Diagnoses III Flashcards
What is a personality d/o?
CAPRI
Personality d/o = deeply ingrained, inflexible pattern of relating to others that is maladaptive and causes sig. impairment
-axis II diagnosis
Pattern of behavior/inner experience which deviates from culture, 2+ (CAPRI)
- cognition
- affect
- personal relations
- impulse control
Cluster A d/o
(a) list from most to least severe
(b) gender difference
(c) mainstay of treatment
Cluster A: ‘mad’ or ‘weird’
-eccentric, peculiar, withdrawn
(a) Most severe: paranoid PD > schizotypal > schizoid
- schizoid has no ideas of reference (no loss of reality) while the other 2 do
(b) all 3 cluster A are more common in males
(c) psychotherapy for all 3 + pharmacotherapy PRN
Symptoms of schizoid personality d/o
Schizoid personality disorder
- *prefer to be alone
- no desire for close relationships
- take pleasure in few activities
- indifferent to criticism
- emotional coldness, detachment, flat affect
- choose solitary activities, gravitate to solitary jobs
- *no loss of reality (no ideas of reference)
Symptoms of schizotypal personality d/o
Schizotypal personality d/o
- *magical thinking: think their thoughts can have special powers on others
- odd, eccentric behaviors, habits, or thinking
- excessive social anxiety
- unusual perceptive experiences
- *ideas of reference
Symptoms of paranoid personality d/o
Paranoid personality d/o
- hostile, angry
- preoccupied w/ trustworthiness/loyalty of others
- reluctance to confide in anyone
- recurrent suspicious of infidelity of spouse
- *ideas of reference
Differentiate paranoid personality disorder from schizophrenia paranoid type
Paranoid PD: ideas of references but NOT DELUSIONS
-while scz paranoid type, paranoia comes w/ delusions (false fixed believes)
Cluster B d/o
(a) Name 4
(b) treatment
Cluster B d/o: ‘bad’ ‘wild’
-emotional, dramatic, inconsistent
(a) Histrionic, narcissistic, antisocial, borderline
(b) Psychotherapy + pharmacotherapy PRN for all 4
Epidemiology of paranoid personality d/o
- males
- minorities, immigrants
- relatives of schizophrenics
Symptoms of histrionic personality d/o
Histrionic personality d/o
- *theatrical expression of emotion: temper tantrums
- *uncomfortable when not the center of attention
- inappropriate provocative, often uses physical appearance to gain attention
- easily influenced by others
- constant need for praise
- use regression as defense mechanism
- speech is impressionistic, lacks details
ex: Dani Warren? boobs out, emotionally theatrical, easily influenced
Histrionic personality d/o
(a) prevalence
(b) gender
(c) associated w/ what type of relationships
(d) common comorbidities
Histrionic personality d/o
(a) 2-3%
(b) females
(c) Superficial relationships
(d) Comorbid w/ somatization and depression
Symptoms of narcissistic personality d/o
Narcissistic PD
- *lack of empathy
- *sense of superiority
- *takes advantage of others for self gain
- preoccupied w/ unlimited wealth, power, success
- envious of others, believes others are envious of them
- believes they are special => only can associate w/ high-status ppl
- inflated sense of entitlement
Differentiate pt’s motivation for taking advantage of others in
(a) narcissistic PD
(b) antisocial PD
Motivation for taking advantage of others
(a) Narcissistic PD: for self-gain, for status and recognition
(b) Antisocial PD: for material gain or subjugation of others
Describe the way that each of the 4 cluster B personality disorders deal w/ time
Histrionic: show less symptoms w/ age
Narcissistic: handle aging poorly
Antisocial: only a diagnosis after 18, symptoms since age 15, history consistent w/ CD. Course may increase or decrease w/ age
Borderline: ppl get worse w/ age (burnout)
Symptoms of antisocial personality d/o
- *NO REMORSE for harmful actions
- wont conform to society => violates laws
- irritability, aggression
- *Charming when first encountered, manipulative: con men, intelligent
Why be careful when treating anxiety in ppl w/ antisocial personality d/o
Caution due to addictive personality
Symptoms of borderline personality disorder
IMPULSIVE I- impulsive: sex, substance, spending M- moodiness** P- paranoid or disassociation under stress U- unstable self image** L- labile interpersonal relationships** S- suicidal gestures or self-harm** I- inappropriate anger V- vulnerability to abandonment => desperately avoid real or perceived abandonment** E- emptiness (feelings of)
Epidemiology of borderline personality do
- 2-3% prevalence
- 2:1 female
- women: 3-10x likely to be victim of incest
- 10% suicide
Cluster C personality d/o
(a) treatment
(b) Name 3
Cluster C personality d/o: ‘sad’ ‘wimpy/worried’
-anxious, fearful
(a) psychotherapy and pharmacotherapy in all
- individual psychotherapy for dependent
- encourage interaction for avoidant
- group therapy for obsessive compulsive
(b) Cluster C: dependent, avoidant, obsessive-compulsive
Symptoms of dependent personality d/o
- *want others to make decisions
- feel helpless when alone
- difficulty initiating projects on their own
- urgently seek new partner if one is lost
- poor self-confidence and fear separation
Symptoms of avoidant personality d/o
- *wants friendships, just hard to form
- *fear of rejection
- unable to interact unless assured that person will like them
- avoid situations in which they may be rejected, seek jobs w/ little interpersonal contact
- hypersensitivity
- feelings of inadequacy
Fear of what in avoidant personality d/o vs. agoraphobia
Avoidant personality d/o- fear of rejection
Agoraphobia- fear of embarrassment
Risk factors for avoidant personality d/o
- common in timid infants
- genetic predisposition
-prone to depression
Symptoms of OCPD
Obsessive compulsive personality d/o
- *preoccupation w/ details such that main point of activity is lost
- perfectionism detrimental to completing task
- will not delegate tasks
- rigid, serious, formal
- workaholic
- hoard meaningless objects
Differentiate obsessive compulsive and narcissistic personality d/o in ppl that overwork themselves
OCPD- workaholic, motivated by the activity itself
Narcissistic- workaholic, motivated by the success
Relationship btwn Axis I and II diagnoses
Pts w/ personality d/o (axis II) are vulnerable to developing symptoms of axis I d/o during stress
Common defense mechanisms used in
(a) histrionic personality d/o
(b) borderline personality d/o
Defense mechanisms
(a) histrionic- often use regression
(b) borderline- often use splitting
Familial association w/ what and cluster A B C disorders
Familial association w/ clusters of personality d/o
- Cluster A and psychotic d/o
- Cluster B and mood d/o
- Cluster C and anxiety d/o
Personality D/o
(a) insight
(b) age of onset
(c) prevalence
Personality D/o
(a) Pts lack insight into their illness- ego-systonic
(b) onset of symptoms must be before early adulthood
(c) international prevalence is 6%. many pts w/ PD will meet the criteria for > 1 d/o and should be classified as having all for which they qualify
Give some example of magical thinking found in personality do
Magical thinking found in schizotypal personality d/o
- belief in clairvoyance or telepathy
- bizarre fantasies or preoccupations
- belief in superstitions
Differentiate schizotypal personality disorder vs. paranoid schizophrenia
Schizotypal personality d/o- pts are not frankly psychotic (tho can become transiently so under stress), don’t have fixed delusions
Use of pharmacotherapy for personality d/o
Pharmacotherapy have minimal use in most personality d/o
-found to be more useful in borderline PD than any other PD: treat psychotic or depressive symptoms
Schizoid vs. avoidant personality do
Schizoid pts prefer to be alone
Avoidant pts want to be w/ others but are too scared of rejection
Time criteria for
(a) depressive episode
(b) manic episode
(c) mixed episode
(d) hypomanic episode
Time criteria
(a) depressive episode: 2+ weeks
(b) manic episode: 1+ week
(c) mixed episode: 1+ week of meeting criteria for both
- usually irritability is the predominant mood state
(d) hypomanic episode: 4+ days
SIG E CAPS
(a) How many to meet criteria?
Depression: 5+ w/ depressed mood or anhedonia
Sleep (increased or decreased) -sleep latency (takes longer to fall asleep) -AM wakening -hypersomnia in atypical depression Interest (lack of) Guilt/hopelessness Energy (decreased) Concentration (impaired) Appetite (increased or decreased) Psychomotor slowling Suicidal ideation
DIG FAST
(a) How many to meet criteria?
Mania: 3+ w/ elevated mood or irritability
Distractibility Insomnia/impulsive behavior Grandiosity Flight of ideas (racing thoughts) Activity (increase) Speech (pressured) Thoughtlessness/talkativeness
What percent of manic episodes
(a) recur
(b) have psychotic features
Manic episodes
(a) 93% recur
(b) 75% have psychotic features
Distinguish hypomania from mania
Hypomania- same in that it meets 3+ manic symptoms, shorter duration, less severe
- no psychotic symptoms
- *no impairment of fxn
MDD
(a) Average age of onset
(b) Duration if untreated
(c) MZ twin concordance
(d) Percent who have SI
Major depressive d/o
(a) 40 yoa
(b) lasts 6-12 mo if left untreated
(c) 90% MZ twin concordance
(d) 2/3 have SI
Distinguish the subtypes of MDD
(a) melancholic
(b) atypical
(c) catatonic
(d) psychotic
(e) seasonal affective
Subtypes of MDD
(a) melancholic: early morning awakening, anhedonia, anorexia
(b) atypical = most common subtype
- hypersomnia, reactive mood, hyperphagia
(c) catatonic- hypomotorism, echolalia/echopraxia, negativism, rigidity
(d) psychotic
(e) seasonal affective- only during winter months
Treatment of MDD
(a) duration
(b) atypical
MDD treatment
first line = SSRIs (second TCAs)
(a) for a MINIMUM of 16 weeks
(b) atypical depression = MAOIs
When is ECT indicated for MDD?
(a) Is ECT more effective in MDD or bipolar d/o?
Use ECT for MDD when
- acutely suicidal
- 2-3 failed medical trials
- catatonia, malnutrition
(a) ECT has higher efficacy in bipolar
Time criteria for
(a) bipolar I
(b) bipolar II
(c) cyclothymia
(d) dysthmia
Time criteria for
(a) bipolar I: 7+ days of mania
(b) bipolar II: 2+ weeks of major depressive episode + at least one hypomania episode (4+ days)
(c) cyclothymia: 2+ years
(d) Dysthymia: 2+ years
What is the most common subtype of depression?
Atypical: hypersomnia, reactive mood, hyperphagia
lol, misnomer much
Criteria for cyclothymia
(a) common comorbidity
Cyclothymia: mild depression + hypomania for 2+ years w/ no normal 2 mo
(a) often co-existant w/ borderline PD
Prognosis of dysthmia, percent that get
(a) MDE
(b) bipolar
(c) lifelong symptoms
Dysthymia
(a) 20% get MDE
(b) 20% get bipolar
(c) 25% get lifelong symptoms
Criteria for dysthymia
(a) prevalence
Dysthymia = mild depression for 2+ years w/ no 2 months euthymic
-never have psychotic features
2 D’s: dysthymic disorder, 2 years of depression, 2 listed criteria, no 2 mos w/o symptoms
(a) 6% prevalence
What is double depression?
Double depression: dysthymia + MDE
Most effective treatment for dysthymia
CBT + psychotherapy
Incidence of
(a) postpartum depression
(b) postpartum psychosis
Incidence of
(a) postpartum depression = 15% of pregnancies
(b) postpartum psychosis = 2% of pregnancies
Time component and criteria for
(a) postpartum depression
(b) postpartum psychosis
(a) Postpartum depression: w/in 4 weeks of delivery
- same criteria for MDD met
(b) Postpartum psychosis: usually w/in 2 weeks of delivery
- can have bipolar type manic symptoms and/or psychotic delusions
Treatment for
(a) postpartum depression
(b) postpartum psychosis
Treatment
(a) Postpartum depression: SSRIs (but caution for breastfeeding), CBT
(b) Postpartum psychosis: hospitalization, antipsychotics
Define rapid cycling
Rapid cycling = 4+ mood episodes in a year
What disorder has the highest rate of suicide
MDD
Diseases that carry a very high risk for developing depression
(a) CNS
(b) Type of cancer
(a) Stroke
(b) Pancreatic cancer
Best treatment for manic woman in pregnancy
ECT
Triad for seasonal affective d/o symptoms
- irritability
- carbohydrate craving
- hypersomnia
