Lecture 23: Affective disturbances in patients with personality disorders Flashcards
Describe some pro’s and con’s of categorical and dimensional approaches to classification?
Categorical (clinical features defined before hand, categories are mutually exclusive and jointly exhaustive, binary approach, diagnosis based on distinct categories representing different diagnoses)
- Pros:
- -> Standardised
- -> Reliable
- -> Helps research of diseases
- -> Aids communication
- -> Clear diagnosis
- Weaknesses:
- -> Symptom definition
- -> Co-morbidity and co-occurence of symptoms
- -> Stigma
- -> Validity concerns
Dimensional (while clinical features are defined in advance degree that a patient stays on a position is a continuum or dimension / diagnosis depends on degree or severity / continuous –> how much or many):
- Pro’s:
- -> Validity
- -> More info on specific symptoms
- -> Wider range of diagnostic factors - more than symptoms
- -> Allows flexibility
- Cons:
- -> Difficiult to communciate diagnosis
- -> Does it hamper disease specific research
- -> Less reliable?
Describe the DSM-V key features of personality disorders?
A personality disorder is:
- An enduring pattern of internal experience and behaviours
- That deviate from the person’s culture
- That start in adolescence
- But are stable over time
- Pervasive and inflexible
- Cause significant distress or impairment
Hoes ICD-11 describe personality disorder?
Problems with the functioning aspects of self (self-worth, self accuracy, self-direction, self-identity) or interpersonal disturbance (maintaining friendships, understanding others perspectives or managing conflict) that occurs for a long period of time - at least 2 years
These problems are illustrated through cognitive patterns, expressed emotion, behaviour or emotional experience and they arise in situations involving just the self as well as others
The pattern is abnormal to developmental level as well as socio-political culture
The pattern causes distress or impairment to personal, family, social or occupational aspects of functioning
What changes occurred in the ICD-11 description of personality disorders?
- No individual PD
- Dimensional approach based on severity of personality disturbance with a sub-diagnostic description of personality difficulty
- 5 qualifiers which indicate the main focus of disturbance (negatively affectivity, anakastia, disinhibition, dissociality, detachment) –> trait specific
- Borderline description specifier also added
Provide descriptions of the following DSM-5 personality disorders
Cluster A (odd or eccentric)
a) Paranoid
b) Schizoid
c) Schizotypal
Cluster B (dramatic, emotional or erratic)
d) Antisocial/dissocial
e) Borderline
f) Histrionic
g) Narcissistic
Cluster C (anxious or fearful)
h) Avoidant
i) Dependent
j) Obsessive-compulsive
a) Distrust and suspiciousness that other’s motives are bad intent
b) Social isolation/detachment and limited range of emotional expression
c) Uncomfortablility in close relationships, cognitive or perceptual distortion and eccentric behaviour
d) Lack of care and violation of others rights
e) Emotional instability, interpersonal instability, self-image instability and impulsivity
f) Dramatic with emotions and seeking attention
g) Grandiose beliefs and need for admiration and lack of empathy
i) Inhibited in social context, hypersensitive to criticism and feels inadequate
j) Clingy behaviour, submissive and need to be taken care of
k) Need for perfectionism, order and control
What percentage of the population may have a personality disorder?
15% based on DSM-!V criteria
70% of prisoners may have antisocial/dissocial personality disorder
10-20% of mental health settings may have borderline personality disorder
Compare and contrast personality disorders to affective disorders?
Onset
- PD –> early adolescence
- Affective disorders –> later adolescence or early adulthood
Course
- PD –> course is continuous
- Afective disorder –> episodic course
Predominately affects
- PD –> All aspects of perception of self and environment and interaction
- Affective Disorder –> specific aspects of self and interactions
Presentation:
- PD –> no change from person’s baseline
- Affective disorders –> abnormal from pre-morbid personality
Causal factors (G >/< E)
- PD –> proportion of environmental contribution is higher than that of affective disorders
- Affective disorder –> compared to PD a higher proportion of genetic contribution to cause, still significant environmental affect
Prevalence
- PD –> 15%
- Affective Disorders –> 7% Depression, 2% Bipolar (close to 20% overall)
Gender ratios
- Affective disorders –> Depression 2:1 women to men, BD 1:1
- PD –> overall 1M: 4F / Dissocial 4M: 1W
Provide some comments on how the changing categorisation of dysthymia represents conflict on whether personality caused or affective disorder caused?
Historically the term has been used for all affective disorders and then as a character/personality trait
Later has been included in diagnostic categories akin to a sub-threshold affective disorder somehow bridging personality and affective disturbance
These changes may also reflect how the paradigm of our understanding of mental health has shifted from psychodynamic concepts of 20th century to neurobiology in 21st century
Describe the prevalence of personality disturbance in patients with BD and Depression?
Depression - 22% have comorbid PD
BD - 25% may have comorbid PD
The rate of personality disorder are higher within patients who have psychiatric disorders compared to the whole population.
Likewise those who have a personality disorder have higher rates of depression and bipolar
Sjastd wt al. 2012 00 provides rates of personality disorders and the proportion of patients with an affective disorder. Rates highest for borderline, antisocial and anankastic.
Name 5 different models for links between personality and affective disorders?
- Distinct clinically similar
- Can’t differentiate the two clinically - On spectrum
- Quantitatively rather than qualitatively distinct - Affective disorder is a risk/causational for PD
- PD is a risk/causational factor for affective disorder
- Share common risk/causational factors
What is the clinical significance of co-morbid Borderline PD with BD
Younger rage of onset
Shorter bipolar episodes
More frequent mood instability and atypical features of bipolar disorder
