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Psychiatry > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

What is someones personality?

A

A set of consistent thoughts, feelings and behaviours shown across time in a variety of settings

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2
Q

What are the 3 hallmarks of a dysfunctional personality?

A
  1. Pervasive – occurs in all/most areas of life
  2. Persistent – evidence from adolescence and continues into adulthood (as personality develops deep in childhood so should be present back at these developmental stages)
  3. Pathological – causes distress to self or others; impairs function (occupation/social/relationships)
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3
Q

What is the aetiology of personality disorder (4)?

A
  1. Genetics
  2. Childhood temperament - a person’s innate or biologically shaped basic disposition to an emotional response and is thought to manifest from birth onwards. It is traditionally distinguished from personality which is thought to develop during later developmental stages.
  3. Childhood experience - neglect, trauma or abuse in childhood
  4. Neurochemical imbalance e.g. impulsive behaviour/aggression and serotonin
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4
Q

What is the prevalence of PD in the following settings and their predominant cluster:

  1. Epidemiological community survey
  2. Primary care
  3. Psychiatric outpatients
  4. Psychiatric inpatients
  5. Prison
A
  1. 10%
  2. 20% C
  3. 30% B
  4. 40% B
  5. 50% B
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5
Q

What does the clinical assessment of PD include (6)?

A
  1. History
  2. Mental state examination
  3. Physical examination (if neccessary)
  4. Differential diagnoses
  5. Risk assessment
  6. Management plan etc
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6
Q

What are some specific qs in the history you want to ask someone if you suspect PD?

A
  1. How long has this been a problem? Before this happened, what kind of person were you?
    - How long has this been a problem? Before this happened, what kind of person were you? If change is recent, or sudden, consider alternative cause
  2. How does this affect your relationships with other people? How would your friends describe you?
    - Personality problems are very often most evident in the context of relationships with others (but not exclusively)
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7
Q

According to DSM-5, what are the 3 clusters of personality disorders?

A

A = Odd and eccentric

  • Schizoid
  • Paranoid
  • Schizotypal

B = Dramatic and emotional

  • Antisocial
  • Histrionic
  • Borderline
  • Narcissistic

C = Anxious and fearful

  • Obsessive compuslive
  • Anxious
  • Dependent
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8
Q

What are the classifications of personality disorders according to ICD-10?

A
  1. Paranoid
  2. Schizoid
  3. Dissocial
  4. Emotionally unstable
    - Impulsive
    - Borderline
  5. Histrionic
  6. Anankastic
  7. Anxious (avoidant)
  8. Dependent
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9
Q

Which personality disorders are classified in DSM but not in ICD-10 (2)?

A
  1. Schizotypal

2. Narcissistic

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10
Q

What are the characteristics of paranoid personality disorder?
(just be aware)

A

SUSPECT

  1. Sensitive
  2. Unforgiving
  3. Suspicious
  4. Possessive and jealous of partners
  5. Excessive self-importance
  6. Conspiracy theories
  7. Tenacious sense of rights
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11
Q

What are the characteristics of schizoid personality disorder?
(just be aware)

A

ALL ALONE

  1. Anhedonic
  2. Limited emotional range
  3. Little sexual interest
  4. Apparent indifference to praise or criticism
  5. Lack of close relationships
  6. One-player activities
  7. Normal social conventions ignored
  8. Excessive fantasy world
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12
Q

What are the characteristics of dissocial personality disorder?
(just be aware)

A

FIGHTS

  1. Forms but cannot maintain relationships
  2. Irresponsible
  3. Guiltless
  4. Heartless
  5. Temper easily lost
  6. Someone else’s fault
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13
Q

What are the common characteristics of both types of emotionally unstable personality disorder?
(just be aware)

A

-2 types:
Borderline type
Impulsive type

-Common features for both types:
Affective instability
Explosive behaviours
Impulsive
Outbursts of anger
Unable to plan or consider consequences
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14
Q

What are the characteristics of borderline type emotionally unstable personality disorder?
(just be aware)

A

SCARS

  1. Self-image unclear
  2. Chronic “empty” feelings
  3. Abandonment fears
  4. Relationships are intense and unstable
  5. Suicide attempts and self-harm

Occasionally experience fleeting psychotic features (pseudohallucination)

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15
Q

What are the characteristics of impulsive type emotionally unstable personality disorder?
(just be aware)

A

LOSE IT

  1. Lacks impulse control
  2. Outbursts or threats of violence
  3. Sensitivity to being criticised or let down
  4. Emotional instability
  5. Inability to plan ahead
  6. Thoughtless of consequences
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16
Q

What are the characteristics of histrionic personality disorder?
(just be aware)

A

ACTORS

  1. Attention Seeking
  2. Concerned with own appearance
  3. Theatrical
  4. Open to suggestion
  5. Racy and seductive
  6. Shallow affect
17
Q

What are the characteristics of anankastic personality disorder?
(just be aware)

A

DETAILED

  1. Doubtful
  2. Excessive detail
  3. Tasks not completed
  4. Adheres to rules
  5. Inflexible
  6. Likes own way
  7. Excludes pleasure and relationships
  8. Dominated by intrusive thoughts
18
Q

What are the characteristics of anxious/avoidant personality disorder?
(just be aware)

A

AFRAID

  1. Avoids social contact
  2. Fears rejection / criticism
  3. Restricted lifestyle
  4. Apprehensive
  5. Inferiority
  6. Doesn’t get involved unless sure of acceptance
19
Q

What are the characteristics of dependent personality disorder?
(just be aware)

A

SUFFER

  1. Subordinate
  2. Undemanding
  3. Feels helpless when alone
  4. Fears abandonment
  5. Encourages others to take decisions
  6. Reassurance needed
20
Q

What are the general things you need to consider when managing personality disorder (7)?

A
  1. Clear boundaries
  2. Demonstrate you are reliable and consistent rather than promising something you cannot deliver
  3. Know your limits - seek help from seniors and keep MDT informed
  4. Splitting - common reaction from patients, where you are the best doctor one day and the worst doctor the next
  5. Beware of transference and countertransference
  6. Patients may need to take responsibility for their actions
  7. Beware the admission trap - admission can foster dependence and disempowering individuals from adopting safer coping strategies. A rule of thumb is that the purpose of admission needs to be clear - e.g. assessment of any co-morbidity, containment of significant risk (with a timescale)
21
Q

What is the short term management of personality disorder?

A
  1. Consider ongoing risks
    - Is patient suicidal/self-harming
    - If the patient has already harmed themselves is this being treated appropriately
    - Is the patient still intoxicated with drink or drugs?
  2. Take a history and consider comorbidity. Is their presentation just the consequence of personality problems or is there another, comorbid, mental illness that needs treating as well?
  3. Carry out a risk assessment
  4. Use all of this information to assess where they can safely be managed and their risks contained
    - Often patients with personality disorder can be safely managed in the community by primary care or by secondary services such as crisis teams or community mental health teams
    - However, if the risks are significant, it can be appropriate to admit personality disorder patients, either informally or under the MHA (remember, personality disorder is considered a “mental disorder” for the purposes of the Mental Health Act).
22
Q

What is the long-term management of patients with personality disorder?

Where are they usually managed?

A

Usually managed as an outpatient

  1. Psychological therapy:
    a. Cognitive Behavioural Therapy (CBT)
    b. Dialectical Behavioural Therapy (DBT)
    c. Cognitive Analytical Therapy (CAT)
    d. Therapeutic communities
  2. Social
    a. Support around stigma
    b. Social inclusion activities
    c. Finance
    d. Housing etc
23
Q

What determines success of therapies in personality disorder?

A

Good engagement from patient and good insight

24
Q

When is personality disorder managed on an inpatient basis? How common is this?

A

Small minority of cases

This occurs when the risks posed by the patient (usually risks to others) are so extreme that they cannot be treated safely in the community. Patients in this group are commonly involved with the criminal justice system as well and inpatient treatment of personality disorder is often carried out by forensic psychiatrists.

25
Q

What place does medication have in treatment of personality disorders?

A
  1. There is little conclusive evidence to suggest that medication can treat personality disorder itself
  2. However, there may be a place for treating some particular facets of personality disorder with medication and we often use medication to address complicating comorbid problems such as mood disorder, psychosis or ADHD
26
Q

What is the prognosis of personality disorder?

A
  1. PD, especially cluster B disorders appear to be linked with a higher rate of suicide, likely due to impulsivity and emotional instability
  2. Cluster B disorders seem to be less common with increasing age. This may reflect the fact that some of the characteristics e.g. impulsivity appear to naturally diminish with age. Whether or not the underlying personality disorder has disappeared is more difficult to say, but the patient’s presentation may change so that they no longer meet the diagnostic criteria.

Psychiatry (16 decks)

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