Personality D Flashcards
personality D DSM
1) pattern of behavior/inner expereine that deviates from person’s culture and is manifested in 2 or more ways: cognition, affect, personal relations, impulse control
2) the pattern: is pervasive and inflexible in a broad range of situations. is stable and has an onset no later than adolescence or early adulthood. leads to sig distress in functioning. not accounted for by mental/medical illness or drugs
personality disorder nmemonic
CAPRI
cognition, affect, personal relations, impulse control
PeD clusters
Cluster A: MAD
Cluster B- BAD
Cluster C- SAD
Cluster A
schizoid, schizotypal, paranoid
pt seem eccentric, peculiar, or withdrawal
familial associations with psych D
Cluster B
antisocial, borderline, histrionic, narcissistic
pt seem emotional, dramatic, inconsistent
familial association with mood D
Cluster C
avoidant, dependent, OC
pt seem anxious or fearful
familial association with anxiety D
personality D tx
hard bc pt not aware that they need tx. chronicl, lifelong. but psychotherapy and group therapy are most helpful
paranoid personality D (PPD) DSM
general distrust of others beginning by early adulthood and present in variety of contexts. need 4/7
1) suspicious without evidence that others are exploiting or deceiving him
2) preoccupation about trustworthiness of acquitances
3) reluctance to confide in others
4) interpretation of benign remarks as threatening or demeaning
5) persistence of grudges
6) perception of attacks on his or her character that are not apparent to others- quick to counterattack
7) recurrence of suspicions regarding fidelity of spouse or lover
PPD
M>F
higher incidence in family of schizophrenics
DD: paranoid schizophrenia. but unlike schizophrenia, PD pt don’t have fixed delusions and are not frankly psychotic. may have transient psychosis under stress.
chronic, lifelong.
PPD tx
psychoterapy. antianxiety meds for short term and antipsychotics for transient psychosis
schizoid PeD DSM
pattern of voluntary social w/d and restricted range of emotional expression, beginning in early adulthood in variety of context. 4/7:
1) neither enjoying or desiring closer relationships including family
2) choosing solitary activities
3) little interest in sex
4) pleasure in few if any activities
5) few friends or confidants
6) indifference to praise or criticism
7) emotional coldness, detachment, flattened affect
SPeD
M=2F. DD-paranoid schizophrenia (no fixed delusions), schizotypal PeD- don’t have same eccentric or magic thinking in schizotypal
chronic but not always lifelong
schizoid is an android
schizotypal PeD DSM
pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions and discomfort with close relationships, beginning by early adulthood and present in a variety of contexts. 5/9
1) ideas of reference
2) old beliefs or magical thinking inconsistent with culture
3) unusual perceptual experiences (such as bodily illusions)
4) suspiciousness
5) inappropriate or restricted affect
6) odd or eccentric appearances or behavior
7) few close friends or confidants
8) odd thinking or speech (vague, stereotyped)
9) excessive social anxiety
magical thinking may include: belief in clairvoyance or telepathy, bizarre fantasies or preoccupations, belief in superstitions
odd behaviors include cults or strange religious practices.
schizotypal PeD DD
paranoid schizophrenia: not frankly psychotic
Schizoid PeD
cluster A tx
psychotherapy. antipsychotics during transient psychosis)
antisocial PD
pattern of disregard for others and violation of the rights of others since age 15. pt must be 18 for this dx. hx of behavior consistent with conduct disorder
3/7
1) failure to conform to social norms by committing unlawful acts
2) lying for personal gain repeatedly
3) impulsivity- failure to plan ahead
4) irribale and aggressive, repeated fights
5) recklessness and disregard for safety of self and others
6) ireesponsible, can’t sustain work or honor financial obligations
7) lack of remorse for actions
antisocial PeD
M>F. higher in poor urban area and prisoners. genetic. dd drug abuse
usually chronic but may improve with age.
many have somatic complaints and substance abuse or MDD
antisocial PeD
1st line- psychotherapy
pharm for sx of anxiety or depression but highly addictive potential
BPD DSM
pervasive pattern of impulsivity and unstable relationships, affects, self image, and behaviors, present by early adulthood and variety of contexts. 5/9
1) desperate efforts to avoid real or imagined abandonment
2) unstable , intense interpersonal relationships
3) unstable self image
4) impulsivity in at least 2 harmful ways (spending, sex, drug)
5) recurrent suicidal threats or self mutilation
6) unstable mood/affect
7) general feeling of emptiness
8) difficulty controlling anger
9) transient, stress related paranoid ideation or dissociative sx
BPD
1-2%, W>M. 10% suicide rate. DD schizophrenia- no frank psychosis.
stable, chronic course. often co-exist with MDD
BPD nmemonic
IMPULSIVE: impulsive, moody, paranoid under stress, unstable self image, labile- intense relationships, suicidal, inappropriate anger, vulnerable to abandonment, emptiness
BPD tx
psychoterhapy
pharm for sx
histrionic PeD (HPD)
pattern of excessive emotionality and attention seeking, present by early adulthood in variety of conetexts5/7
1) uncomfortable when not the center of attention
2) inappropriately seductive or provocative behavior
3) uses physical appearache to draw attention to self
4) has speech that is impressionist and lacking in detail
5) theatrical and exaggerated expression of emotion
6) easliy influenced by others or situation
7) perceives relationships are more intimate than they actually are
HPD epi, dd, course, tx
often use defensive regression- revert to childlike behaviors
2-3%, W>M
DD: Borderline PeD, - more suicide/depression/ less functional.
chronic, improve with age
psychotx. pharm for depressive or anxious sx
narcissistic personality disorder (NPD) DSM
pattern of grandiosity, need for admiration, lack of empathy beginning by early adulthood and present in a variety of contexts 5/9
1) exaggerated sense of self importance
2) preoccupied with fantasies of unlimited money, success etc
3) belives he is unique and can only associate with other high status ppl
4) needs exessvive admiration
5) has sense of entitlement
6) takes adv of others for self gain
7) lacks empathy
8) envious of others or believes others are envious of themselves
9) arrogant or haugty
NPD dd
antisocial PeD. both explode but NPD want status and rec while APeD want material gain or subjugation of others.
NPD couse tx
chronic, higher incidence of depression and midlife crisis bc other importance they place on youth and power
tx: psychotherapy. lithium if mood swings of comorbid mood disorder is dx
avoidant PeD DSM
patter of social inhibition, hypersensitivity and feelings of inadequacy since early adulthood. 4/7
1) avoids occupation with interpersonal contact bc fear criticism and rejection
2) unwilling to interact unless certain of being liked
3) cautious of interpersonal relationships
4) preoccupied with being criticized or rejected in social situations
5) inhibited in new social situations bc feels inadequate
6) believes he is socially inept and inferior
7) reluctant to engage in new activities for fear of embarrassment
avoidant PeD DD
schizoid PeD: don’t desire companionship
social phobia- embarrassement in particular setting while this is rejection overall and sense of inadequacy. many have both
dependent PeD- both cling to relationships. but DPeD actively/ aggressively seek relationships while this are slow to get involved.
Dependent PeD DSM
pattern of submissive and clinging behavior due to excessive need to be taken care of. 5/8
1) difficulty making everyday decisions w/o reassurance from others
2) needs other to assume responsibilities for most ares of his/her life
3) can’t express disagreement c fear losing approval
4) difficulty initiating proj bc lack self confidence
5) goes to excessive length to obtain support from others
6) feels helpless when alone
7) urgently seeks another relationship when one ends
8) preoccupied with fears of being left to take care of self
dependent PeD epi, dd, course, tx
M>M
DD- avoidance PeD, borderline PeD and histrionic (all sep on others but these two can’t maintain long relationships.)
chornic, decr with age
prone to depression when lose dependent person
tx: psychotx.
OCPeD DSM
preoccupation with orderliness, control, perfection at expense of efficiency. early adulthood. 4/8
1) precook with details, rules, lists, org such that major pt of activity is lost
2) perfectionism that is detrimental to completion
3) excessive devotion to work
4) excessive conscientiousness and scrupulousness about morals and ethics
5) will not delgate tasks
6) unable to discard worthless obj
7) miserly
8) rigid and stubborn
OCPeD epi DD, tx
M>W. oldest child, genetic
DD: OCD- OCPD don’t have recurrent obsessions or compulsions + egosyntonic. narcissitic PeD- both involve assertive and ahcievement but NPD are motivated by status while OCPD motived by work itself
unpreditable course may dev OCD.
tx: psycho. pharm tx sx
personality disorders not otherwise specified (NOS)
don’t fet in ABC. passive aggressive PeD, depressive PeD, sadomasochistic PeD, sadistic PeD
substance abuse
pattern of substance use leading to impairment or distress for at least 1 year with 1/4
1) failure to fulfill obligations at work, school, home
2) use in dangerous situations
3) recurrent substance related legal prob
4) conti use despite social or interpersonal problem
substance dependence DSM
use leading to impairment or distress manifested by 3/7 w/in 12mo
1) tolerance
2) withdrawal
3) using substance more than originally intended
4) persistent desire or unsuccessful effort to cut down
5) sig time spent in getting, using or recovering
6) decr social, occupational, or recreational activités bc of use, continued use despite subsequent physical or psych problem.
dx of dependence supersede dx of abuse
substance abuse/dep epi
17% in US. M>W. most common, caffeine, alcohol, nicotine. commonly get depressive sx.
alcohol ptwy
dd
alcohol ptwy
activates GABA and 5HT R in CNS and inhibits glutamate R. result in sedating effect
alcohol + alc deH –> acetaldehyde + ald deH –> acetic acid.
CAGE
2 yes = abuse. 1 yes= suspicion
1) have you ever wanted to cut down on drinking
2) have you ever felt annoyed by criticism of your drinking
3) have you ever felt guilty about drinking?
4) have you ever taken a drink as an eye opener (to prevent shakes)
alcohol intox dx
serum EtOH. 50% show sx when BAL >150mg/dl.
CT head rule out subdural hematoma
DD: hypoglycemia, hypoxia, mixed Et-OH drug overdose, ethylene glycol, methanol poisoning, hepatic encephalopathy, psychosis, psychomotor seizures
alcohol intox tx
acute intox: ensure ABC. monitor electrolyte and Acid base status. finger stick glucose to exclude hypoglycemia
thiamine, naloxone (reverse opiods) and folate
dependence: AA, disulfiram (inhibit aldehyde deH), psychotx, SSRI, naltrexone (decr craving)
EtOH w/d
lifting of chronic depressant effect on CNS –> CNS excitation.
sx begin 6-24hr and last 2-7d
Mild: irritability, tremor, insomnia
modrate: diaphoresis, fever, disorientation
Severe: grand mal seizure, DT
alc withdrawal syndrome sx and signs
insomnia, anxiety, tremor, irritability, anorexia, tachycardia, hyperreflexia, HTN, fever, seizure, hallucination, delirium
delirium tremens (DTs)
begins w/n 72 hr of cessation. 5% of hospitalized EtOH w/d cases. 15-20% die if untreated. delirium, visual/tactile hallu, gross tremor, autonomic instability, fluctuating levels of psychomotor activity
