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psychiatry > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

What are psychosexual disorders?

A

disturbances in sexual function secondary to emotional and / or mental causes. This category includes sexual dysfunctions, sexual perversions (paraphilias), and gender identity disorders, and is separate from sexual disorders that may arise from an underlying medical condition.
• Sexual dysfunctions may be characterized as a disturbance of sexual desire, arousal, or orgasm; sexual pain; or difficulties with sexual performance.

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2
Q

What is a gender identity disorder?

A

• Characterize individuals who desire to be, or insist that they are, members of the other sex.
• Gender identity disorder symptoms can develop as early as ages 2 to 4.
o In boys, the cross-gender identification is manifested by a preoccupation with toys, dress and activities that are stereotypically female.
o Girls identify with the opposite gender in the preoccupation of role-play, dreams and fantasies.
• However, only a small number of children will continue to have symptoms that meet criteria for this disorder in adolescence or adulthood.
• In adults, such gender-identification can lead to sex-change operations

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3
Q

What investigations should you do in psychosexual disorders?

A

medical cause of sexual dysfunction,

Observation of an individual’s orientation, dress, mannerisms, behavior, and content of speech provide essential signs to diagnose Gender Identity Disorder.

neurological, psychiatric, and psychological evaluation.

rule out physical and / or medical concerns that may cause a sexual dysfunction disorder. e.g. Hormone tests - thyroid function tests to rule out hyperthyroidism or hypothyroidism; sex hormone binding globulin (SHBG); testosterone, estradiol, and prolactin levels; and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in women.

Toxicology screens can be performed to rule out the presence of substances or medication that may be causing the condition.

A test for erections (penile tumescence) may be done for sexual perversion (while individual views images of sexual obsession) or done to check for erectile failure (at night).

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4
Q

What is the psychosocial management of psychosexual disorders?

A

sex therapy may be helpful if the individual is involved in a relationship combined with supportive psychotherapy
• Behavior therapy is also used in sexual perversions and cognitive therapy addresses self-beliefs that sex leads to deviant behavior. involves desensitization and assertiveness training.
• Hypnotherapy may be helpful, focusing on the distressing symptoms.
• Group therapy can help support those with guilt, shame, or anxiety concerning a sexual problem. Family and marital therapy can be helpful.

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5
Q

What is the biological management of psychosexual disorders?

A

Androgen blockers can be useful for sexual perversions such as pedophilia or exhibitionism.
• Selective serotonin reuptake inhibitors (SSRIs) are used for sexual perversions including voyeurism, exhibitionism, paedophilia, frotteurism, and also for rapists.
• Estrogen, progesterone, and anti-androgens are given for compulsive sexual behavior in men.
• Psychodynamic psychotherapy and psychoanalysis are not usually effective.
• Gender identity disorders can be treated with hormone therapy and sex change surgery to help the individual physically resemble the opposite sex. These measures are generally taken only after rigorous psychological evaluation.

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6
Q

What are the possible complications with psychosexual disorders and their treatment?

A
  • Sexual dysfunctions can result in a failed relationship and subsequent depression.
  • Sexual perversions may lead to arrest, criminal conviction, and loss of the individual’s job or marriage.
  • Surgery or hormonal treatments used in gender identity disorders may lead to complications or side effects.
  • Sexual reassignment surgery can cause scarring of the vagina and breast tissue.
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7
Q

What is a personality disorder?

A

A severe disturbance in the personality and behavioural tendencies of the individual; not directly resulting from disease, damage or other insult to the brain or from another psychiatric disorder; usually involving several areas of the personality; nearly always associated with considerable personal distress and social disruption; and usually manifest since childhood or adolescences and continuing throughout adulthood.

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8
Q

What are the Group A personality disorders?

A

Paranoid and Schizoid

Odd, bizarre, eccentric.

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9
Q

What are the Group B personality disorders?

A

Antisocial, Borderline, Histrionic, Narcissistic

Dramatic, erratic

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10
Q

What are the Group C personality disorders?

A 
Avoidant
Dependent
Obsessive Compulsive  (Anankastic)
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11
Q

What is the epidemiology of PD?

A
  • It is estimated that PD affect about 10% of the population.
  • Excess of PD in males, younger adults and urban communities
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12
Q

What are the features of Paranoid PD?

A
  • characterised by a pervasive distrust of others including friends and partners
  • as result patient is GUARDED and SUSPICIOUS - constantly on the look out for clues or suggestions to confirm his fears
  • strong sense of self-importance and personal rights - overly sensitive to setbacks and rebuffs
  • Easily feels shame and bears grudges
  • As result difficultly engaging in in close relationships and tendency to be WITHDRAWN
  • Principal ego defence mechanism is projection
  • More common in males
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13
Q

What are the features of schizoid personality disorder?

A
  • Means tendency to withdraw away from external world and focus towards one’s inner life
  • Person is detached and aloof  prone to introspection and fantasy
  • No desire for social or sexual relationships  indifferent to others and to social norms and conventions
  • Lacks emotional response - in extreme examples can appeard cold and callous
  • Different from EUPD as no desire for interaction and no fear of judgement
  • Not really any Tx as often can function fine
  • Been suggested that these patients not only have a rich inner life but are quite sensate and experience a deep longing for intimacy - however they find initiating and maintaining interpersonal relationships too difficult/distressing and so retreat into their inner worlds
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14
Q

What are the features of antisocial personality disorder?

A
  • More common in men than women
  • Callous unconcern for the feelings of others
  • Disregards social rules and obligations, irritable and afressive, acts impulsively, lacks guilt and fails to learn from experience
  • No difficulty in finding relationships - ‘charming psychopath’ but realationships are fiery, short lived and turbulent
  • PD with highest correlation to crime
  • MacDonald’s triad in childhood - bedwetting, pyromania, cruelty to animals
  • Other possible Hx findings –? Bullying, truancy, poor employment hx, convictions for violence, brief relationships, substance misuse
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15
Q

What is the aetiology of EUPD?

A
  • Interaction between genetic predisposition and invalidating environment Ie bad early experience
  • This causes: underlying mood dysregulation
  • Has been suggested that it often results from childhood sexual abuse and this may be one of the reasons it is more common in women
  • Prevalence is 1.6%
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16
Q

What are the ICD10 criteria for EUPD?

A
  • Marked tendency to be impulsive
  • Unstable mood
  • Intense anger and violent outbursts
  • Outbursts of violence or threatening behaviour
  • Disturbance of self image; chronic feelings of emptiness
  • Intense unstable relationships
  • Suicidal threats and self harm
17
Q

What are the 4 problem areas in EUPD?

A
  • Difficulty tolerating distress → self harm etc
  • Problems with interpersonal relationships
  • Problems regulating mood
  • Problems with sense of self
18
Q

What other features can be seen in EUPD?

A

• Ego defence mechanisms used
o Splitting/concrete thinking
o Projection - denying the existence of one’s own unconscious impulses or qualitites in themselves and instead attributing them to others
o Projective identification - forcing parts of self onto another (1.6%)

19
Q

What is the treatment for EUPD?

A

Gold standard is DBT
Patients learn skills to address each of the problem areas. Also, CBT, mentalisation based therapies, psychoanalytic, therapeutic communities

General management
•	Individual needs assessment
•	Manage Crises
•	Manage comorbidity
•	Refer to specialist services
•	Drug treatment not for the disorder itself but to manage any comorbid conditions
•	Clarity
•	Avoid admission if possible: only use as a last resort to manage risk
20
Q

What are the features of Histrionic PD?

A
  • Lack of self worth - depend on attention and approval of others
  • Often dramatic and manipulate attention
  • Take great care in physical appearance and behave in an overly charming or inappropriately seductive manner
  • Crave excitement and act on impulse or suggestion - can put themselves at risk of accident or being exploited
  • Dealings with other people often seem insincere or superficial - this impacts their relationships
  • More rejected more histrionic = vicious cycle
21
Q

What are the features of narcissistic PD?

A
  • Person has grandiose sense of self-importance, entitlement and need to be admired
  • Envious of others and expects them to be same as themselves
  • Lacks empathy and readily exploits others to achieve his goals
  • May seem self-absorbed, controlling, intolerant, selfish and insensitive
  • If feels slighted or ridiculed may be provoked into a fit of destructive anger and revenge seeking  narcissistic rage
  • Ego protective mechanisms  projection, denial and distortion
  • Not specifically described in ICD10
22
Q

What are the features of Anankastic PD?

A
  • Excessive preoccupation with details of rules, lists, order, organisation
  • Perfection so extreme prevents a task from being completed
  • Typically doubting, cautious, rigid, controlling, humourless and miserly
  • High level anxiety arises from perceived lack of control over a universe who evades their understanding and the more they try to control the more out of control they feel
  • Problems with relationships through placing unreasonable demands on them
  • They tend to view their obsessions as rational and consistent with their self-image
23
Q

What are the features of Anxious avoidant personality disorder

A
  • Persistently tense and believes they are socially inept and unappealing and as a result feels embarrasses, criticised or rejected - avoids meeting people unless certain of being liked
  • Associated with actual or perceived rejecting by parents of peers during childhood
  • Research suggests they excessively monitor their internal reactions and the internal reactions of other people
  • Prevents them from engaging in a natural and fluent social situation
24
Q

What are the features of dependent PD?

A
  • Lack of self-confidence and an excessive need to be taken care of
  • Needs a lot of help to make every day decisions and life decisions to be made for them
  • Fear of abandonment - goes through considerable lengths to secure and maintain relationships
  • Naive childlike attitude and have limited insight to themselves/others - reinforces lack of self-confidence and leaves them particularly vulnerable to being abused/exploited

psychiatry (12 decks)

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