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PSYCHIATRY > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

What is meant by personality?

A

predictable patterns of

  • thinking
  • feeling
  • behaving
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2
Q

When did the theory of personality “traits” come about?

A

1920s-1930s

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3
Q

What is the 5 Factor model?

A 
5 big personality traits:
Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism
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4
Q

What does the ICD-10 define as a Personality Disorder?

A
  • Individuals characteristics and behaviour deviate markedly from expected
  • Manifests in >1 of cognition, affect, impulses, interpersonal functioning
  • Behaviour is inflexible, maladaptive, dysfunctional
  • Causes patient distress
  • Stable and long duration
  • onset in late childhood/adolescence
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5
Q

What four categories can a personality disorder manifest in?

A

Cognition
Affect
Impulses
Interpersonal functioning

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6
Q

What makes a characteristic more likely to be a personality disorder rather than a trait?

A
  • Pervasive (not just related to specific situations)
  • Causes distress and/or
  • Causes impairment of functioning in most areas
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7
Q

Clinical assessment of personality disorders usually takes longer than one appointment. TRUE/FALSE?

A

TRUE

- Rating scales usually have many questions and take a bit of time to complete

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8
Q

Give examples of screening questionnaires used to assess personality disorders in clinic?

A

Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD)
- carried out by clinician, qs based on DSM-IV

International Personality Disorder Examination (IPDE)
- Quick screening method, self administered

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9
Q

What is meant by heritability?

A

Proportion of the condition that is due to genetics

e.g. heritability of 0.6 = 60% genetic, and 40% environmental

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10
Q

What Clusters of personality disorders have a higher heritability?

A

Cluster B - Dramatic and Emotional = higher genetic heritability

Cluster C - all higher except Avoidant

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11
Q

What cluster of personality disorders have lower heritability?

A

Cluster A - Odd and Eccentric (paranoid, schizoid)

Avoidant (Cluster C) also has low heritability

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12
Q

What proportion of people in the general population have a personality ‘disorder’?

A

10.6%

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13
Q

Personality disorders are more common in the population than many physical conditions such as IBD, epilepsy, and diabetes. TRUE/FALSE?

A

TRUE

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14
Q

A high prevalence of personality disorders are unspecified. TRUE/FALSE?

A

TRUE

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15
Q

Compare the prevalence of Personality Disorders in the general population to that in psychiatric outpatients and inpatients.

A

General population - 10.6%
Psychiatric Outpatients - 31%
Psychiatric Inpatients - 54%

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16
Q

Describe the Clusters of Personality disorders described in the ICD-10

A

Cluster A - Odd and Eccentric

  • Paranoid
  • Schizoid

Cluster B - Dramatic and Emotional

  • Dissocial (previously antisocial)
  • Emotionally Unstable (Impulsive/ Borderline)
  • Histrionic

Cluster C - Anxious and Dependent

  • Avoidant
  • Dependent
  • Anankastic
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17
Q

What two types of personality disorders are not included in the ICD-10 criteria?

A

Narcissistic

schizotypal

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18
Q

What are the ICD-10 criteria for Paranoid personality disorder and how many criteria are required for a diagnosis?

A

4 or more of the following:

  • Sensitive to setbacks
  • Hold grudges
  • Suspicious
  • misconstrue neutral/friendly actions as hostile
  • suspicions of sexual infidelity in partner
  • excessive self-importance
  • Preoccupation with “conspiracies” of the world
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19
Q

What are the ICD-10 criteria for Schizoid personality disorder and how many criteria are required for a diagnosis?

A

4 or more of the following:

  • Few activities provide pleasure
  • Cold/ flattened affect
  • cant express warm feelings towards others
  • difficulty accepting praise/criticism
  • Little interest in sexual experiences with others
  • Chooses solitary activities
  • Preoccupation with fantasy
  • No close friends
  • Insensitive to social norms/conventions
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20
Q

What are the ICD-10 criteria for Schizotypal personality disorder and how many are required for this diagnosis?

A

5 or more of:

  • Ideas of reference
  • Odd beliefs/magical thinking (e.g. belief in clairvoyance/ telepathy)
  • Unusual perceptual experiences, including bodily illusions
  • Odd thinking and speech
  • Suspicious/paranoid
  • Inappropriate/ constricted affect
  • Behaviour is odd/eccentric/peculiar
  • Lack of close friends
  • Social anxiety doesn’t diminish with familiarity
21
Q

What are the ICD-10 criteria for Dissocial personality disorder and how many are required for this diagnosis?

A

3 or more of:
Callous unconcern for feelings of others
Irresponsible & disregard for social norms/rules/ obligations
Incapacity to maintain enduring relationships, though no difficulty to establishing them
Very low tolerance to frustration and low threshold for aggression/violence
Incapacity to experience guilt, or to profit from adverse experience, particularly punishment
Marked proneness to blame others

22
Q

What is the difference between antisocial personality disorder and psychopathy?

A 
Antisocial = based on behaviour
psychopathy = set of ‘deficits’ in emotional and cognitive functioning
23
Q

What are the 4 facets of psychopathy disorders?

A

Facet 1 - Interpersonal

  • superficial charm
  • grandiose self-worth

Facet 2 - Affective

  • lack of remorse/guilt
  • shallow affect

Facet 3 - Lifestyle

  • Prone to boredom
  • Impulsive/ Irresponsible

Facet 4 - Antisocial

  • poor behavioural
  • especially in childhood
24
Q

What are the criteria of the ICD-10 for Impulsive Emotionally Unstable Personality Disorder?

A

3 of:

  • act unexpectedly, without considering consequences
  • Quarrelsome behaviour/conflicts with others
  • outbursts of anger or violence
  • Difficulty maintaining course of action offering no reward
  • Unstable mood
25
Q

What additional criteria of the ICD-10 indicate a Borderline Emotionally Unstable Personality Disorder ?

A

Plus 2 of:

  • uncertainty about self-image
  • Intense/unstable relationships
  • efforts to avoid abandonment
  • Recurrent threats/acts of self-harm
  • Chronic feelings of emptiness
26
Q

What criteria of Narcissistic Personality Disorder are outlined in the DSM-V?

A

5 of:

  • grandiose logic of self-importance
  • fixation with fantasies of infinite success/brilliance #
  • belief they are extraordinary and can only be understood by other extraordinary people
  • desire for admiration
  • sense of entitlement
  • oppressive behaviour
  • No empathy
  • Resentment of others/ feeling resentment from others
  • egotistical/conceited behaviours
27
Q

What ICD-10 criteria indicate an anankastic personality disorder?

A

4 of:

  • doubt/caution
  • Preoccupation with details/rules
  • Perfectionism
  • Conscientiousness
  • preoccupation with productivity (causes exclusion of pleasure/relationships)
  • Pedantic
  • Rigidity and stubbornness
  • insistence that others conform to their way of doing things
  • reluctance to allow others to do things
28
Q

What are the ICD-10 criteria of avoidant personality disorder?

A

4 of:

  • feelings of tension/apprehension
  • Belief that one is inferior to others
  • worried about being criticised/rejected in social situations
  • Unwilling to get involved with people unless certain of being liked
  • Avoidance of social/occupational activities due to fear of criticism, disapproval or rejection
29
Q

What are the ICD-10 criteria of dependent personality disorder?

A

4 of:

  • allowing others to make important life decisions
  • Unwilling to make reasonable demands on the people they depend on
  • uncomfortable or helpless when alone
  • fears of being left to take care of oneself
  • Limited capacity to make everyday decisions without advice/reassurance
30
Q

Describe the prognosis of personality disorders

A
  • Most personality disorders are stable over time

- many people show improvements in symptoms/behaviour over time

31
Q

What should be the focus of treatment in personality disorders?

A

Treatment of any comorbidity (e.g. depression, anxiety)

32
Q

What personality disorders are thought of as “non-responders” to treatment?

A

Cluster A - Paranoid and Schizoid

Cluster B - Histrionic and Dissocial

Cluster C - Anankastic and Avoidant

33
Q

Why are pharmacological treatments not recommended for personality disorders?

A
  • cannot cure a personality disorder
  • can impair functioning
  • can contribute to pessimism when progress does not occur
34
Q

What classes of drugs can be used in personality disorders to reduce individual symptoms/ tackle comorbidities?

A

Low dose antipsychotics
Antidepressants
Mood stabilisers
Benzodiazepines

35
Q

Low dose antipsychotics are used to reduce what symptoms in personality disorders?

A

reduce the suspiciousness of Cluster A disorders
=> paranoid, schizoid and schizotypal

  • Can help with borderline personality disorder if paranoid or hearing voices
36
Q

What antipsychotics are used in low dose to treat individual symptoms of personality disorders?

A

quetiapine
olanzapine
haloperidol

37
Q

What symptoms are reduced by antidepressants in personality disorders?

A
  • mood/emotional difficulties with cluster B disorders
    => dissocial, EUPD, histrionic, and narcissistic
  • reduce anxiety in cluster C disorders
    => anankastic, avoidant and dependent
38
Q

What types of antidepressant are used to treat personality disorder symptoms?

A

SSRIs + mirtazapine

39
Q

What symptoms of personality disorders are treated by mood stabilisers, and what mood stabiliser is often used?

A
  • unstable mood and impulsivity in EUPD

- lamotrigine often used

40
Q

What drugs can be useful if a patient with a personality disorder is in crisis?

A

short-term use of Benzodiazepines/hypnotics

  • sedative
  • e.g. diazepam and zopiclone
41
Q

What specific treatments are used for avoidant personality disorder?

A
  • Social skills training (Helps increase self-efficacy and functioning)
  • Some evidence for antidepressants
42
Q

What specific treatments are used in emotionally unstable personality disorder?

A
  • Dialectical Behavioural Therapy (GOLD STANDARD)
  • Mentalization Based Therapy
  • Systems Training for Emotional Predictability and Problem Solving (STEPPS)
  • admission if required
43
Q

What are the aims of Dialectical Behavioural Therapy?

A
  • helps to accept/regulate emotions
  • Individual or Group sessions
  • Learn new skills to replace harmful behaviour
  • Address mental health/personal problems
  • Mindfulness
  • Interpersonal effectiveness
  • Distress tolerance
44
Q

What are the aims of Mentalization Based Therapy?

A
  • group and individual sessions

- to better understand and control impulses, emotions and behaviours and improve relationships

45
Q

What is involved in the STEPPS programme?

A
  • CBT based training programme
  • Focus on stabilisation
  • add on to usual treatment
  • 20 weeks and includes homework
  • Significant others are involved in training
46
Q

When is inpatient care used to treat EUPD?

A
  • acute increase in suicide risk
  • Changes to medication not managed in the community
  • Clarification/Treatment of comorbid diagnosis
47
Q

What pharmacological treatments have SOME evidence for use in EUPD?

A

Topiramate
Antidepressants
Haloperidol
Olanzapine (BUT WEIGHT GAIN)

48
Q

How should dissocial personality disorder be treated?

A
  • group-based cognitive and behavioural interventions
  • aim to solve problems such as impulsivity, interpersonal difficulties and antisocial behaviour
  • pharmacological treatment is not recommended

PSYCHIATRY (35 decks)

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