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Y5 Psychiatry > Personality Disorder > Flashcards

Personality Disorder Flashcards

1
Q

Define Personality Disorder.

A

A set of consistent thoughts, feelings, and behaviours shown across time in a variety of settings which may lead to suffering of the individual or others

  • Exaggerated personality traits
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2
Q

What 3 features must be present for the diagnosis of a Personality Disorder?

A
  • Pervasive - occurs in all/most areas of life
  • Persistent - evident/starts in adolescence and continues through adulthood
  • Pathological - causes distress to self or others, impairs function
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3
Q

What 3 clusters do Personality Disorders fall into?

A
  • Cluster A - odd or eccentric = paranoid, schizoid, schizotypal
  • Cluster B - dramatic, erratic, or emotional = dissocial, EUPD, histrionic, narcissistic
  • Cluster C - anxious and fearful = anankastic, anxious-avoidant, dependent
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4
Q

What 6 features are required by the ICD-10 for the diagnosis of a Personality Disorder?

A
  • Relationships affected - Pathological
  • Enduring - Persistent
  • Pervasive
  • Onset in childhood/adolescence - Persistent
  • Results in distress - Pathological
  • Trouble in occupational/social performance - Pathological
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5
Q

What are the risk factors for Personality Disorders?

A
  • Biological
    • Genetics
    • Sex - Overall = M > F
      • M > F in cluster A and C
      • F > M in cluster B
    • Neurotransmitter theories:
      • Lower 5-HT in cluster B
  • Psychosocial
    • Childhood temperament - difficult from >3 years-old
    • Childhood experiences/trauma - insecure attachment
    • Cognitive theories - confirmation bias perpetuation - i.e. if you’re negative, you spark ‘negativity’ in others, confirming your thoughts
    • Psychological defences - overly reliant on defence mechanisms - ‘acting out’, ‘splitting’, ‘projection’, ‘fantasising’ etc
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6
Q

What is the prognosis of Personality Disorder?

A
  • Personality disorders disrupt relationships, education and employment
  • Change in severity over time - i.e. Cluster B often burn out as you age
  • Long-term risk is 10% suicide rate
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7
Q

What is the difference between Schizotypal PD and Schizoid PD?

A
  • Schizotypal = some positive schizophrenia symptoms
    • Eccentricity and eccentric thoughts/ideas = MAIN DIFFERENCE
    • Paranoid or bizarre ideas - Believe in ‘magic’ and ‘fairies’
    • Social withdrawal
    • Cold/inappropriate affect
  • Schizoid = just negative schizophrenia symptoms
    • Anhedonic
    • Limited emotional range / Apparent indifference to praise/criticism
    • Little sexual interest
    • Lacks close relationships / One-player activities
    • Normal social conventions are ignored
    • Excessive fantasy world
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8
Q

What are the signs and symptoms of Schizotypal PD?

A
  • Some positive schizophrenia symptoms):
    • Eccentricity and eccentric thoughts/ideas
    • Paranoid or bizarre ideas - believe in ‘magic’ and ‘fairies’
    • Social withdrawal
    • Cold/inappropriate affect
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9
Q

What are the signs and symptoms of Paranoid PD?

A
  • Sensitive
  • Unforgiving
  • Suspicious
  • Possessive and jealous of partners
  • Excessive self-importance
  • Conspiracy theories
  • Tenacious sense of rights
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10
Q

What are the signs and symptoms of Schizoid PD?

A
  • Anhedonic
  • Limited emotional range
  • Little sexual interest
  • Apparent indifference to praise/criticism
  • Lacks close relationships
  • One-player activities
  • Normal social conventions are ignored
  • Excessive fantasy world
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11
Q

What are the signs and symptoms of Histrionic PD?

A
  • Attention-seeking
  • Concerned with appearance
  • Theatrical
  • Open to suggestions
  • Racy and seductive
  • Shallow affect
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12
Q

What are the signs and symptoms of EUPD?

A
  • Affective instability - feeling of emptiness
  • Explosive behaviour
  • Impulsive - includes self-harm tendency
  • Outbursts of anger
  • Unable to plan/consider consequences
  • Childhood trauma
  • Pervasive fear of abandonment
  • Unstable relationships
  • Black and White thinking - Spliting
  • MOST COMMON PD - 2% of population or 40% of PD
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13
Q

What are the signs and symptoms of Dissocial/Antisocial PD?

A
  • Forms but cannot maintain relationships
  • Irresponsible / Impulsive
  • Guiltless
  • Heartless / No empathy
  • Temper easily lost
  • Someone else’s fault
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14
Q

What are the signs and symptoms of Anakastic PD?

A
  • Doubtful
  • Excessive detail
  • Tasks not completed
  • Adheres to rules
  • Inflexible
  • Likes their own way
  • Excludes pleasure and relationships
  • Dominated by intrusive thoughts
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15
Q

What are the signs and symptoms of Anxious/Avoidant PD?

A
  • Avoids social contact
  • Fear of rejection / criticism
  • Restricted lifestyle
  • Apprehensive
  • Inferiority
  • Doesn’t get involved unless sure of acceptance
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16
Q

What are the signs and symptoms of Dependent PD?

A
  • Subordinate
  • Undemanding
  • Fears abandonment
  • Feels helpless when alone
  • Encourage others to make decisions
  • Reassurance needed
17
Q

What are the sub-types of EUPD?

A
  • Borderline = disturbance in self-thought
  • Impulsive = mainly impulsivity
18
Q

Reuben suspected that his colleagues at the Post Office were getting preferential treatment, despite his certainty that he was the best worker there. When he was offered overtime, it was ‘only the shifts that no-one else wanted’. This confirmed his suspicion, and so he resigned, feeling insulted. Five years later he is still convinced that his boss was corrupt.

What is the diagnosis?

A

Paranoid PD

19
Q

Masson was a night security guard, content with solitude and daydreaming his shift away. His manager passed on complaints from the day staff that he left a ‘body odour smell’ in the office, but he didn’t try to wash. Although people thought he was odd, he really didn’t care. He wasn’t interested in having friends or a sexual partner, preferring his own company. He was neither happy nor sad about this; that was just life.

What is the diagnosis?

A

Schizoid PD

20
Q

Paige met her boyfriend for lunch. He suggested a bottle of wine, so she ordered champagne! Tottering on her pink stilettos, she fell into his lap as she got out of her chair. Everyone stared but Paige shrieked with laughter! She became bored and flirted with the waiter, but when he ignored her, she left, announcing loudly, ‘I’ll never eat here again!’

What is the diagnosis?

A

Histrionic PD

21
Q

Phoebe had been on two dates with her perfect university lecturer — she already knew they’d get married! When he cancelled a date because of work, Phoebe felt so alone. A familiar numb feeling of emptiness returned, reminding her of when her ex-boyfriend left. Phoebe told him she was going to kill herself and it was his fault. She slammed down the phone and cut her wrists with scissors—she couldn’t bear to be alone again. The bastard!

What is the diagnosis?

A

EUPD - Borderline Sub-type

22
Q

Jake joined the local snooker club and was getting on well with the other members until he accused his opponent of cheating during a ‘friendly’ game. Jake quickly lost his temper, breaking the other man’s nose with his cue and storming out. He was banned from the club but felt that it was ‘the other guy’s fault’ for cheating; he deserved his broken nose.

What is the diagnosis?

A

Dissocial/Antisocial PD

23
Q

Reece, the cricket club’s treasurer, had developed his own detailed filing system. When the chairman delivered a big box of receipts, the day before the committee meeting, Reece was annoyed—this would take ages to sort out! The chairman tried to help, but kept ruining the system, and Reece sent him away, staying up all night to do the job properly. The next day, he couldn’t stop wondering whether he had made mistakes.

What is the diagnosis?

A

Anankastic PD

24
Q

Luca had wanted to attend an evening class for ages but was too anxious to go alone. When a friend finally took him, Luca kept silent. He knew he wasn’t as clever as everyone else and worried they would dislike him. He also worried that his friend would stop going and he wouldn’t have anyone to talk to. Better to stay at home than be rejected.

What is the diagnosis?

A

Anxious / Avoidant PD

25
Q

Hanne lived with her younger sister Rebecca. Hanne did the housework but needed Rebecca’s advice for even the simplest tasks: ‘Rebecca is so clever and capable — she makes all the important decisions! How would I ever cope without her if she got married and left me alone?’

What is the diagnosis?

A

Dependent PD

26
Q

Define Avoidance / Denial?

A

Pretending a problem doesn’t exist.

27
Q

Define Splitting.

A

An immature response where a person cannot reconcile the good and bad in someone and only views people as all-good or all-bad

  • i.e. often ending relationships explosively and cannot maintain relationships
  • EUPD - borderline type more so
28
Q

Define Dissociation.

A

An immature ego defence where one assumes a different identity to deal with a situation.

29
Q

Define Sublimation.

A

A mature ego defence where one takes an unacceptable personality trait and uses it to drive a respectable work that does not conflict with their ego/values

  • i.e. a youth with anger issues signs up to a boxing academy
30
Q

Define Reaction Formation.

A

An immature ego defence where one suppresses unacceptable emotions and replaces them with their exact opposite.

  • i.e. a man with homoerotic desires becomes a champion of anti-homosexual policy
31
Q

Define Regression.

A

Revert to an immature behaviour in a stressful situation

  • i.e. bang a desk in frustration
32
Q

Define Identification.

A

Someone models the behaviour of someone else

  • i.e:
    • someone abused as a child becomes a child abuser as an adult
    • a widow taking over her late husband’s voluntary work
    • an older brother playing with a dead younger brother’s toys
33
Q

Define Displacement.

A

Defence mechanism when someone takes out their emotions on a neutral person (someone who is not likely to respond to them)

34
Q

Define Projection.

A

A person assumes an innocent/neutral character is responsible or as guilty as the patient, for the patient’s actions

  • One person’s affect / emotions / character is seen on someone with them
35
Q

What investigation are appropriate for suspected PD?

A
  • Second interview - and collateral history
    • Check for REPORT criteria
    • List personality traits and match to cluster criteria - ≥3, and REPORT required
    • Use questionnaires, specific instruments for each cluster, etc.
36
Q

What is the management of PD?

A
  • Biological
    • Antipsychotics – reduce impulsivity and aggression (Cluster B)
    • Anti-histamines - aid sleep / treat insomnia
    • Antidepressants (SSRIs) – reduce impulsivity and anxiety (Clusters B, C)
    • Anticonvulsants / Lithium – useful for labile (quickly changing) affect (Cluster B)
  • Psychological
    • 1st line: CBT – focus on interactions between thoughts, feelings, and behaviours, here and now
      • Group-based CBT is 1st line in antisocial PD
      • DBT / Dialectical behaviour therapy is 1st line in EUPD
    • CAT / Cognitive analytical therapy - focuses on specific issues to describe and develop methods to change ideas
    • Mentalisation - EUPD
    • Psychodynamic therapy
  • Social
    • Therapeutic Community
    • Crisis Plan
37
Q

What is DBT?

A
  • Dialectical behaviour therapy - a sub-type of CBT
    • Focuses on factors contributing to emotional instability
    • Indication = Emotional swings
    • Aims to introduce 2 important concepts:
      • Validation – your emotions are acceptable
      • Dialectics – showing you things in life are rarely black or white, helping you to be more open

Y5 Psychiatry (11 decks)

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