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Psychiatry Exam 1 > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Characteristic of all personality disorders

A
  • Consistent over time
  • Behavior/traits difficult to modify
  • Character deficits are ego-syntonic (bad insight)
  • Use defense mechanisms (often primative)
  • Anxiety and depression common presenting symptoms
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2
Q

Behavior in PDs deviates in at least 2/4 areas:

A
  • Cognition (perception, interpretation)
  • Affectivity (range, intensity, lability, appropriateness of emotional response)
  • Interpersonal fxning
  • Impulse control
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3
Q

Paranoid Personality Disorder Description

A

Pervasive distrust/suspiciousness of others –> motives interpreted as malevolent; often uses projection as defense mechanism

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4
Q

Paranoid PD Criteria

A

4+:

  • Suspects w/o basis to be exploited, deceived, or harmed
  • Questions w/o justification loyalty/trustworthiness
  • Reluctant to confide in others (fears info will be used against them)
  • Reads hidden meaning (demeaning/threatening)
  • Bears grudges, is unforgiving
  • Perceives attacks on character/reputation and quick to act angrily
  • Recurrent suspicions w/o justification re: fidelity of spouse/partner
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5
Q

Management of Paranoid PD

A
  • Develop trusting relationship
  • Be honest/straightforward but not overly intimate
  • Inform at each step of diagnosis/tx plan
  • Anticipate anger, suspiciousness and noncompliance
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6
Q

Schizoid PD Description

A

Pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal setting

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7
Q

Schizoid PD Criteria

A

4+:

  • Neither desires/enjoys close relationships
  • Chooses solitary activities almost always
  • Little if any interest in sexual experiences w/ another person
  • Takes pleasure in few if any activities
  • Lacks close friends/confidants
  • Appears indifferent to praise/critcism
  • Shows emotional coldness, detachment, flattened affect
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8
Q

Schizoid PD management

A
  • Appreciate need for privacy
  • Focus on technical aspects of tx
  • Avoid very personal, close relationship
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9
Q

Schizotypal PD Description

A

Pattern of social/interpersonal deficits marked by acute discomfort w/ and reduced capacity for close relationship as well as by cognitive/perceptual distortions and eccentricities of behavior

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10
Q

Shizotypal PD Criteria

A

5+:

  • Ideas of reference
  • Odd beliefs, magical thinking
  • Unusual perceptual experiences
  • Odd thinking and speech (vague, circumstantial)
  • Suspiciousness or paranoid ideation
  • Inappropriate or constricted affect
  • Behavior/appearance that is odd, eccentric, peculiar
  • Lack of close friends/confidants
  • Excessive social anxiety
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11
Q

Management of schizotypal PD

A

Avoid judgmental attitude about patient’s beliefs

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12
Q

Antisocial PD Description

A

Pattern of disregard for/violation of rights of others since age 15yrs (over 18 yrs, m>f)

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13
Q

Antisocial PD Criteria

A

3+:

  • Fails to conform to social normal w/ respect to lawful behavior
  • Deceitfulness
  • Impulsivity/failure to plan ahead
  • Reckless disregard for safety of self/others
  • Consistent irresponsibility
  • Lack of remorse

Evidence of conduct disorder w/ onset before 15 yrs

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14
Q

Antisocial PD management

A

Be aware that you might be manipulated, pt may feign physical symptoms, use firm no-nonsense approach (not punitive but w/ limits)

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15
Q

Borderline PD Description

A

Pattern of instability of interpersonal relationships, self-image, and affects and marked impulsivity; often use splitting as defense mechanism, F>M

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16
Q

Borderline PD criteria

A

5+:

  • Frantic efforts to avoid real/imagined abandoment
  • Pattern of unstable and intense interpersonal relationships
  • Identity disturbance (unstable sense of self)
  • Impulsivity in at least 2 ares that are potentially self damaging
  • Recurrent suicidal behavior, threats, gestures, self-mutilation
  • Affective instability
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or lack of control of anger
  • Transient, stress-related paranoid ideation or dissociative symptoms
17
Q

Boderline PD Management

A
  • Tailor meds to pt symptoms (antipsychotics often used)
  • Patient may split staff, act in unstable/angry manner
  • Consistent tx approach to manage pt’s fears of abandonment
  • Monitor countertransference, discuss w/ supervisor
18
Q

Histrionic PD Description

A

Pattern of excessive emotionality and attention seeking beginning by early adulthood and present in variety of contexts

19
Q

Histrionic PD Criteria

A

5+:

  • Uncomfortable in situation where not center of attention
  • Inappropriate seductive/provocative behavior
  • Consistently uses physical appearance to draw attention to self
  • Rapidly shifting and shallow expression of emotion
  • Self-dramatization, theatricality, exaggerated expressions of emotions
  • Easily influenced by others/circumstances
  • Considered relationships more intimate than they are
20
Q

Management of Histrionic PD

A
  • Prepare for overly dramatic expression of complaints – dont overreact
  • Set clear boundaraies
  • Avoid close relationship – may be misinterpreted as sexual
21
Q

Narcissistic PD Description

A

Pattern of gradiosity, need for admiration, lack of empathy

22
Q

Narcissistic PD Criteria

A

5+:

  • Grandioise sense of self importance
  • Preoccupied w/ fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Believes they are special/unique and can be understood only by special high-status people
  • Req excessive admiration
  • Sense of entitlement
  • Interpersonally expoitative
  • Lacks empathy
  • Envious of others
  • Shows arrogant, haughty behavior/attitude
23
Q

Narcissistic PD Management

A

Acknowledge pts sense of self-importance and include pt in decision making as appropriate
Tactfully acknowledge the physicians knowledge
Anticipate pt may degrade more junior members of team

24
Q

Avoidant PD Description

A

Pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

25
Q

Avoidant PD Critera

A

4+:

  • Avoids social/occupational activies that involve interpersonal contact due to fears of criticism and rejexn
  • Unwilling to get involved w/ people unless certain of being liked
  • Shows restraint w/in intimate relationships
  • Preoccupied w/ being criticized or rejected in social situations
  • Inhibited in new social situations because feels inadequate
  • Views self as socially inept, inferior, personally unappealing
  • Unusually reluctant to take personal risks or engage in new activities because may prove embarrassing
26
Q

Management of Avoidant PD

A

Pt likely timid to disclose personal details/symptoms
Physician may need to take initiative in discussing medical care
Approach should build trust and emphasize availability/respect

27
Q

Dependent PD Description

A

Excessive need to be taken care of that leads to submissive/clinging behavior and fears of separation

28
Q

Dependent PD Criteria

A

5+:

  • Difficulty making everyday decisions w/o excessive advice/reassurance from others
  • Needs others to assume responsibility for most major areas
  • Difficulty expressing disagreement w/ others
  • Difficulty initiating projects or doing things on their own
  • Great lengths to get others to like/support them, even volunteering to do unpleasant things
  • Uncomfortable/helpless when alone
  • Urgently seeks another relationship when one ends
  • Unrealistically preoccupied w/ fears of being left to care for themselves
29
Q

Dependent PD Management

A
  • Recognize that illness provides secondary gain in form of caretaking/attention
  • Schedule regular, brief appts
  • Pt may be overly compliant w/ acceptance of tx
  • Set firm, realistic limits on doctor-pt relationship
  • Watch for burnout/negative countertransferance
30
Q

OCPD Description

A

Pattern of preoccupation w/ orderliness, perfectionism, mental, and interpersonal control at expense of flexibility, openness, efficiency

31
Q

OCPD Criteria

A

4+:

  • Preoccupied w/ details, rules, lists, order organization, or schedules to extent that major point of activity lost
  • Perfectionism that interferes w/ task completion
  • Excessively devoted to work and productivity to exclusion of leisure/friendships
  • Over conscientious, scrupulous, and inflexible about morality, ethics, values
  • Unable to throw out worthless objects
  • Reluctant to delegate tasks/work in a group unless other submit exactly to their way of doing things
  • Miserly spending style
  • Rigid and stubborn
32
Q

Management of OCPD

A
  • Recognize pt is particularly troubled by loss of control related to illness
  • Be “scientific” physician who can provide detailed explanations and includes pt in decision making
  • Pt should be given as much control over tx as possible

Psychiatry Exam 1 (9 decks)

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