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(C) BD > Lecture 20: Personality Disorders > Flashcards

Lecture 20: Personality Disorders Flashcards

1
Q

What is personality?

A

Enduring patterns of perceiving, relating to, and thinking about the environment and oneself.

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2
Q

What is a personality disorder?

A

Personality traits that are inflexible and maladaptive enough to cause significant distress and impairment of functioning.

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3
Q

What sub-groups are personality disorders MC in?

A
  • Psychiatric patients
  • Criminals
  • Alcohol-dependent
  • Drug-dependent (highest)
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4
Q

What are the common comorbidities with personality disorders?

A
  • Reckless/impulsive behaviors
  • Psychiatric comorbidities
  • Functional impairment
  • Non-compliance with treatment
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5
Q

What are the screenings for personality disorders?

A
  • Minnesota multiphasic personality inventory-2 restructured form (MMPI-2-RF)
  • Million clinical multiaxial inventory-3 (MCMI-III)
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6
Q

What are common effects on a clinical relationship with personality disorder?

A
  • Challenging to develop provider-patient support
  • More likely to see problems with distrust, irritability, etc
  • Increased risk of signing out AMA, after-hours calls, etc.
  • Patients tend to be very demanding but think their behavior is appropriate.
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7
Q

Describe a cluster A personality disorder.

A
  • Schizotypal (Awkward)
  • Schizoid (Aloof)
  • Paranoid (Accusatory)

Odd and cynical patients

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8
Q

Describe a cluster B personality disorder.

A
  • Borderline (Borderline)
  • Narcissistic (Best)
  • Antisocial (Bad)
  • Histrionic (flamBoyant)

Emotional, over the top patients.

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9
Q

Describe a cluster C personality disorder.

A
  • Dependant (Clingy)
  • Avoidant (Cowardly)
  • Obsessive-Compulsive (Compulsive)
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10
Q

What kind of traits would I expect in someone with cluster A disorders?

A
  • Paranoid: suspicious, overly sensitive, mistrustful (Fear)
  • Schizoid: shy, introverted, withdrawn, avoids close relationships. (Elsa)
  • Schizotypal: superstitious, socially isolated, eccentric (Sheldon)
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11
Q

What etiology increases the risk of cluster A disorders?

A

Parents who have irrational bursts of anger.

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12
Q

What is the cardinal symptom of a paranoid personality disorder?

A

Generalized distrust or suspiciousness of others such that their motives are interpreted as malevolent.

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13
Q

On PE, how would someone with a paranoid personality disorder present?

A
  • Formal
  • Skeptical
  • Mistrustful
  • Poor eye contact
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14
Q

How do we treat someone with paranoid personality disorder?

A
  • Antipsychotics (acute decompensation or frank delusions)
  • Therapy (often difficult)
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15
Q

Who is schizoid personality disorder most common in? (Elsa)

A

Men, but it is rare to see since they are avoidant.

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16
Q

What are possible risk factors for schizoid personality disorder?

A
  • Pregnancy during a famine
  • Environment devoid of nurturing
  • Autism
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17
Q

What are the cardinal symptoms of schizoid personality disorder?

A
  • Detachment from relationships
  • Introversion
  • Restricted range of emotional expression
  • Does not desire/enjoy close relationships
  • Preference for solitary pursuits
  • Poor social interaction due to impaired interpretations
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18
Q

How do we treat schizoid personality disorder?

A
  • Potentially antidepressants
  • Therapy (difficult since they do not feel distressed)
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19
Q

What is schizotypal personality disorder most commonly linked to? (Sheldon)

A

Genetic link to schizophrenia

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20
Q

What are the cardinal symptoms of schizotypal personality disorder?

A
  • Peculiar thoughts
  • Speech and behavior
  • Magical beliefs
  • Social difficulties
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21
Q

How does someone with schizotypal personality disorder tend to present on PE?

A
  • Constricted affect
  • Odd beliefs
  • Odd mannerisms
  • Tangential
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22
Q

How do we treat schizotypal personality disorder?

A
  • Low-dose antipsychotics (lamotrigine, lithium, etc…)
  • Group therapy
  • Individual therapy
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23
Q

What are the 4 types of cluster B disorders?

A
  • Antisocial (Jafar) (Bad)
  • Borderline (anakin) (Borderline)
  • Histrionic (regina george) (flamBoyant)
  • Narcissistic (Scar) (Best)
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24
Q

What patient groups is antisocial personality disorder MC in?

A
  • Prisoners
  • Alcoholics

Most likely to be serial killers

25
Q

What etiologies contribute to antisocial personality disorder?

A
  • 5x more common with first-degree relatives that have it, esp. identical twins.
  • Abusive or absent parents
  • Low socioeconomic status
26
Q

What are the cardinal symptoms of antisocial personality disorder?

A
  • Recurrent disregard for and violation of the rights and feelings of others
  • Poor job performance
  • Marital instability
  • Often have childhood diagnosis of conduct disorder
  • Pathological lying
  • LACK of remorse/guilt
  • Often manipulative, untrustworthy people.

Similar to conduct disorder

27
Q

How do we treat antisocial personality disorder?

A
  • Therapy (socially based interventions with others of similar temperaments and problems are tx of choice)
28
Q

What is the prognosis of antisocial personality disorder?

A

Terrible ):
Most treatment-refractory personality disorder.

29
Q

Who is borderline personality disorder MC in? (Anakin)

A

Women.

30
Q

What are borderline personality patients most in danger of?

A

Suicide. 80% have attempted.

31
Q

What patient groups are borderline personality disorder MC in?

A
  • Psych OP
  • Psych IP
  • ER patients
32
Q

What etiologies contribute to borderline personality disorder?

A
  • More common in families with BPD
  • Childhood trauma
  • Parental neglect
33
Q

What are the cardinal symptoms of borderline personality disorder?

A
  • Impaired relatedness with others (stormy)
  • Labile mood
  • Impulsivity
  • Self-injurious behavior
  • Poor self-image
  • Unstable relationships
  • Mood changes
  • Suicidal
  • Negative outlooks
34
Q

How do we treat borderline personality disorder?

A
  • Lithium (esp if high SI risk)
  • Carbamazepine (behavior control)
  • Antipsychotics
  • SSRIs
35
Q

What suggests a poor prognosis for borderline personality disorder?

A
  • Self-destructive behavior
  • Sabotaging treatment
  • Increase towards schizophrenia like symptoms.
36
Q

What is unique about histrionic personality disorder? (Regina George)

A
  • More likely to seek treatment
  • More common in women
37
Q

What etiologies contribute to histrionic personality disorder?

A
  • Associated with antisocial personality disorder.
  • Problematic parent-child relationships
38
Q

What are the cardinal symptoms of histrionic personality disorder?

A
  • Excessive, superficial emotionality and sexuality
  • Attention-seeking
  • Evade unpleasant responsibilities
  • Control others
  • Labile mood
  • Seductive
  • Overly concerned with physical appearance
  • DEPENDENT on provider
39
Q

How do we treat Histrionic personality disorder?

A
  • MAOIs (maybe)
  • SSRIs (tx of comorbidities)
  • Therapy (Group, couple/marital, individual)
40
Q

How is the prognosis for histrionic personality disorder?

A

Pretty good, generally improves over time.

41
Q

Who is narcissistic personality disorder MC in?

A

Men

42
Q

What are the theories behind narcisstic personality disorder? (Scar)

A
  • Excessive appreciation as a child
  • Underappreciation as a child
43
Q

What are the cardinal symptoms of narcisstic personality disorder?

A
  • Grandiosity
  • Notable lack of empathy
  • Lack of consideration for others
  • Sense of entitlement
  • Deserve special treatment
  • Hypersensitivity to criticism
  • Self-absorbed
  • Externalizing problems
  • Depressed and withdrawn if self-image is damaged.
44
Q

How do we treat narcissistic personality disorder?

A
  • Treat comorbidities
  • Group therapy (but difficult if they get criticized)
  • Couple/marital therapy (avoid criticizing them)
  • Individual
45
Q

How is the prognosis of narcissistic personality disorder?

A
  • Symptoms generally don’t improve over time without treatment
  • Depression common in middle-aged and older.
46
Q

What are the three cluster C disorders?

A
  • Avoidant (Piglet) (Cowardly)
  • Dependent (Cinderella) (Clingy)
  • Obsessive-Compulsive (Prof Mellert) (Compulsive)
47
Q

What are the etiologies of avoidant personality disorder?

A
  • Stagnation when going through normal developmental stage of shyness and fear of strangers.
  • Caution when diagnosing a young child, because they may outgrow the shyness.
48
Q

What are the cardinal symptoms of avoidant personality disorder?

A
  • Persistent pattern of avoidance
  • Anxiety, leading to restricted lifestyle
  • Introversion with limited social interactions
  • Awkward and uncomfortable in social situations
  • Fears of rejection
  • Very passive
  • Poor response to criticism
49
Q

How do we treat avoidant personality disorder?

A
  • SSRIs
  • MAOIs
  • BBs
  • Anxiolytics (buspirone, BZDs)
  • Group therapy
  • Individual therapy
50
Q

What suggests a poor prognosis for avoidant personality disorder?

A
  • Other personality disorders
  • Poor environments

Normally has one of the best prognosis of the personality disorders

51
Q

What are the cardinal symptoms of dependent personality disorder? (Cinderella)

A
  • Lifelong interpersonal submissiveness
  • Poor self-esteem
  • Fear of abandonement
  • Lack of self-confidence
  • Often seek to be in a new relationship
  • Difficulty making decisions alone
  • Outwardly agree with others even if they inwardly disagree.
52
Q

How do you treat dependent personality disorder?

A
  • SSRIs/TCAs can treat associated symptoms.
  • Family/couples therapy to reinforce patient autonomy
  • Group: Considerable benefit!
  • Individual therapy: assertiveness training
53
Q

How is the prognosis for dependent personality disorder?

A
  • Generally good, especially if no other comorbidities.
  • More capacity for empathy or trust
54
Q

What are the etiologies behind OCPD? (Prof Mellert)

A
  • Overly controlling parenting
  • Stagnation in “anal stages” of development
  • More common first-degree relatives
55
Q

What are the cardinal symptoms of OCPD?

A
  • Rigidity
  • Constricted affect
  • Inflexibility
  • Stubbornness
  • Need for orderliness and control
  • Perfectionist
  • Frugal
  • Occupational difficulty (poor group work)
  • Devoted to work
  • Preoccupation with lists
56
Q

What is the difference between OCPD and OCD?

A
  • OCPD does not act on actual obsessions.
  • OCD is much more focused on specific obsessions and generally are distressed from their behaviors.
  • OCD spends much more time on their tasks.
57
Q

How do we treat OCPD?

A
  • SSRIs may help (fluoxetine/prozac, fluvoxamine/luvox)
  • Therapy (pts generally don’t feel distressed, so difficult)
58
Q

How is the prognosis of OCPD?

A
  • Generally good if no comorbidities
  • Self-discipline and organization may preclude complications
  • Prone to anxiety and depression

(C) BD (25 decks)

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