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Psychiatry Mix > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

What is a personality disorder?

A

Inflexible, maladaptive, rigidly pervasive pattern of behaviour which causes distress or impaired functioning (person is not usually aware of problem). Presents in early adulthood.

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2
Q

How do you remember the 3 clusters of personality disorders in DSM-5?

A

A, B, C = Weird, Wild, Worried

A = Weird: Accusatory, Aloof, Awkward

B = Wild: Bad to the Bone

C = Worried: Cowardly, Compulsive, Clingy

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3
Q

What personality disorders appear in cluster A?

A

A = Weird: Accusatory, Aloof, Awkward

Paranoid

Schizoid (distant)

Schizotypal (not in ICD PDs - odd beliefs, magical thinking)

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4
Q

What personality disorders appear in cluster B?

A

B = Wild: Bad to the Bone

Antisocial (aka dissocial in ICD)

Boderline (aka emotional unstable with impulsive and borderline type in ICD)

Histrionic

Narcissistic (not in ICD PDs)

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5
Q

What personality disorders appear in cluster C?

A

C = Worried: Cowardly, Compulsive, Clingy

Avoidant (aka anxious in ICD)

Obsessive-compulsive (aka anankastic in ICD)

Dependent

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6
Q

What are the 8 personality disorders in ICD-10?

A

F60.0 Paroid

F60.1 Schizoid

(no schizotypal)

F60.2 Dissocial (antisocial in DSM)

F60.3 Emotionally unstable (borderline in DSM)

F60.4 Histrionic

F60.5 Anankastic (obsessive compulsive PD in DSM)

F60.6 Anxious (avoidant in DSM)

F60.7 Dependent

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7
Q

ICD-10 characterists of Paranoid Personality Disorder?

A
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8
Q

ICD-10 characterists of Schizoid Personality Disorder?

A

SchizoiD = Distant

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9
Q

ICD-10 characterists of Dissocial Personality Disorder?

A

(antisocial in DSM-5)

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10
Q

ICD-10 characterists of Emotionally Unstable Personality Disorder?

A

(aka Borderline personality disorder in DSM-5)

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11
Q

ICD-10 characterists of Histrionic Personality Disorder?

A
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12
Q

ICD-10 characterists of Anankastic Personality Disorder?

A

(aka Obsessive Compulsive Personality Disorder in DSM-5)

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13
Q

ICD-10 characterists of Anxious (Avoidant) Personality Disorder?

A
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14
Q

ICD-10 characterists of Dependent Personality Disorder?

A
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15
Q

What is needed to meet diagnosis of Enduring Personality Change?

What types are there?

A

F62.0 - Enduring personality change after catastrophic experience:

  • Personality change is present for at least two years, following exposure to catastrophic stress.

The disorder is characterized by a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of “being on edge” as if constantly threatened, and estrangement. Post-traumatic stress disorder (F43.1) may precede this type of personality change.

F62.1 - Enduring personality change after psychiatric illness

Personality change persists for at least two years, and is attributable to the traumatic experience of suffering from a severe psychiatric illness.

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16
Q

Treatment for PD is bio-psycho-social, what occurs in bio?

A

1. Biological: medication

• Antipsychotic drugs (usually at a low dose)

  • Can reduce the suspiciousness of the three cluster A personality disorders (paranoid, schizoid and schizotypal).*
  • Can help with borderline personality disorder if people feel paranoid, or are hearing noises or voices*

• Antidepressant

  • Can help with the mood and emotional difficulties that people with cluster B*
  • personality disorders (antisocial or dissocial, borderline or emotionally unstable,*
  • histrionic, and narcissistic) have*
  • Some of the selective serotonin reuptake inhibitor antidepressants (SSRIs) can*
  • help people to be less impulsive and aggressive in borderline and antisocial*
  • personality disorders*
  • Can reduce anxiety in cluster C personality disorders (obsessive-compulsive,*
  • avoidant and dependent)*

• Mood stabilisers
Medication such as lithium, carbamazepine, and sodium valproate can also reduce impulsiveness and aggression.

17
Q

Treatment for PD is bio-psycho-social, what occurs in psycho?

A

2. Psychological: talking treatments or therapies

Psychotherapies seem to work well, particularly for cluster B personality disorders . They all have a clear structure and idea of how they work which must be explained to the patient.
Therapy can last for years, and may have to be more than once a week.

  • Mentalisation - combines group and individual therapy. It aims to help you better understand yourself and others by being more aware of what’s going on in your own head and in the minds of others. It is helpful in borderline personality disorder.
  • Dialectical Behaviour Therapy – this uses a combination of cognitive and behavioural therapies, with some techniques from Zen Buddhism. It involves individual therapy and group therapy, and has been claimed to significantly reduce self-harm in patients with borderline personality disorder
  • Cognitive Therapy - a way to change unhelpful patterns of thinking.
  • Schema Focused Therapy - a cognitive therapy that explores and changes collections of deep unhelpful beliefs. Again, it seems to be effective in borderline personality disorder. Transference Focused Therapy - a structured treatment in which the therapist explores and changes unconscious processes. It seems to be effective in borderline personality disorder.
  • Dynamic Psychotherapy - looks at how past experiences affect present behaviour. It is similar to Transference Focused Therapy, but less structured.
  • Cognitive Analytical Therapy - a way to recognise and change unhelpful patterns in relationships and behaviour
  • Treatment in a therapeutic community – this is a place where people with long-standing emotional problems can go to (or sometimes stay) for several weeks or months. Most of the work is done in groups. People learn from getting on – or not getting on - with other people in the treatment group. It differs from ‘real life’ in that any disagreements or upsets happen in a safe place. People in treatment often have a lot of say over how the community runs. In the UK, it is more common now for this intensive treatment to be offered as a day programme, 5 days a week.
18
Q

Treatment for PD is bio-psycho-social, what occurs in social?

A

3. Social : support - Social Services

Many people with personality disorder can lead full lives with support. This can be emotional - somebody to talk to - or practical - help with sorting bills out or arranging things. The support can be given by friends and families, self-help groups and networks, as well as your GP or mental health team.

Support might be needed occasionally, when things get particularly difficult, or you regularly. Family support and community network (day-based or residential therapeutic community)

Admission to hospital usually happens only as a last resort (e.g. when a person with borderline personality disorder is harming themselves badly) and for a short time. A lot of help that was once only offered on hospital wards is now available in day centres and clinics.

Complex Needs Service (CNS) – for people with long-standing and hard to resolve emotional problems or interpersonal difficulties

19
Q

What are some other differential diagnoses when considering a personality disorder?

A

Dementia F00-02

Substance Misuse F10-19

Psychotic disorders F20-22

Affective disorders F30-33

Anxiety disorders F40-45 (especially phobia and panic disorder)

Obsessive-compulsive disorder F42

Learning disability (Mental retardation) F70-73

Autism F84

Psychiatry Mix (8 decks)

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