Personality Disorders Flashcards
PDs are often thought to be ‘untreatable’ by definition
True
Personality disorders types
Antisocial Avoidant Borderline Dependent Histrionic Narcissistic Obsessive-compulsive Paranoid Schizoid Schizotypal
Antisocial is more common in men
true
Antisocial PD is characterised by
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
Impulsiveness or failure to plan ahead;
Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
Reckless disregard for safety of self or others;
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Avoidant PD is characterised by
Unwillingness to be involved unless certain of being liked
Preoccupied with ideas that they are being criticised or rejected in social situations
Restraint in intimate relationships due to the fear of being ridiculed
Reluctance to take personal risks doe to fears of embarrassment
Views self as inept and inferior to others
Social isolation accompanied by a craving for social contact
Borderline PD is characterised by?
Unstable interpersonal relationships which alternate between idealization and devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts
Borderline PD is DRIVEN by?
Efforts to avoid real or imagined abandonment
Avoidant PD is DRIVEN by
Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.
Dependent PD features
Difficulty making everyday decisions without excessive reassurance from others
Need for others to assume responsibility for major areas of their life
Difficulty in expressing disagreement with others due to fears of losing support
Lack of initiative
Unrealistic fears of being left to care for themselves
Urgent search for another relationship as a source of care and support when a close relationship ends
Extensive efforts to obtain support from others
Unrealistic feelings that they cannot care for themselves
Histrionic PD is driven by?
Need to be the centre of attention
Histrionic PD features?
Inappropriate sexual seductiveness
Rapidly shifting and shallow expression of emotions
Suggestibility
Physical appearance used for attention seeking purposes
Impressionistic speech lacking detail
Self dramatization
Relationships considered to be more intimate than they are
Narcissistic PD
Grandiose sense of self importance Preoccupation with fantasies of unlimited success, power, or beauty Sense of entitlement Taking advantage of others to achieve own needs Lack of empathy Excessive need for admiration Chronic envy Arrogant and haughty attitude
Obsessive-compulsive PD
Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
Paranoid pd
Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character
Schizoid PD
Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family
Schizotypal PD
Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Schizotypal PD speech is always incoherent
false
Odd speech without being incoherent
PDs are often thought to be ‘untreatable’ by definition
true
PD approach to mx
however, a number of approaches have been shown to help patients, including:
psychological therapies: dialectical behaviour therapy
Somatisation disorder is?
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
Illness anxiety disorder (hypochondriasis) is?
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results
Conversion disorder- patient deliberately feigns sx
false
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
Conversion disorder is
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
Dissociative disorder is?
dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
new term for multiple personality disorder
dissociative identity disorder (DID) - the most severe form of dissociative disorder
Factitious disorder is?
also known as Munchausen’s syndrome
the intentional production of physical or psychological symptoms
Malingering is?
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
One of the most popular models of grief divides it into 5 stages.
Denial: this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual. Occasionally people may focus on physical objects that remind them of their loved one or even prepare meals for them
Anger: this is commonly directed against other family members and medical professionals
Bargaining
Depression
Acceptance
Features of atypical grief reactions include:
delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins
prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months
Chronic insomnia may be diagnosed if a person has trouble falling asleep or staying asleep at least
three nights per week for 3 months or longer.
Insomnia ix
Diagnosis is primarily made through patient interview, looking for the presence of risk factors.
Sleep diaries and actigraphy may aid diagnosis. Actigraphy is a non-invasive method for monitoring motor activity.
Polysomnography is not routinely indicated. It may be considered in patients with suspected obstructive sleep apnoea or periodic limb movement disorder, or when insomnia is poorly responsive to conventional treatment.
Insomnia mx
Short-term management of insomnia:
Identify any potential causes e.g. mental/ physical health issues or poor sleep hygiene.
Advise the person not to drive while sleepy.
Advise good sleep hygiene: no screens before bed, limited caffeine intake, fixed bed times etc.
ONLY consider use of hypnotics if daytime impairment is severe.
There is good evidence for the efficacy of hypnotic drugs in short-term insomnia. However, there are many adverse effects
daytime sedation, poor motor coordination, cognitive impairment and related concerns about accidents and injuries. In addition, tolerance to the hypnotic effects of benzodiazepines may be rapid (within a few days or weeks of regular use).
The hypnotics recommended for treating insomnia are
short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).
Diazepam is not recommended but can be useful if the insomnia is linked to daytime anxiety.
Use the lowest effective dose for the shortest period possible.
If there has been no response to the first hypnotic, do not prescribe another. You should make the patient aware that repeat prescriptions are not usually given.
It is important to review after 2 weeks and consider referral for cognitive behavioural therapy (CBT).
Other sedative drugs (such as antidepressants, antihistamines, choral hydrate, clomethiazole and barbiturates) are not recommended for managing insomnia.
