PD overview

Question 1

Define personality disorder

Answer 1

A deeply ingrained and enduring pattern of inner experience + behaviour that deviates markedly from expectations in the individual’s culture, is pervasive + inflexible, has an onset in adolescence or early adulthood, is stable over time + leads to distress or impairment

Question 2

Epidemiology PDs

Which are most common

Answer 2

• Dissocial > histrionic > paranoid

- 4-13%

Question 3

Risk factors for PDs

Answer 3

• Society → low socioeconomic status
• Genetics (+ve FHx)
• Dysfunctional family → poor parenting + parental deprivation
• Abuse during childhood → sexual (BPD → Dr asked Charlie), physical, emotional, neglect

Question 4

Pathophysiology + aetiology of PDs

Answer 4

Biological:
o	Genetic
o	Neurodevelopmental (abnormal cerebral maturation)
Environmental:
o	Adverse social circumstance
o	Difficult childhood experience

Question 5

Clinical features of PDs

Answer 5

• Pt’s w/ PD have no insight
• Usually co-morbidities
• Individuals often present in crisis (following life events: e.g. relationship problems…etc)
• Many improve w/ time (uncommon in elderly)

Question 6

What are the clusters

Answer 6

1. Cluster A (Weird):
   a. Paranoid
   b. Schizoid
2. Cluster B (Wild):
   a. Dissocial (antisocial)
   b. Emotionally unstable personality disorder
   i. Borderline
   ii. (Impulsive)
   c. Histrionic
3. Cluster C (Worriers):
   a. Dependent
   b. Anxious (avoidant)
   c. Anankastic

Question 7

Investigations PD

Answer 7

1. Collateral Hx = important
2. Questionnaires: Personality Diagnostic Questionairre
3. Psychological testing: MMPI
4. CT head (or MRI): organic causes of personality change (frontal lobe tumours + intracranial bleeds)

Question 8

Treatment PD

Answer 8

1. Identify + Rx co-morbid mental health disorders
2. Treat symptoms
3. Some evidence for antipsychotics, mood stabilisers and antidepressants for specific Sx’s or co-morbidities
4. Psychological therapy
5. Social support
6. Treat co-existing substance misuse
7. Admission (if risks ^)
8. Crisis plan (agreed w/ patient)

+ RISK ASSESSMENT

Question 9

Biological treatments

Answer 9

• Atypical antipsychotics (olanzapine) – short term in certain PDs (paranoid)
• Mood stabilisers [anti-convulsants + lithium] (e.g. in emotionally unstable PD) for Sx’s such as mood instability + aggression
• Small role for anti-depressants

Question 10

Psychological treatments

Answer 10

• Psychodynamic psychotherapy (not mainstay according to oxford handbook)
• CBT
• DBT (dialectical behavioural therapy) → improve impulse control + reduce self-harm in emotionally unstable PD

Question 11

Social treaments

Answer 11

• Support groups
• Substance misuse services
• Assistance: housing, finance + employment
• Help to access education, voluntary work, meaningful occupation + work