First Aid: Personality Disorders Flashcards
1
Q
What word is used to describe the lack of insight patients with personality disorders have?
A
ego-syntonic
2
Q
What is the DSM-IV criteria for diagnosing personality disorders?
A
- Pattern of behavior/inner experience that deviates from the person’s culture and is manifested in 2 or more of the following ways: Cognition, Affect, Personal relations, impulse control
- The pattern is pervasive an inflexible in a broad range of situations, is stable and has onset NO LATER THAN adolescence/early adulthood, leads to significant distress in functioning, and is not accounted for by another mental/medical illness or substance use
3
Q
What is the population prevalence for each of the personality disorders?
A
1%
4
Q
What are the cluster A personalities?
A
Schizoid
Schizotypal
Paranoid
5
Q
How do patients with cluster A personalities appear?
A
Eccentric
Peculiar
Withdrawan
6
Q
Cluster A has familial association with what type of disorders?
A
psychotic
7
Q
What are the cluster B personalities?
A
Antisocial
Borderline
Histrionic
Narcissistic
8
Q
How do patients with cluster B personalities appear?
A
Emotional
Dramatic
Inconsistent
9
Q
Cluster B has familial association with what type of disorders?
A
mood
10
Q
What are the cluster C personalities?
A
Avoidant
Dependent
Obsessive-Compulsive
11
Q
How do patients with cluster C personalities appear?
A
Anxious or fearful
12
Q
Cluster C has familial association with what type of disorders?
A
anxiety
13
Q
What is an example of a personality disorder, NOS?
A
passive-aggressive personality disorder
depressive personality disorder
sadomasochistic personality disorder
sadistic personality disorder
14
Q
How do you treat a personality disorder?
A
- VERY difficult (patients do not perceive problem, so do not seek treatment)
- Pharmacologic treatment of little use
- Psychotherapy and group therapy are the most helpful
15
Q
Angry and hostile patient with pervasive distrust and suspiciousness of others.
A
Paranoid Personality Disorder
16
Q
What is the DSM-IV criteria for Paranoid personality disorder?
A
General distrust of others, beginning by early adulthood and present in a variety of contexts. At least 4 s/s must be present.
17
Q
What are the s/s of paranoid personality disorder?
A
- Suspicion (without evidence) that others are exploiting or deceiving him or her
- Preoccupation with doubts of loyalty or trustworthiness of acquaintances
- Reluctance to confide in others
- Interpretation of benign remarks as threatening or demeaning
- Persistence of grudges
- Perception of attacks on his or her character that are not apparent to others (quick to counter-attack)
- Recurrent of suspicions regarding fidelity of spouse or lover
18
Q
What is the prevalence of paranoid personality d/o?
A
.5-2.5%
19
Q
Which gender is more likely to have paranoid personality disorder?
A
men
20
Q
What would a family history of someone with paranoid personality look like?
A
may have family members with schizophrenia
21
Q
How does paranoid personality d/o differ from paranoid schizophrenia?
A
Pts with PPD do NOT have any fixed delusions and are NOT frankly psychotic (though may get transient psychosis under stressful situations)
22
Q
What is the prognosis for PPD?
A
- Some patients may eventually be diagnosed with schizophrenia
- The disorder usually has a chronic course, causing lifelong marital and job-related problems
23
Q
How do you treat PPD?
A
- Psychotherapy
- Antianxiety medication
- Short course of antipsychotics if they get transient psychosis
24
Q
Eccentric and reclusive patient with lifelong pattern of social withdrawal who is quiet, unsociable, and prefers to be alone.
A
Schizoid Personality Disorder
25
What sort of affect does a patient with Schizoid Personality Disorder have?
constricted or flattened
26
What is the DSM-IV criteria for diagnosing Schizoid Personality Disorder?
Pattern of voluntary social withdrawal and restricted range of emotional expression beginning by early adulthood and present in a variety of contexts. Requires 4 s/s.
27
What are the s/s of Schizoid Personality Disorder?
- Neither enjoying or desiring close relationships (including family)
- Generally choosing solitary activities
- Little (if any) interest in sexual activity with another person
- Taking pleasure in few activities (if any)
- Few close friends or confidants (if any)
- Indifference to praise or criticism
- Emotional coldness, detachment, or flattened affect
28
What is the prevalence of Schizoid Personality Disorder?
7%
29
What gender is more likely to have Schizoid Personality Disorder?
Men 2X more likely
30
Does Schizoid Personality Disorder have a family h/o schizophrenia?
NO
31
What is Schizoid Personality Disorder similar to?
Avoidant personality disorder (except that APD patients desire close relationships)
32
How do you treat Schizoid Personality Disorder?
- Psychotherapy is treatment of choice
- Low dose antipsychotics if transient psychosis
- Anti-depressants if pt has comorbid depression
33
Strange and eccentric patient has eccentric behavior and peculiar thought pattern.
Schizotypal Personality Disorder
34
What is the DSM-IV diagnostic criteria for Schizotypal Personality Disorder?
Pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, and discomfort with close relationships. Begins by early adulthood and is present in a variety of contexts. Need 5 or more s/s.
35
What are the s/s of Schizotypal Personality Disorder?
- Ideas of reference (including delusions)
- Odd beliefs and magical thinking, inconsistent with cultural norms
- Unusual perceptual experiences (such as bodily illusions)
- Suspiciousness
- Inappropriate or restricted affect
- Odd or eccentric appearance or behavior
- Few close friends or confidants
- Odd thinking or speech (vague, stereotyped, etc.)
- Excessive social anxiety
36
What are some examples of magical thinking seen in Schizotypal Personality Disorder?
- belief in clairvoyance or telepathy
- bizarre fantasies or preoccupations
- belief in superstitions
37
What is the prevalence of Schizotypal Personality Disorder?
3%
38
What is the treatment of Schizotypal Personality Disorder?
- Psychotherapy (treatment of choice)
| - Low-dose antipsychotics for transient psychosis
39
Charming patient who is impulsive, deceitful and has a history of law-breaking and lacks remorse for his actions.
Antisocial Personality Disorder
40
What is the DSM-IV criteria for diagnosing Antisocial Personality Disorder?
- Pattern of disregard for others and violation of the rights of others since age 15.
- Pt must be at least 18 yo for diagnosis.
- History of behavior as child/adolescent must be consistent with conduct disorder
- Need 3 or more s/s
41
What are the s/s of Antisocial Personality Disorder?
- Failure to conform to social norms by committing unlawful acts
- Deceitfulness/repeated lying/manipulating others for personal gain
- Impulsivity/failure to plan ahead
- Irritability and aggressiveness/ repeated fights or assaults
- Recklessness and disregard for safety of self or others
- Irresponsibility/ failure to sustain work or honor financial obligations
- Lack of remorse for actions
42
What events may be seen in the childhood history of a person with Antisocial Personality Disorder?
Being Abused
Hurting animals
Starting fires
43
What is the prevalence of Antisocial Personality Disorder in men or women?
- Men 3%
| - Women 1%
44
What is the epidemiology of Antisocial Personality Disorder?
Higher incidence in poor urban areas and in prisoners
45
What is the genetic component of Antisocial Personality Disorder?
5X increased risk among first degree relatives
46
What is an essential part of the history in a patient with potential Antisocial Personality Disorder?
Ascertain if drug abuse started before or after their antisocial behavior
47
What is the prognosis of Antisocial Personality Disorder?
- Usually has chronic course
| - Some improvement of symptoms may occur as patient ages
48
What are some common comorbidities of Antisocial Personality Disorder?
- Multiple somatic complaints
- Substance abuse
- Major depression
49
How do you treat Antisocial Personality Disorder?
- Psychotherapy (treatment of choice)
| - Pharmacotherapy (treats symptoms of anxiety or depression but use with caution due to high addictive potential)
50
Pt presents to ED due to failed suicide attempt. Has multiple cuts along arms and seems to have an unstable mood. Pt has poor self image and unstable relationships with others (feels alone in the world).
Borderline Personality Disorder
51
What is the DSM-IV criteria for diagnosing Borderline Personality Disorder?
Pervasive pattern of impulsivity and unstable relationships, affects, self-image, and behaviors, present by early adulthood and in a variety of contexts. Need at least 5 s/s.
52
What are the s/s of Borderline Personality Disorder?
IMPULSIVE
- Impulsive in at least 2 potentially harmful ways (spending, sex, substances)
- Moody (unstable mood/affect)
- Paranoid ideation or dissociative symtpoms under stress
- Unstable self image
- Labile, intense relationships
- Suicidal threats or attempts are recurrent or self-mutilation
- Inappropriate anger that is difficult to control
- Vulnerable to and desperately avoids real or imagined abandonment
- Emptiness
53
What does the "borderline" in Borderline Personality Disorder come from?
Pt's being on the borderline of neurosis and psychosis
54
What is the prevalence of Borderline Personality Disorder?
1-2%
55
What is the gender difference in Borderline Personality Disorder?
women are 2X more likely
56
What is the prognosis for Borderline Personality Disorder?
10% commit suicide
57
What are the common comorbidities of Borderline Personality Disorder?
- Major depression
- Substance abuse
- Suicide gestures and accidently kill themselves
58
What is the treatment for Borderline Personality Disorder?
- Psychotherapy
- Pharmacotherapy to treat psychotic or depressive symptoms as necessary (MORE USEFUL IN THIS THAN IN ANY OTHER PERSONALITY D/O)
59
What is a defense mechanism commonly used by those with Borderline Personality Disorder?
splitting (others are all good or all bad)
60
Sexually inappropriate and provocative patient is dramatic, flamboyant and extroverted but has never had a long-lasting and meaningful relationship. Seeks attention from everyone she meets and is excessively emotional.
Histrionic Personality Disorder
61
What is the DSM-IV criteria for Histrionic Personality Disorder?
Pattern of excessive emotionality and attention seeking, present by early adulthood and in a variety of contexts. At least 5 s/s must be present.
62
What are the s/s of Histrionic Personality Disorder?
- Uncomfortable when not center of attention
- Inappropriately seductive or provocative behavior
- Uses physical appearance to draw attention to self
- Has speech that is impressionistic and lacking in detail
- Theatrical and exaggerated expression of emotion
- Easily influenced by others or situation
- Perceives relationships as more intimate than they actually are
63
What defense mechanism is commonly used by those with Histrionic Personality Disorder?
Regression (revert to child-like behaviors)
64
What is the prevalence of Histrionic Personality Disorder?
2-3%
65
What is the gender differences in Histrionic Personality Disorder?
Women > men
66
Which type of patient is more functional, one with Histrionic Personality Disorder or Borderline Personality disorder?
Histrionic Personality Disorder
67
What is the prognosis for Histrionic Personality Disorder?
- Usually has chronic course
| - Symptoms may improve with age
68
What is the treatment for Histrionic Personality Disorder?
- Psychotherapy
| - Pharmacotherapy to treat depressive or anxious symptoms as necessary
69
Non-empathetic patient has a pattern of grandiosity and need for admiration. Demands special treatment and exploits others for own gain but has a fragile self esteem.
Narcissistic Personality Disorder
70
What is the DSM-IV criteria for Narcissistic Personality Disorder?
Pattern of grandiosity, need for admiration and lack of empathy beginning by early adulthood and present in a variety of contexts. Need 5 or more s/s.
71
What are the s/s of Narcissistic Personality Disorder?
- Exaggerated sense of self-importance
- Preoccupied with fantasies of unlimited money, success, brilliance, etc.
- Believes that he or she is special or unique and can only associate with other high-status individuals
- Needs excessive admiration
- Has sense of entitlement
- Takes advantage of others for self-gain
- Lacks empathy
- Envious of others or believes others are envious of him or her
- Arrogant or haughty
72
What is the prevalence of Narcissistic Personality Disorder?
less than 1%
73
How do you differentiate between an Antisocial personality and Narcissistic Personality Disorder?
- NPD patients exploit others for status and recognition
| - APD patinets want material gain or simply exploit to subjugate others
74
What happens when someone with Narcissistic Personality Disorder does not get the recognition they desire?
they become depressed
75
What is the prognosis for Narcissistic Personality Disorder?
- Chronic course
| - Higher incidence of depression and midlife crisis (high value on youth and power)
76
What is the treatment for Narcissistic Personality Disorder?
- Psychotherapy
| - Antidepressants or lithium may be used as needed (mood swings if pt has comorbid mood disorder)
77
Extremely shy patient stays in room and has intense fear of rejection to the point where he only takes jobs if he can work alone. Desires companions.
Avoidant Personality Disorder
78
What is the DSM-IV criteria for Avoidant Personality Disorder?
Pattern of social inhibition, hypersensitivity and feelings of inadequacy since early adulthood. At least 4 s/s.
79
What are the s/s of Avoidant Personality Disorder?
- Avoids occupation that involves interpersonal contact due to fear of criticism and rejection
- Unwilling to interact unless certain of being liked
- Cautious of intrapersonal relationships
- Preoccupied with being criticized or rejected in social situations
- Inhibited in new social situations because he or she feels inadequate
- Believes he or she is socially inept and inferior
- Reluctant to engage in new activities for fear of embarrassment
80
What is the prevalence of Avoidant Personality Disorder?
1-10%
81
How do you differentiate between social phobia and Avoidant Personality Disorder?
- If evident since before adulthood, more likely a personality disorder
- Social phobia is fear of EMBARRASSMENT in public, avoidant personality disorder is overall fear of REJECTION and inadequacy
- CAN HAVE BOTH!
82
How is an avoidant personality similar to a dependent personality?
Both cling to relationships (but avoidant is slow to get involved and dependent is aggressively seeking relationships)
83
What is the prognosis for Avoidant Personality Disorder?
- Usually chronic
| - Symptoms usually worse in adolescence (attractiveness and socialization are very important)
84
What are common comorbidities with Avoidant Personality Disorder?
- Anxiety disorders
| - Depressive disorders
85
What is the treatment for Avoidant Personality Disorder?
- Psychotherapy (assertive training)
- Beta blockers (control autonomic symptoms of anxiety)
- SSRIs (if pt has major depression)
86
Pt with poor self-confidence fears separation and cannot seem to care for himself. Allows others to make his decisions.
Dependent Personality Disorder
87
What is the DSM-IV criteria for Dependent Personality Disorder?
Pattern of submissive and clinging behavior due to excessive need to be taken care of. Need at least 5 s/s.
88
What are the s/s for Dependent Personality Disorder?
- Difficulty making everyday decisions without reassurance from others
- Needs others to assume responsibilities for most areas of his or her life
- Cannot express disagreement because of fear of loss of approval
- Difficulty initiating projects because of lack of self-confidence
- Goes to excessive lengths to obtain support from others
- Feels helpless when alone
- Urgently seeks another relationship when one ends
- Preoccupied with fears of being left to take care of self
89
What is the prevalence of Dependent Personality Disorder?
1%
90
What is the gender difference in Dependent Personality Disorder?
women > men
91
What type of patients begin to express dependent traits? Can these patients get diagnosed with DPD?
patients with debilitating illnesses (NO, features must manifest before early adulthood)
92
What is the course of Dependent Personality Disorder?
- Usually chronic
- Symptoms decrease with age or therapy usually
- Pt often prone to depression, especially after loss of person on whom they are dependent
93
What is the treatment for Dependent Personality Disorder?
- Psychotherapy
| - Pharmacotherapy to treat symptoms of anxiety or depression
94
Stiff, serious and formal patient is described by others as a perfectionist. Is inflexible and extremely orderly but tends to be unable to complete simple tasks in a timely manner. Very successful in his career but does not have many friends.
Obsessive-Compulsive Personality Disorder
95
What is the DSM-IV criteria for a patient with OCPD?
Pattern of preoccupation with orderliness, control, and perfectionism at the expense of efficiency, present by early adulthood and in a variety of contexts. Need at least 4 s/s.
96
What are the s/s of OCPD?
- Preoccupation with details, rules, lists and organization such that the major point of the activity is lost
- Perfectionism that is detrimental to the completion of task
- Excessive devotion to work
- Excessive conscientiousness and scrupulousness about morals and ethics
- Will not delegate tasks
- Unable to discard worthless objects
- Miserly
- Rigid and stubborn
97
What gender is more likely to have OCPD?
Men > women
98
True or false: OCPD is most commonly seen in the youngest child in a family.
FALSE: most commonly seen in the oldest child
99
What is the genetic component of OCPD?
Increased incidence in first degree relatives
100
How do you differentiate between OCD and OCPD?
- OCPD patients do not have recurrent obsessions or compulsions
- OCPD patients are ego-syntonic (are not aware they have a problem)
101
How do you differentiate between OCPD and NPD?
NPD patients are motivated to achieve due to status, OCPD patients are motivated by the work itself
102
What is the prognosis for OCPD?
- Some develop OCD
- Some develop schizophrenia
- Some develop MDD
- Some improve, some remain stable
103
What is the treatment of choice for OCPD?
psychotherapy
104
Pt is a stubborn, inefficient procrastinator who alternates between compliance and defiance and resists fulfillment of tasks. Always making excuses but lacks assertiveness and complains about misfortunes. Manipulates others to do chores and errands for them.
Passive-Aggressive Personality disorder
