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PMHNP > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

DSM 5 Description of Personality Disorders

A
  • Onset in adolescence or early adulthood
  • Endures over time
  • Deviates from cultural standard
  • Rigid and pervasive
  • Social/Functional impairment
    • Does not occur with: another mental illness, another medical illness, pervasive developmental disorder, effects of substance/medications
    • Cluster A, B, C
    • Other Specified/Unspecified: PD traits but does not meet DSM 5 criteria
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2
Q

Risk for Violence with Personality Disorders

A

1) With diagnosis of substance misuse
2) Followed by Cluster B
3) TO a lesser extent schizophrenia spectrum disorders
4) Positive correlation: Paranoid, narcissistic, passive-aggressive

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3
Q

Cluster A Personality Disorders

A

Paranoid, Schizoid, Schizotypal

  • odd, eccentric
  • loner
  • emotionally distant
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4
Q

Cluster B Personality Disorders

A

Borderline, Narcissistic, Antisocial, Histrionic

  • Dramatic, erratic
  • Egocentric
  • Lack appreciation/concern for others
  • Lack of empathy/ minimal functioning conscience
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5
Q

Cluster C Personality Disorders

A

Avoidant, Dependent, Obsessive-compulsive

  • Avoidant, anxious, and fearful
  • Preoccupied with rules or reactions of others
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6
Q

Paranoid Personality Disorder (Cluster A)

A
  • SUSPECT (paranoid)
      • Spousal infidelity suspected
      • Unforgiving
      • Perceives attacks of others
      • Everyone viewed as friend or enemy
      • Confiding in others is feared
      • Threats perceived in benign events
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7
Q

Differential Diagnosis: Paranoid Personality Disorder

A
  • More common in families with schizophrenia
  • Distinguished from delusional and schizophrenia by absence of: fixed delusions, hallucinations, thought disorder
  • Distinguished from personality disorder by absence of intense relationships
  • Can be a precursor to schizophrenia
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8
Q

Personality Disorder Treatment

A
  • Prolonged intensive psychotherapy
  • Pharmacological treatment of anxiety/agitation symptoms
  • Occasional use of antipsychotics to manage delusional thoughts
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9
Q

Schizoid Personality Disorder: Cluster A

A
  • DISTANT (social withdrawal)
      • Detached or flat affect
      • Indifferent to criticism or praise
      • Sexual experiences of little interest
      • Task performed solitarily
      • Absence of close friends
      • Neither desires or enjoys closeness
      • Takes pleasure in few activities
  • DSM 5 criteria when 4 of 7 are met
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10
Q

Schizoid Personality Disorder Differential Diagnosis

A
  • Male to female 2:1
  • Lack of nurturing in childhood
  • May be successful in isolated jobs
  • Distinguished from schizotypal and schizophrenia: no delusions, hallucinations, thought disorder; Less oddity than schizotypal
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11
Q

Schizoid Personality Disorder Treatment

A
  • Psychotherapy
  • Cautious group therapy: Defense structure
  • Pharmacological intervention only for symptom control
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12
Q

Schizotypal Personality Disorder

A
  • ME PECULIAR (Not your typical pal)
      • Magical thinking
      • Experiences unusual perceptions
      • Paranoid ideation
      • Eccentric behavior or appearance
      • Constricted or inappropriate affect
      • Unusual or odd thinking and speech
      • Lacks close friends
      • Ideas of reference
      • Anxiety in social settings
      • Rule out psychotic and pervasive developmental disorders
  • DSM criteria 5 of 9 characteristics
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13
Q

Schizotypal Personality Disorder Treatment

A
  • 10% commit suicide, periodic risk assessment
  • Psychotherapy, nonjudgment focus
  • Antipsychotic medications may be needed with ideas of reference, illusions
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14
Q

Antisocial Personality Disorder: Cluster B

A
  • CORRUPT (sociopath)
  • DSM requires three or more symptoms
  • Conformity to law is lacking
  • Obligations ignored
  • Reckless disregard for safety of self or others
  • Remorse lacking
  • Underhanded
  • Planning insufficient (impulsive)
  • Temper
  • Symptoms notable before 15, may be diagnosed with conduct disorder
  • Must be 18
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15
Q

Antisocial Personality Disorder: Predisposing factors

A
  • 75% of people who have committed crimes
  • Lower socioeconomic
  • Parental deprivation in first 5 years
  • Males with AUD
  • Five times greater with first degree male relative with ASPD
  • Association with anxiety and depression
  • Symptoms may decrease with aging
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16
Q

Antisocial Personality Disorder: Treatment

A
  • Psychotherapy
  • Self-help groups
  • CBT: “Moral recognition therapy”
  • Valporate for rage symptoms, especially if EEG is abnormal
17
Q

Borderline Personality Disorder: Cluster B

A
  • I DESPAIRR (borders both neurosis and psychosis)
  • Identity disturbance
  • Disordered unstable affect with marked mood reactivity
  • Emptiness feelings
  • Suicidal behaviors
  • Paranoid ideation under duress
  • Abandonment sense
  • Impulsivity
  • Rage
  • Relationship instability
  • DSM criteria: 5 or more symptoms
  • Females 75%
  • HX childhood abuse/sexual abuse
18
Q

Borderline Personality Disorder: Treatment

A
  • Psychotherapy
  • Individual and Group therapy (not usually)
  • Behavioral therapy and social skills training
  • Limit setting
  • Olanzapine: mood stabilization
  • SSRI: depression
  • MAOI: impulsive behaviors
19
Q

Histrionic Personality Disorder: Cluster B

A
  • PRAISE ME (dramatic)
  • Provocative: Relationships overvalued
  • Attention seeking and uncomfortable when not
  • Influenced easily
  • Style of speech exaggerated
  • Emotions shallow and rapid shifting
  • Made-up in ways to draw attention
  • Emotions exaggerated
  • Begins in early adulthood
  • Females more than males
  • Substance use and somatization disorders common
  • DSM criteria: 5 or more
20
Q

Histrionic Personality Disorder: Differential

A
  • Self-destructiveness and identity disturbance differentiate BPD from HPD
  • Narcissistic PD is more grandiose, arrogant, and lacking in empathy compared to HPD; Narcissistic PD craves recognition for superiority, whereas HPD settles for recognition of weakness or fragility
  • Individuals with ASPD manipulate for power, profit or personal gratification; HPD manipulate for nurturing
21
Q

Histrionic Personality Disorder: Treatment

A
  • Psychotherapy with focus on identification of emotions/insight
22
Q

Narcissistic Personality Disorder: Cluster B

A

*SPEECIAL (Grandiosity)

  • Special, believes in own uniqueness
  • Preoccupied by fantasies
  • Envious
  • Entitlement
  • Excessive admiration required
  • Conceited
  • Interpersonal exploitation
  • Arrogant
  • Lacks empathy

DSM criteria 5 or more symptoms

23
Q

Narcissistic Personality Disorder: Differential

A
  • 50-75% male
  • Associate with anorexia and SUD
  • BPD, HPD, and ASPD all have narcissistic traits; distinguishing feature of NPD is grandiosity
24
Q

Avoidant Personality Disorder: Cluster C

A
  • CRINGES (inferiority complex/nervous)
  • Certainly of being liked criteria for involvement
  • Rejection sensitive and preoccupied
  • Intimate relationships avoided
  • New relationships avoided
  • Gets around occupational work that involves interpersonal contact
  • Embarrassment potential prevents new activities
  • Self-view is on of inferiority, ineptness
  • DSM criteria 4 characteristics
25
Q

Avoidant Personality Disorder: Differential

A
  • Males = Females
  • DIffer from schizoid because they desire social contact
  • DIffer from dependent with focus on avoidance of humiliation not being cared for
  • Differ from paranoid personality, avoid s interactions our of perceptions of inadequacy not malice.
  • Strong overlap with anxiety disorder
    *
26
Q

Avoidant Personality Disorder: Treatment

A
  • Psychotherapy: insight-oriented, behavior modification, assertivenes training, Group/family therapy
  • Treat anxiety with SSRIs
27
Q

Dependent Personality Disorder: Cluster C

A
  • RELIANCE (needy)
  • Reassurance required for decisions
  • Expressing any disagreement is difficult
  • Life responsibilities assumed by others
  • Initiating projects difficult
  • Alone not tolerated
  • Nurturance needs excessive
  • Companionship needed urgently at all times
  • Exaggerated fears of being left to care for others
28
Q

Dependent Personality Disorder: Treatment

A
  • Similar to Avoidant
  • Psychotherapy: insight-oriented, behavior modification, assertiveness training, group/family therapy
  • Treat anxiety with SSRIs
29
Q

Obsessive-compulsive Personality Disorder: Cluster C

A
  • LAW FIRMS (perfectionism)
  • Loses the point of activities
  • Ability to finish anything compromised by desire for perfection
  • Worthless objects overvalued and cherished
  • Friendships excluded as work focus of life
  • Inflexible and overly conscientious
  • Reluctant to delegate
  • Miserly
  • Stubborn
30
Q

Obsessive-compulsive Personality Disorder: Differential

A
  • OCPD pre-occupations and ego-syntonic; OCD obsessions/compulsions are ego-dystonic
31
Q

Obsessive-compulsive Personality Disorder: Treatment

A
  • Behavioral therapy
  • Cognitive therapy
  • SSRIs for anxiety

PMHNP (19 decks)

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