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BPM2 Exam 5 - Neurology and Bahavioral Science 3 > NB13-3 & 13-4 - Personality, Disruptive, Impulse Control, and Conduct Disorders > Flashcards

NB13-3 & 13-4 - Personality, Disruptive, Impulse Control, and Conduct Disorders Flashcards

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1
Q

List the personality disorders and describe how they are grouped together.

A

Cluster A (aka - odd/eccentric) - paranoid, schizoid, and schizotypal

Cluster B (aka - dramatic/emotional/erratic) - histrionic, borderline, narcissistic, antisocial

Cluster C (aka - anxious/fearful) - avoidant, dependent, obsessive-compulsive

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2
Q

What is the general definition of a personality disorder? When do these disorders typically start to present?

A

A chronic and pervasive pattern of perceiving, relating, & thinking about the environment and oneself that is culturally deviant, maladaptive, and/or distressful.

The characteristics of these disorders typically start to appear in childhood-adolescence with behaviors solidifying with age. Not usually diagnosed until adulthood

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3
Q

What is the general treatment plan and prognosis for personality disorders.

A

Treatment is usually some kind of CBT. Medications can be used as an adjunct

Prognosis isn’t good because treatment can be difficult due to:

  • patient disinterest
  • the inherent difficulty in unlearning entrenched behaviors
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4
Q

How does a person with a paranoid personality disorder (PPD) generally behave? What are some differential diagnoses for this disorder?

A

The general theme of their behavior is distrust and suspicion.

Differential Diagnoses:

  • Delusional Disorder Persecutory Type - these patients are sure of their paranoias while PPD patients are just suspicious
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5
Q

How does a person with a schizoid personality disorder typically behave?

A

The general theme of their behavior is interpersonal detachment. They typically:

  • lack a desire for close relationships
  • prefer solitary activities
  • derive pleasure in few activities
  • are indifferent to praise/criticism
  • are emotionally cold/detached
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6
Q

How does a person with a schizotypal personality disorder typically behave?

A

The general them of their behavior is eccentricity. Example symptoms:

  • ideas of reference (assuming things are directed right at you)
  • odd beliefs or magical thinking
  • unusual perceptual experiences (almost like a hallucination)
  • odd thinking and speech (vague/metaphorical)
  • suspiciousness
  • odd appearance
  • problematic social relatedness
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7
Q

What are the differential diagnoses for schizotypal personality disorder?

A

Schizotypal behaviors are on the schizophrenia spectrum those disorders should be considered as before diagnosis. Schizotypals don’t have psychotic symptoms but they may eventually develop them.

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8
Q
A

E

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9
Q
A

B

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10
Q

How does a person with a histrionic personality disorder typically behave?

A

The general them of their behavior is excessive emotionality. Example symptoms:

  • need to be center of attention
  • inappropriately provocative behavior
  • shallow and rapidly shifting emotions
  • impressionistic speech that lacks detail
  • exaggerated emotional expression
  • considers relationships intimate
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11
Q

How does a person with a borderline personality disorder typically behave?

A

The general them of their behavior is instability. Example symptoms:

  • unstable intense relationships with alternating idealization and devaluation
  • frantically avoids abandonment
  • marked reactivity of mood
  • chronic feelings of emptiness
  • unstable self-image
  • self-damaging impulsivity
  • suicidal gestures/self-mutilation
  • transient stress related dissociation/paranoia
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12
Q

How is borderline personality disorder usually treated?

A

With dialectical behavioral therapy (DBT) which is essentially CBT with a focus on self-acceptance yet the need to change. Usually utilizes the following techniques:

  • Mindfulness
  • Distress Tolerance
  • Emotion regulation
  • Interpersonal effectiveness

The goal is to help the patient become aware of the sequence of emotions and thoughts that precede destructive behavior and to break that sequence.

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13
Q

How does a person with narcissistic personality disorder (NPD) typically behave?

A

The general theme of their behavior is grandiosity. Example Symptoms:

  • grandiose sense of self-importance
  • preoccupied with success
  • requires admiration
  • sense of entitlement
  • interpersonally exploitative
  • lacks empathy with haughty attitudes
  • An insult to their narcissism often results in a rage reaction
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14
Q

What differential diagnoses should be considered before diagnosing narcissistic personality disorder?

A
  • Delusional disorder grandiose type - these patients typically have a single grandiose belief of delusional proportion and the belief usually occurs abruptly and at an older age. In NPD, the person just shows a general arrogance
  • BPI Disorder - these patients must have mood disturbances with more symptoms than grandiosity
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15
Q

How would a person with antisocial personality disorder (ASPD) typically behave?

A

The general theme of their behavior is a pervasive disregard for other’s rights. Example symptoms:

  • repeated unlawful acts
  • deceitfulness
  • irritability and aggressiveness
  • reckless disregard for safety of self or others
  • irresponsibility
  • lack of remorse

Person must be at least 18 and there must be evidence of a Conduct Disorder with onset before 15

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16
Q
A

E

It’s not “B” because several ASPD symptoms are required for diagnosis

17
Q
A

B

18
Q

How would a person with avoidant personality disorder typically behave? What are the differential diagnoses?

A

The general theme to their behavior is an inferiority complex. Differential diagnoses are:

  • Schizoid Personality Disorder (SPD) - SPD patients have no desire for a relationship while avoidant personality patients desire relationships but are reluctant to initiate them
  • Social Anxiety Disorder - SAD patients will exhibit markedly higher amounts of fear of negative evaluations
19
Q

How would a person with dependent personality disorder behave?

A

The general theme of their behavior is excessive need to be cared for. Example symptoms are

  • indecisive
  • difficulty disagreeing
  • difficulty initiating due to low confidence
  • goes to excessive lengths to keep/gain support
  • feels helpless when alone
  • urgently seeks another relationship if one ends
20
Q
A

A

21
Q

How would a person with obsessive-compulsive personality disorder (OCPD) behave?

A

The general them to their behavior is inflexible perfectionism and control. Example symptoms:

  • preoccupation with details, rules, and lists until point of activity is lost
  • excessive devotion to work
  • rigid and stubborn
  • over conscientious/scrupulous
  • reluctance to delegate or work with others
  • hoarding and miserly behavior
22
Q

What are the differential diagnoses for OCPD?

A
  • OCD - this disorder also involves uncontrolled intrusive thoughts and/or repeated rituals
23
Q

What is the most common way for physicians to assess a patient’s personality traits?

A

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2)

24
Q

Lis the disruptive, impulse-control, and conduct disorders (DICCDs) we need to know and say what the common features between these disorders are.

A
  • Oppositional defiant disorder
  • Conduct disorder
  • Intermittent explosive disorder
  • Kleptomania
  • Pyromania

Patients with these disorders have problems with the self-control of emotions and behaviors to the point that they begin violating the rights of others and/or bring others into conflict with societal norms or authority figures.

25
Q

What are the diagnostic criteria for oppositional defiant disorder (ODD)?

A

The patient exhibits consistent behaviors/emotions characterized by:

  • Angry/Irritable mood
  • Argumentative/Defiant behavior
  • Vindictiveness

These behaviors do NOT result in serious violations of the rights of others (just minor violations).

26
Q

What are the diagnostic criteria for conduct disorder (CD)?

A

Repeated and persistent serious violations of rights/societal norms with at least 3 of the following symptoms occurring in or across any of the four categories:

  • Aggressive Conduct - bullies, uses weapons, cruelty to people/animals, rape, stolen with confrontation
  • Deliberate Property Destruction
  • Deceit/Theft - broken in, lies, stolen without confrontation
  • Serious Violation of Rules - breaking curfew, running away, truancy

Can be diagnosed in adults but most commonly seen in minors. Without correction, these kids could eventually be diagnosed with ASPD

27
Q

List the subtypes of CD.

A
  • Childhood-Onset Type (<10 yrs)
    • Usually boys
    • Usually characterized by aggression
    • Often have a history of ODD
  • Adolescent-Onset Type (>10 yrs)
    • Usually boys but girls are common also
    • Usually characterize by serious violations of rules (not aggressvie)
28
Q
A

B

29
Q

What is the etiology of ODD and CD? What is the usual treatment plan?

A

Multi-factorial causes, possibly including:

  • child’s constitutional temperament
  • suboptimal parenting techniques

Treatment usually involves anger management and communication skills training alongside parental training.

30
Q

What are the diagnostic criteria for intermittent explosive disorder (IED)?

A

Recurrent disproportionate outbursts representing a failure to control aggressive impulses as manifested by either:

  • Verbal aggression or non-damaging physical aggression occurring frequently
  • Damaging physical aggression occurring infrequently

Outbursts cannot be explained by other disorders and are usually brought on by feelings of frustration

31
Q

What are the differential diagnoses for IED?

A
  • CD & ASPD - these patients have habitual symptoms with IED patients are intermittent
  • Adjustment disorder with disturbance of conduct - with these patients the disturbed conduct is in response to significant psychosocial stressor. In IED it’s usually several small things causing the conduct
  • Disruptive Mood Dysregulation Disorder (DMDD) - these patients also have an an irritable baseline mood while IED patients have a normal baseline mood
32
Q

What are the diagnostic criteria for Kleptomania?

A

The patient experiences the following symptoms:

  • Recurrent irresistible stealing of unneeded objects
  • Increasing tension before stealing
  • Pleasure, gratification, or relief when stealing

The stolen items must be unwanted and are usually of low value and are hoarded, given away, or returned. Otherwise, it could just be ordinary shoplifting

33
Q
A

D

34
Q

What are the diagnostic criteria for pyromania?

A
  • Multiple episodes of deliberate fire setting with preceding tension or emotional arousal
  • Fascination with fire and fire paraphernalia
  • Pleasure, gratification, or relief when setting fires or witnessing/participating in the aftermath
  • No other cause or motivating factor
35
Q
A
  1. Not likely
  2. Not Likely (more pay?)
  3. Likely
  4. Not likely
  5. Likely
36
Q

Describe the biochemical correlates for impulse control problems.

A
  • Decreased serotonin is associated with poor PFC impulse control
  • Increased DA, especially in the VTA-Nucleus accumbens circuit, is associated with rewarding sensations that may overide the brains impulse control capacity
37
Q

What are the typical treatment approaches for impulse control problems?

A
  • Behavioral Therapy Techniques
    • teach to avoid triggers or substitute a behavior when triggers are encountered
    • associate impulse with something noxious (aversion therapy)
    • expose patient to triggers but disallow impulsive action to occur (exposure & response prevention)
  • Many medications have been tried (ie - SSRIs) but with variable success

BPM2 Exam 5 - Neurology and Bahavioral Science 3 (19 decks)

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