personality disorder Flashcards
Obsessive- Compulsive disorder involves what
- anxiety;
- obsessions;
- compulsions;
Obsessions
characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry
Compulsions
repetitive behaviors aimed at reducing the associated anxiety
what are common compulsions
- washing/cleanliness;
- repeat checking {orderly routine to ensure safety in house};
- hoarding and compulsive buying;
- harmful acts {i.e. person goes over bump in road and fears it is a body; may harm others veering in and out of traffic to return to make sure it was not a person
18% of people with OCD will start having symptoms when
before the age of 18
Management of OCD
- CBT and exposure-ritual-prevention;
- other psychotherapy;
- medications: SSRIs, SNRIs, tricyclics
- ECT
What should not be given for OCD
- benzodiazepines because will not treat OCD, and may become compulsion
Characteristics of schizophrenia
- thought disturbance;
- disrupted social behavior;
- inability to determine what is real
positive schizophrenia symptoms, patient experiences
things others do not
negative schizophrenia symptoms indicate
lack of a full emotional life
Positive schizophrenia symptoms
Hallucinations: - auditory; - visual; - tactile; - gustatory; - olfactory; Delusions; disordered thoughts and speech
Delusions with schizophrenia
beliefs in something that is not real
Disordered thoughts and speech with schizophrenia
word salad: say random words at any given time
Negative schizophrenia symptoms
- emotional blunting, flat affect;
- inability to form relationships;
- poverty of speech {can’t find words to express one’s self};
- inability to experience pleasure
Prevalence of schizophrenia
1% of total population;
more prevalent in males than females
most commonly, first symptoms of schizophrenia occurs when
in late adolescence and early 20s;
CAUSES of schizophrenia
- definitive cause unknown, likely multifactorial;
- genetics;
- prenatal development;
- early environment;
- neurobiology;
- psychological/social processes
FNP role for pt with schizophrenia
- treatment in conjunction with psychiatry;
- need to address other medical issues;
- i.e. smoking cessation, home safety, coordination of care
FNP needs to address what with patients with schizophrenia
- other medicatl issues;
- side effects from meds:
- weight gain;
- obesity;
- obesity can lead to DM, htn, and HLD which will all need to be treated concurrently with psychiatric meds;
- elevated blood sugars
Personality disorders cluster A
- odd type; includes: - paranoid; - schizoid; - schizotypal
Personality disorder cluster B
dramatic type;
- antisocial;
- borderline;
- histrionic;
- narcissistic
Personality disorder cluster C
anxious type;
- avoidant
- dependent;
- obsessive-compulsive
Personality disorder Cluster D
unspecified {only psychopathy is considered a diagnosis};
- passive-aggressive;
- sadistic;
- self-defeating;
- psychopathy
DSM fluidity with clusters
cluster C and D are currently in flux;
Treatment concerns for personality disorders
- doesn’t always require treatment;
- complex disorders demand specialty treatment;
- recognition and appropriate referral is crucial on primary care level
Cluster A Paranoid characterized by
paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others, without any basis in reality
Cluster A Paranoid signs and symptoms
- hypersensitivity;
- hypervigilance;
- identification of things in their environment that support their paranoia
Scenario for cluster A Paranoid
patient may see someone standing by the door as “waiting for them” versus someone who is simply waiting for a ride, unrelated to them
Cluster A: Schizoid characterized by
a lack of interest in social relationships
Cluster A: Schizoid signs and symptoms
- tend toward a solitary lifestyle;
- secretiveness;
- emtional coldness;
- apathy;
- may have rick and elaborate, exclusively internal, fantasy world
Cluster A: Schizotypal characterized by
a need for social isolation;
Cluster A: Schizotypal signs and symptoms
- uncomfortable in big groups;
- shy in social situations;
- odd behavior or thinking;
- often unconventional beliefs;
- peculiar speech patterns and odd modes of dress;
- paranormal and superstitious beliefs;
- may respond abnormally in conversation, not respond at all, or talk to self;
Cluster B: Dramatic subtype
- extremely dramatic in their presentation;
- comes with frustrating and/or dangerous behavior
What is the most difficult personality disorder to deal with
Cluster B: Dramatic subtype
Cluster B: Antisocial (Sociopathic) characterized by
a pervasive pattern of disregard for, or violation of, the rights of others {go out of their way};
Cluster B: Antisocial (Sociopathic) signs and symptoms
- less moral sense or conscience than others;
- commonly have patterns of crime, legal problems, and aggressive, impulsive behavior
Cluster B: Borderline marked by
- impulsivitiy and instability of affect
Cluster B: Borderline signs and symptoms
- interpersonal relationship disruption;
- abnormal self-image;
- tend to project internal sx onto others;
- intense fears of abandonment;
- extreme anger and irritability;
- idealization and devaluation
Describe idealization and devaluation in borderline personality disorder
- effusive in praise of provider {you get me};
- adamant that provider is awful;
- all good or all bad and no in between;
- even if they see you as good now, it will change to bad later;
- avoid believing the praise because you shouldn’t believe the torment later;
Cluster B: Histrionic characterized by
- a pattern of excessive attention-seeking emotions;
Cluster B: Histrionic symptoms can include
- aggressive sexual behavior;
- inappropriate seductive behavior;
- egocentrism;
- self-indulgence;
- manipulative behavior to achieve their needs
does males or females suffer from histrionic personality disorder more
females 4:1
Cluster B: Narcissistic: characterized by
excessive preoccupation with personal adequacy, power, prestige, and vanity;
Cluster B: Narcissistic symptoms
unable to see or appreciate how their behavior affects other people, or worse, willfully cause harm to others for personal gain
Tips for primary care providers when dealing with personality disorders
- difficult to manage d/t gray areas;
- difficult to know when to medicate;
- draw boundearies with disruptive/demanding patients;
- enforce same rules for all patients;
- disruptive behavior constitutes referral
