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Neuro > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Describe theories of personality development

A 
Cloninger neurobiological model 
3 dimensions of temperament (genetically determined):
•	Novelty seeking (DA)
•	Reward dependence (NE)
•	Harm avoidance (5-HT)
4 dimensions of character (shaped by learning and environment): 
•	Persistence
•	Self-directedness
•	Cooperativeness
•	Self-transcendence

Five-factor model
Dimensions:
• Extraversion (extraverted vs. introverted)
• Agreeableness (agreeable vs. antagonistic)
• Neuroticisms (sensitive/emotional vs. resilient/calm)
• Openness to experience (open vs. closed)
• Conscientiousness (dutiful/disciplined vs. not)

Genetic factors likely involved
Role of childhood events (ex: trauma, abuse, maltreatment)

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2
Q

Define personality disorder

A

Enduring pattern of maladaptive traits that are inflexible and pervasive across a broad range of situations and cause significant distress or impairment

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3
Q

Recognize the three clusters of personality disorders

A
  • Cluster A (odd, eccentric)
  • Cluster B (dramatic, emotional)
  • Cluster C (anxious, fearful)
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4
Q

List the Cluster A personality disorders

A
  • Paranoid
  • Schizoid
  • Schizotypal
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5
Q

List the Cluster B personality disorders

A
  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
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6
Q

List the Cluster C personality disorders

A
  • Avoidant
  • Dependent
  • Obsessive-Compulsive
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7
Q

Paranoid Personality disorder

A
  • Pervasive distrust and suspiciousness (motives interpreted as malevolent)
  • Do not meet full criteria for schizophrenia, delusional disorder or mood disorder with psychotic features
  • Generally do not seek medical attention (don’t trust others)
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8
Q

Schizoid personality disorder

A
  • Pervasive detachment from social relationships
  • Restricted range of expression of emotions
  • Often socially isolated by choice
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9
Q

Schizotypal personality disorder

A

• Ideas of reference, odd beliefs, unusual perceptions, odd thinking/behavior/speech, suspiciousness or paranoia, inappropriate or constricted affect, lack of close friends and social anxiety

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10
Q

Antisocial personality disorder

A

Pattern of disregard for and violation of rights of others occurring since age 15 years; indicated by 3 or more:

  • failure to conform to social norms
  • deceitfulness (repeated lying, conning others)
  • impulsivity
  • irritability and aggressiveness
  • consistent irresponsibility
  • lack of remorse

Also:

  • at least 18 years old
  • evidence of conduct disorder with onset before age 15
  • not during course of schizophrenia or bipolar disorder
  • Note: Conduct disorder = aggression to people and animals, destruction of property, deceitfulness or theft, other serious violations of rules
  • Comorbidities: substance use disorders, mood and anxiety disorders, ADHD, pathological gambling
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11
Q

Borderline personality disorder

A
  • Pattern of instability of interpersonal relationships, self-image, and impulsivity; beginning in early adulthood and present in a variety of contexts; indicated by 5 or more:
  • frantic efforts to avoid abandonment
  • pattern of unstable and intense interpersonal relationships, alternating between idealization and devaluation
  • identity disturbance
  • impulsivity in at least 2 areas that are potentially self-damaging
  • recurrent suicidal behavior
  • affective instability due to marked reactivity of mood
  • chronic feelings of emptiness
  • inappropriate, intense anger or difficulty controlling anger
  • transient, stress-related paranoid ideation or sever dissociative symptoms

• Co-morbidities: mood disorders, PTSD, other anxiety disorders, eating disorders, substance use disorders

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12
Q

Histrionic personality disorder

A
  • Pervasive pattern of excessive emotionality and attention seeking
  • Symptoms: uncomfortable when not center of attention, rapidly shifting emotions, using physical appearance to draw attention to oneself, being theatrical and dramatic, and/or easily influenced by others
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13
Q

Narcissistic personality disorder

A
  • Pervasive pattern of grandiosity, need for admiration, and lack of empathy
  • Egotistical, inflate their accomplishments, often manipulate or exploit those around them to achieve own aims
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14
Q

Avoidant personality disorder

A
  • Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
  • Socially isolated because of anxiety and fear of embarrassment
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15
Q

Dependent personality disorder

A
  • Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
  • Co-morbid depressive and anxiety disorders common
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16
Q

Obsessive-compulsive personality disorder

A
  • Perfectionistic, preoccupied with orderliness and details, inflexible, stubborn, overly conscientious
  • Pervasive, present in most situations, interfere with functioning

Different from OCD by level of insight:
• OCPD = ego syntonic (don’t believe they have a problem)
• OCD = ego dystonic (anxiety, find symptoms disturbing)

17
Q

Describe the epidemiology, pathophysiology, clinical presentation, course, and prognosis of borderline personality disorder

A

Epidemiology
• 2% prevalence with 3:1 ration of women to men

Pathophysiology
• People with high emotional vulnerability who are exposed to invalidating childhood environment
• Result: discrepancy between internal emotions and how others in environment describe or respond

Clinical presentation
• Severe disturbance of mood and behavior
• Unstable relationships, severe distortions of self-image, impulsive and dangerous behavior (self-harm)

Course
• 10% complete suicide
• Chronic but about 50% no longer meet full criteria 10 years after 1st diagnose

18
Q

Describe the epidemiology, pathophysiology, clinical presentation, course, and prognosis of antisocial personality disorder.

A

Epidemiology
• 3% in men; 1% in women
• Associated with high rates of criminality

Clinical presentation
• Disregard for others
• Violation of rights of others
• Marked lack of empathy

Course:
• Associated childhood behaviors: truancy, fire-setting, cruelty to animals
• Usually met criteria for conduct disorder in childhood

Prognosis
• Chronic
• 12% remission over 30 years

19
Q

List the treatments available for borderline personality disorder, including psychotropic medications and psychosocial interventions.

A

Psychosocial:
Dialectical behavioral therapy
• Occurs at least weekly for 1 year
• Teach validation, mindfulness, developing emotional regulation, distress tolerance, interpersonal effectiveness skills
• Reduces self-harm, emotional disturbance, hospitalization rates in BPD

Pharmacotherapy:
o Antidepressants: dysphoria and anxiety
o Antipsychotics: treat dissociative and psychotic symptoms
o Anticonvulsants: treat mood instability and impulsivity

Avoid:
• Benzodiazepines: cause disinhibition, may be misused
• TCA’s: risk of death with overdose

Neuro (20 decks)

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