Eating And Personality Disorders

Question 0

Cluster B dramatic emotional or erratic

Answer 0

Antisocial PD
Narcissistic PD
Histrionic PD
Borderline PD

Question 1

Cluster A eccentric or odd

Answer 1

Paranoid personality d/o
Schizoid personality d/o
Schizotypal personality d/o

Question 2

Cluster C anxious or fearful

Answer 2

Avoidant PD
Dependent PD
Obsessive compulsive PD

Question 3

Diagnostic criteria for PD

Answer 3

Enduring pattern of experience and behavior in 2 or more areas where pt differs from cultural expectations

• cognition (perceiving self and others)
• affectivity (range, intensity, lability, appropriateness of emotional response)
• interpersonal functioning
• impulse control
• belief that there is problem with outside world, not with self

Question 4

Schizotypal vs schizoid

Answer 4

Schizoid -

• inability to form close interpersonal relationships
• chooses solitary activities
• indifferent to praise or criticism
• cold detached and denies strong emotions

Schizotypal

- deficits in social and interpersonal functioning 
- no close relationships beyond family 
- marked paranoid social anxiety that doesn't decrease with familiarity
- distortion of cognition
 - odd speech restricted affect bizarre appearance and behaviors

Question 5

Borderline PD features

Answer 5

Instability of affect impulse control , interpersonal relationships, identity

• fear of abandonment (intense)
• intense and unstable relationships
• impulsive w sex food drugs
• chronic feeling of emptiness
• stress induced paranoia or brief psychotic episodes
• dissociations or disruption of usually integrated functions of consciousness memory identity or perception of environment

Question 6

Treatment of personality disorders

Answer 6

Psychotherapy first line in all cases

Cluster A (paranoid schizoid schizotypal)
- cognitive therapy , social skill building
Cluster B (antisocial narcissistic, histrionic, borderline)
- cognitive for narc and hist
- dialectic behavioral (DBT) - firstline for Borderline mindfulness and acceptance
Cluster C- avoidant dependent OCD
- CBT - focus on changing maladaptive thinking patterns

Question 7

Pharmacotherapy for personality disorders

Answer 7

Therapy is first line
- pharmacotherapy for symptoms (depression anxiety etc)
- A and C - no established pharm tx
- B - antisocial personality d/o
- lithium (1200mg/day - level 0.6-1.5 meq/L)
- phenytoin 300 mg/day
- divalproex 750mg/day
- CBZ 450 mg/day
- stimulants for inattentive impulsivity
-SSRI for hostility impulsivity aggression
sertraline 150-200mg;
fluoxetine 60-80mg

Cluster B - Borderline PD
- avoid BZD if possible, don’t use bupropion if eating d/I, TCA avoided with suicidality
IPT plus fluoxetine first line
Consider antipsychotics and mood stabilizers if ineffective
Others
Naltrexone , clonidine for hyperaeousla , fatty acids

Question 8

Medication for bulimia nervosa

Answer 8

Fluoxetine start at 10-20mg with goal of 60mg qday

Question 9

Binge eating pharmacotherapy

Answer 9

Topiramate sibutramine (removed from US market) and zonisamide effective in binge suppression and weight loss
SSRI - cital escital fluox sert decrease binge frequency
NOT lamotrigine

Question 10

Cluster b personality disorders

Answer 10

Only ones respknsive to pharmacotherapy 
Antisocial
Narcissistic 
Histrionic
Borderline