Personality D/O

Question 1

Borderline personality d/o
Dx
Tx

Answer 1

Cluster B
dx: Recurrent suicidal behavior-> treats, gestures, self-mutilating behavior
Chronic feeling of emptiness
Efforts to avoid abandonment
Impulsiveness-> sex, substance, reckless driving, binge eating, spending
Labile moods and mood instability
Transient paranoid ideation or dissociative sx
Inappropriate episodes of intense anger
Identity disturbance

Tx: first line: Psychotherapy

Mood stabilizers-> target sx of affective dysregulation, impulsivity, aggression
Antipsychotics-> small/moderate effect on tx affective dysregulation

Question 2

Antisocial personality d/o
Dx
Tx

Answer 2

Cluster B
Dx:
Feared social situations
Breaks laws, no remorse or guilt, appears friendly on surface
Manipulative of relationships to gain power or material things
>18 yrs old (otherwise think conduct disorder)
Ex: The joker, Tony soprano

Tx:
Jail
Psychotherapy-> Set rules, Insist they are followed

Question 3

Cluster A personality D/Os

Answer 3

Social detachment w/ unusual behaviors
Weird, odd, eccentric

Schizotypal
Schizoid
Paranoid

Question 4

Cluster B Personality D/Os

Answer 4

Dramatic, wild, erratic, impulsive, emotional

Borderline
Narcissistic
Histrionic
Antisocial

Question 5

Cluster C Personality D/Os

Answer 5

Anxious, worried, fearful

Dependent
Obsessive-compulsive
Avoidant

Question 6

Avoidant Personality d/o
Dx
Tx

Answer 6

Cluster C
Fears rejection and criticism
Wants relationships but does not pursue them
Passes on promotions
Social withdrawal, awkward and uncomfortable in social situations
Ex-> Napoleon Dynamite, shy hot librarian

Tx:
Avoid power struggles
Make pts choose 
Psychotherapy
Social training
CBT, group therapy 
Pharmacotherapy:
BB for anxiety
SSRIs for depression

Question 7

Body dysmorphic d/o
Dx
Tx

Answer 7

Dx:
Excessive preoccupation that 1+ body part is deformed or an over exaggeration of a minor flaw
Females, teenagers
Linked with anxiety and depression

Tx:
Antidepressants 
SSRIs (prozac)
TCAs (clomipramine) 
Psychotherapy

Question 8

Dependent Personality d/o
Dx
Tx

Answer 8

Cluster C
Dx:
Dependent, submissive behavior (very needy and clingy)
Constantly needs to be reassured, relies on others for decision-making and emotional support
Will not initiate things
Intense discomfort when alone
Tx:
-Psychotherapy
-Anxiolytics or Antidepressants for symptomatic control

Question 9

Histrionic Personality d/o
Dx
Tx

Answer 9

Cluster B
Dx:
Attention seeking, want to be center of attention 
Dramatic
Flamboyant 
Seductive behavior
Sexually inappropriate 

Tx:
Psychotherapy:
CBT
Individual/group therapy 
No approved meds

Question 10

Narcissistic Personality d/o
Dx
Tx

Answer 10

Cluster B
Dx:
Grandiose self image and need for admiration from others
Difficulty displaying empathy 
Eccentric dress to draw attention 
Demands special treatment 

Tx: Psychotherapy&raquo_space; pharmacotherapy

• Individual or group therapy
• Gross affective instability (threats to others, poses threat to self/others)-> mood stabilizers (topiramate; valproic acid)

Tx narcissistic pt w/ chief complaint
-Begin w/ signed contract between healthcare provider and pt regarding acceptable communication and behavior in the office

Question 11

Obsessive-Compulsive d/o
Path
Pt
Dx
Tx

Answer 11

OCD
Path:
Anxiety disorder characterized by a combo of thoughts (obsessions) + behaviors (compulsions)
Pt:
Obsessions: recurrent or persistent thoughts/images
Specifiers:
-Good/fair insight: recognizer OCD beliefs are not true or may not be true
-Poor insight: thinks OCD beliefs are probably true
-Absent insight/delusional beliefs: completely convinced that the OCD beliefs are true
AND
Compulsions: repetitive behaviors the person feels driven to preform to reduce/prevent stress from the obsession

Dx:
4 major patterns
-Contamination (compulsion may include cleaning or hand washing)
-Pathologic doubt (forgetting to unplug iron)
-Symmetry/precision (must arrange objects w/ precision)
-Intrusive obsessive thoughts w/o compulsion

Tx:
Antidepressants -> SSRIs (prozac, Zoloft, Paxil), TCAs, SNRIs
CBT

Question 12

Obsessive-Compulsive Personality d/o
Dx
Tx

Answer 12

Cluster C
Dx:
Obsessions 
Perfectionist, preoccupied with details, rules and schedules 
Perfection at the expense of efficacy 

Tx:
Psychotherapy 
Pharmacologic +/-
BB for anxiety
SSRIs for depression

Question 13

Paranoid Personality d/o
Dx
Tx

Answer 13

Cluster A
Dx:
Suspicious, cold, humorless
Distrustful: misinterprets the actions of others as malevolent
Preoccupation with doubt regarding the loyalty of others
Dx:

Tx:
Psychotherapy 
CBT
Group or individual 
Pharmacotherapy 
Short-term, low dose antipsychotic if severe (haldol) or benzos (anxiety or agitation)

Question 14

Schizoid Personality d/o
Dx
Tx

Answer 14

Cluster A
Dx:
Few friends, loner, indifference to praise or criticism 
Happy not having any relationships 
Ex: night-shift toll booth, MC males

Tx:
Typically won’t see this pt
Psychotherapy: Individual or group therapy 
Pharmacologic: +/- short-term, low dose
-Antipsychotics
-Antidepressants
-Psychostimulants

Question 15

Schizotypal Personality d/o
Dx
Tx

Answer 15

Cluster A
Dx
Magical thinking, aloof and isolated, metaphoric speech
Usually suggestive of schizophrenia but WITHOUT psychosis (delusions)

Tx:
Psychotherapy: CBT, Individual, group therapy 
Pharmacologic: +/- short-term, low dose
-Antipsychotics
-Antidepressants
-Benzos