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Behavioral Medicine > Personality Disorders 1 > Flashcards

Personality Disorders 1 Flashcards

1
Q

Define personality trait

A
  • Flexible pattern in which we interact with others and the environment
  • We are aware of our personality

(i.e. kind, confident, lazy, rude)

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2
Q

Define personality disorder

A
  • Fixed/Inflexible, maladaptive pattern that causes distress or impaired function.
  • The patient is unaware of this.
  • Different than culturally expected & accepted range
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3
Q

What is the most common personality disorder in clinical settings?

A

Borderline PD

(2-6% of the population)

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4
Q

Diagnostic criteria for personality disorder

A

At least 2 or more of the following deviate significantly from cultural expectations:

  1. Cognition (e.g., perceives events, others, or self in an inappropriate way)
  2. Affectivity
  3. Interpersonal functioning
  4. Impulse control/need for gratification

(must also be stable and pervasive)

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5
Q

Personality disorder epidemiology

A
  1. 30%-50% of psychiatric outpatients
  2. 15% of psychiatric inpatients
  3. General population with 10%-13% prevalence
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6
Q

Greek History (Hippocrates) – four temperaments:

A
  1. Pessimistic melancholic (black bile)
  2. Overly optimistic sanguine (blood)
  3. Irritable choleric (yellow bile)
  4. Apathetic phlegmatic (phlegm)
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7
Q

Abraham believed that personality disorders originated from arrests in one of Freud’s psychosexual stages (4):

A
  1. Development → personality types
  2. Oral stage → dependent PD
  3. Anal stage → obsessive compulsive PD
  4. Phallic stage → hysterical type
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8
Q

Etiology of personality disorders (4)

A
  1. Neurobiology (5HT or DA changes)
  2. Nurture
  3. Hx of abuse (physical & sexual)
  4. Less mature defense mechanism (i.e. projection)

(strong genetic component)

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9
Q

Serotonin abnormalities are linked to _____ personalities (2).

A
  1. Borderline PD
  2. Antisocial PD

(appears to mediate behavioral inhibition)

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10
Q

Diagnostic process for personality disorder

A
  1. Hx: social & personal
  2. Mental Status Exam

(some will become apparent from physician/patient relationship)

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11
Q

What are some details to look for when obtaining a history for personality disorders?

A
  1. problems in several domains of life
  2. collateral information

(usually present for a different C/C. Do not rush to get a dx; it may take several visits)

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12
Q

Cognitive-Behavioral therapies diminish ______ and increase traits of _____.

A
  • Impulsiveness
  • Assertiveness

(Techniques include relaxation training and role-playing exercises)

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13
Q

Cognitive-Behavioral therapies include techniques such as relaxation training and role-playing exercises; cognitive strategies include _____ (2).

A
  1. identifying internal mental schemes that misidentify situations or aspects of themselves
  2. learn modification
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14
Q

Personality Disorders: Pharmacotherapy includes (3)

A
  1. SRI’s: decrease impulsivity or aggression
  2. Mood stabilizers
  3. Anti-psychotics

(No medications currently approved by FDA)

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15
Q

What are the three clusters of personality disorders

A

Cluster (A, B, C) remember: WWW = Weird, Wild, Worried = Eccentric, Dramatic, Anxious

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16
Q

Which personality disorders fall under the “Weird”/Category A?

A
  1. Paranoid
  2. Schizoid
  3. Schizotypal

(they are “strange & eccentric”)

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17
Q

Paranoid personality disorder: clinical features (5)

A
  1. Deep-seated distrust of others
  2. Guarded & suspicious
  3. Project unacceptable thoughts onto others (i.e. “You’re judging me!”)
  4. Find “evidence” by misinterpret benign events
  5. Think others want to harm, exploit or trick them

(projection is due to humiliation or being object of excessive parental rage)

18
Q

Paranoid personality disorder: etiology (2)

A
  1. Object of excessive parental rage or repeatedly humiliated by others → vulnerability and feelings of inadequacy → project hostility and rage onto others & blame others for shortcomings
  2. Link to Delusional disorder
19
Q

Paranoid personality disorder: Ddx (3)

A
  1. Paranoid schizophrenia
  2. Delusional disorder
  3. Schizotypal personality

(they are able to pull themselves together and appear undistressed when examined)

20
Q

Paranoid personality disorder: Tx (3)

A
  1. Build trust with patient
  2. Antidepressants
  3. CBT (usually resisted)

(therapist must be respectful, straightforward and non-intrusive)

21
Q

Schizoid personality disorder: clinical features

(described broadly in DSM I & II. DSM III subdivided into schizoid, avoidant and schizotypal)

A
  1. Chooses social isolation
  2. Few friends
  3. Few Hobbies
  4. Flat affect: cold, detached, aloof

(occupation usually req little social interaction: night guard, computer tech, lab tech, etc)

22
Q

Schizoid personality disorder: clinical features

(described broadly in DSM I & II. DSM III subdivided into schizoid, avoidant and schizotypal)

A
  1. Chooses social isolation
  2. Few friends
  3. Few Hobbies
  4. Flat affect: cold, detached, aloof

(occupation usually req little social interaction: night guard, computer tech, lab tech, etc)

23
Q

Schizoid personality disorder: prevelance

A

8% of population

24
Q

Schizoid personality disorder: Ddx (2)

A
  1. Schizotypal disorder (must have cognitive and perceptual distortion)
  2. Avoidant (desires relationship; fear rejection)

(schizoid does NOT care to have relationships)

–Broadly defined in DSM I and II, subdivided into schizoid, avoidant and schizotypal in DSM III

25
Q

Schizoid personality disorder treatment (3)

A
  1. CBT → social involvement
  2. Group therapy → social skills
  3. Antidepressants

(they usually avoid treatment & ask few questions; caregiver needs to respect privacy and let patient come to them)

26
Q

Schizoid personality disorder: etiology

A

Experienced cold, neglectful and ungratifying relationships in early childhood→as adults they assume relationships are not valuable or worth pursuing

(Childhood pattern of shyness and may be inherited; genetic spectrum with schizophrenia)

27
Q

Schizotypal personality disorder hold ______ beliefs that lead to ______.

A
  • Odd beliefs or magical thinking → fear of social interaction and few friends
28
Q

Schizotypal PD: etiology (3)

A
  1. Biological abnormality (increased CSF)
  2. Impaired executive fxn
  3. Schizophrenia (minus enduring psychosis)

(3% of population)

29
Q

Schizotypal personality disorder: clinical features (7)

A
  1. Speech: odd & idiosyncratic
  2. Eccentric behavior
  3. Cognitive & perceptual distortions
  4. Affect: constricted or inappropriate
  5. Socially isolated
  6. Suspicious
  7. Impaired smooth pursuit (EOM)

(linked to schizophrenia)

30
Q

Schizotypal personality disorder: cognitive & perceptual distortions (5)

A
  1. Ideas of reference (delusion that events are of special importance/connection to onself)
  2. Bodily Illusion (see something in the corner of ones eye; but the know that it isn’t real)
  3. Telepathy, 6th sense, etc.
  4. Strange or fantastical thinking
  5. Superstition

(open to challenges in their beliefs)

31
Q

What is a key difference between schizophrenia and schizotypal personality disorder?

A

Schizotypal = Open to challenges in their beliefs

32
Q

Schizotypal PD: eccentric behaviors (3)

A
  1. Talk to themselves in public
  2. Inappropriate gesturing
  3. Peculiar dress/unkept
33
Q

Schizotypal personality disorder: Ddx (3)

A
  1. Schizoid personality disorder
  2. Paranoid personality disorder
  3. Schizophrenia spectrum (without enduring psychosis)
34
Q

Schizotypal personality disorder: Trmt

A
  1. Emphasize social skills
  2. Low-dose antipsychotic to help with anxiety and psychotic feature

(avoidant to treatments; only come when psychotic or depressed)

35
Q

Which 4 personality disorders fall under the “Wild”/Category B?

(“Dramatic” & “Erratic”)

A
  1. Antisocial PD
  2. Borderline PD
  3. Histrionic PD
  4. Narcissistic PD

(“Dramatic & erratic”)

36
Q

Antiscocial Personality Disorder: clinical features (5)

(Older terms: “Moral Insanity” & “Psychopathic Personality”)

A
  1. Disregard for the rights of others
  2. Break the law
  3. Impulse
  4. Can be glib or charming
  5. Lack remorse (enjoy outwiting or exploiting others)

(fail in relationships; SUD)

37
Q

Antiscocial Personality Disorder: etiology

A
  1. Abnormal serotonin transport
  2. Absent, assaultive or inconsistent parenting
  3. Family history of substance abuse and or anti-social members

(die early due to suicide, accident, homicide, SUD)

38
Q

A subgroup of which personality disorder takes a sadistic pleasure and being harmful?

A
  • Antisocial personality disorder
39
Q

Antiscocial Personality Disorder must be ____ years old to dx; if sx appear before the age of 15, it indicates _____.

A
  • 18
  • Conduct Disorder
40
Q

Antiscocial Personality Disorder: Tx

A
  1. CBT
  2. Mood stabilizers
  3. Antidepressants

(very resistant to tx)

41
Q

Antiscocial Personality Disorder: Ddx

A

Nacissitic PD (smart enough to stay out of trouble with the law; antisocial think they are above it all and do get into trouble)

(co-morbid: ADHD)

Behavioral Medicine (35 decks)

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