- assess and treat pain
- review medications regularly
What is a personality disorder
The manifestation of extreme personality traits that interfere with everyday life and contribute to significant suffering, functional limitations, or both.
They are associated with an inferior quality of life, poor health, and premature mortality
Possible causes of personality disorders
In childhood - sexual abuse - physical abuse - emotional abuse - neglect - being bullied Emotional/environmental factors - truanting - bullying others - being expelled - running away from home - deliberate self-harm - prolonged periods of misery - genetic factors
What are the different traits/patterns associated with personality disorders
- negative affectivity trait
- detachment trait
- dissociality trait
- disinhibition trait
- anakastia trait
- borderline pattern
Describe negative affectivity trait
- tendency to experience a broad range of negative emotions eg:
- range of negative emotions with a frequency and intensity out of proportion to the situation
- emotional lability and poor emotion regulation
- negativistic attitudes
- low self-esteem and self confidence
- mistrustfulness
Describe detachment trait
- social detachment (avoid soical interactions, lack of friends, avoidance of intimacy)
- emotional detachment (reserve, aloofness, limited emotional expression and experience)
Describe dissociality trait
- disregard for rights and feelings of others
- self-centeredness
- lack of empathy
Describe disinhibition trait
- tendency to act rashly based on immediate external or internal stimuli, without consideration of potential negative consequences
- impulsivity
- distractibility
- irresponsibility
- recklessness
- lack of planning
Describe anankastia trait
- narrow focus on rigid standard of perfection and of right and wrong, and on controlling own and other’s behaviours and controlling situations to ensure conformity to these standards
- perfectionism
- emotional and behavioural constraint (control over emotional expression, stubbornness, risk-avoidance, perseveration)
Describe what a borderline pattern is
- frantic efforts to avoid abandonment
- unstable and intense interpersonal relationships
- identity disturbance (unstable self image or sense of self)
- act rashly
recurrent episodes of self harm - emotional instability
- chronic feelings of emptiness
- transient dissociative symptoms or psychotic like features
What are the three categories of personality disorder
- suspicious
- emotional and impulsive
- anxious
If someone meets the criteria for more than one type this could be mixed personality disorder
ICD-11 abolishes all types of specific categories of personality disorder apart from the general diagnosis of personality disorder
What are the 3 suspicious personality disorders
- paranoid personality disorder
- schizoid personality disorder
- schizotypal personality disorder
What are the 4 emotional and impulsive personality disorders
- antisocial personality disorder (ASPD)
- borderline personality disorder (BPD) / emotionally unstable personality disorder (EUPD)
- histrionic personality disorder
- narcissistic personality disorder
what are the 3 anxious personality disorders
- avoidant personality disorder
- dependent personality disorder
- obsessive compulsive personality disorder (OCPD)
What is emotionally unstable personality disorder (EUPD)
Personality disorder characterised by definite tendency to act impulsively and without consideration to the consequences.
Mood unpredictable and liable to outbursts of emotion, incapacity to control the behavioural explosions
Personality
- borderline
- aggressive
- explosive
Presentation of EUPD
- relationship difficulties
- recurrent self harm
- threats of suicide
- depression
- bouts of anger
- impulsivity
- social difficulties
- transient psychotic symptoms
Investigations for EUPD
- toxicology screen: substance abuse is common
- HIV and STI screen
- psychological testing: diagnostic interview for DSM-IV personality disorders (DIDP-IV), personality assessment schedule (PAS)
Conditions associated with EUPD
- anxiety
- alcohol misuse
- drug misuse
- depression
- recurrent self harm
- eating disorders
- PTSD
- physical conditions: arteriosclerosis, HTN, hepatic disease, cardiovascular disease, GI disease, arthritis, STIs
EUPD management
- identify short term and long term aims
- develop crisis plan
- psychotherapy
- normally don’t give medication in EUPD as they don’t affect severity of EUPD
- give medication to manage symptoms
What is paranoid personality disorder
Personality disorder characterised by excessive sensitivity to setbacks, unforgiveness of insults, suspiciousness and a tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous.
Recurrent suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner
A combative and tenacious sense of personal rights
May be excessive self importance
What is schizoid personality disorder
Personality disorder characterised by withdrawal from affectional, social and other contacts with preference for fantasy, solitary activities, and introspection.
limited capacity to express feelings and to experience pleasure
What is dissocial personality disorder
Personality disorder characterised by disregard for social obligations, and callous unconcern for feelings of others.
low tolerance to frustration and low threshold for discharge of aggression, including violence
tendency to blame others or to offer plausible rationalisations for behaviour
Personality:
- amoral
- antisocial
- asocial
- psychopathic
- sociopathic
What is histrionic personality disorder
Personality disorder characterised by: shallow and labile affectivity, self-dramatisation, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, continuous seeking for appreciation, excitement and attention
What is anankastic personality disorder
Personality disorder characterised by feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity
Insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive compulsive disorder
Personality
- compulsive
- obsessional
What is anxious/avoidant personality disorder
Personality disorder characterised by feelings of tension and apprehension, insecurity and inferiority
continuous yearning to be liked and accepted, hypersensitivity to rejection and criticism with restricted personal attachments, tendency to avoid activities by habitual exaggeration of potential dangers or risks in everyday situations
What is dependent personality disorder
personality disorder characterised by pervasive passive reliance on other people to make major and minor life decisions
great fear of abandonment, feelings of helplessness and incompetence, passive compliance with wishes of elders and others, weak response to demands of daily life
