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Psychiatry > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

what is personality?

A

cluster of relatively predictable patterns of thinking, feeling and behaving that is generally consistent across time, space and context
multidimensional spectrum rather than rigidly defined categories

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2
Q

what are the 5 factors personality in the 5 factor model?

A 
social adaptability
conformity
will to achieve
emotional control
inquiring intellect
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3
Q

what 5 features overlap in the structure of personality?

A 
neuroticism
openness
conscientiosness
extraversion
agreeableness
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4
Q

6 part definition of personality disorder?

A
  1. enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individuals culture
    this pattern is manifested in 2 or more of
    - cognition (ways of perceiving and interpreting things)
    - affectivity
    - interpersonal functioning
    - impulse control
  2. the enduring pattern is inflexible and persuasive across broad range of personal and social situations
  3. the enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning
  4. the pattern is stable and of long duration and its onset can be traced back to at least adolescence or early adulthood
  5. the enduring pattern is not better explained as a manifestation or consequence of another mental disorder
  6. the enduring pattern is not attributable to the psychological effects of a substance or another medical condition
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5
Q

what is anankastatic personality disorder?

A

also called obsessive compulsive personality disorder
feelings of doubt and caution
preoccupation with details, rules, lists, order etc
perfecitonism, excessive conscientiousness and scruptulousness
preoccupation with productivity which interferes with relationships and pleasure
rigidity, stubbornness and adherence to social conventions
unreasonable insistence that others submit to his/her way

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6
Q

what is the difference between a trait and a disorder?

A

traits are common and can cause problems
only a disorder is it is pervasive (not just related to specific situations) and cause distress and/or impairment of functioning in most areas

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7
Q

how can personality be measured?

A 
clinical assessment
rating scales (ZAN-BPD, PAS, PDQ-4)
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8
Q

aeitiology of personality disorder?

A

environmental and genetic influences
anxious and fearful PD (cluster C) most hereditary
odd and eccentric (cluster A) least hereditory

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9
Q

how common is personality disorder?

A

very
present in 10% of general population and 33% of psychiatric outpatients and 50% of psychiatric inpatients
(more than diabetes)

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10
Q

cluster A personality disorders?

A

paranoid
schizoid
schizotypal (in US)

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11
Q

cluster B PDs?

A

dissocial (antisocial in US)
emotionally unstable (borderline in US)
borderline (histrionic in US)
histrionic (narcissistic)

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12
Q

cluster C PDs?

A

anxious (avoidant in US)
dependant
anankastic (obsessive compulsive in US)

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13
Q

features of paranoid PD?

A

pervasiv distrust and suspiciousness of others beginning in early adulthood and present with 4 of the following

  • suspects others are exploiting/harming/deceiving them
  • preoccupied with doubts about loyalty/trustworthiness of others
  • reluctant to confide in others due to fear that information will be used against them
  • reads hidden demeaning/threatening meanings into benign events/remarks
  • persistently bears a grudge
  • perceives attacks on their character/reputation and quick to react angrily
  • recurrent suspicions regarding fidelity of spouse or sexual partner
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14
Q

features of schizoid PD?

A

pervasive pattern of detachment from social relationships and restricted range of expression of emotions
beginning in early childhood and present with at least 4 of
- neither desires or enjoys close relationships/family
- almost always chooses solitary activity
- has little interest in sexual experiences
- takes pleasure in few activities
- lacks close friends or confidants other than first degree relatives
- appears indifferent to praise or criticism
- shows emotional coldness, detachment or flattened affectivity

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15
Q

features of antisocial PD?

A

persuasive pattern of disregard for and violation of the rights of others
occurring since age 15 and present with 3 of
- failure to conform to social norms (lawful behaviour etc)
- deceitfulness
- impulsivity or failure to plan ahead
- irritability/aggressiveness
- reckless disregard for safety of self/others
- consistent irresponsibility (including work etc)
- lack of remorse

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16
Q

what is borderline personality disorder?

A

pervasive pattern of instability of interpersonal relationships, self image and affect
marked impulsivity
beginning early adulthood and present with at least 5 of the following
- frantic efforts to avoid or real or imagined abandonment
- pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
- identity disturbance (unstable self image/sense of self)
- impulsivity in at least 2 areas that are potentially damaging
- recurrent suicidal behaviour, gestures or threats or self mutilating behaviour
- affective instability due to a marked reactivity of mood
- chronic feelings of emptiness
- inappropriate intense anger or difficulty controlling anger
- transient stress related paranoid idealisation or severe dissociative symptoms

17
Q

features of histrionic PD?

A

pervasive pattern of excessively emotionality and attention seeking
beginning in early adulthood and present with 5 of
- uncomfortable in situations where they aren’t centre of attention
- inappropriately sexual or provocative behaviour
- rapidly shifting and shallow expression of emotions
- uses physical appearance to draw attention to self
- impressionistic speech lacking in detail
- self dramatisation, theatricality and exaggerated expression of emotion
- suggestibility
- thinks relationships are more intimate than they are

18
Q

features of avoidant PD?

A

pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
beginning in early adulthood and present with 4 of
- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
Is unwilling to get involved with people unless certain of being liked.
Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
Is preoccupied with being criticised or rejected in social situations.
Is inhibited in new interpersonal situations because of feelings of inadequacy.
Views self as socially inept, personally unappealing, or inferior to others.

Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

19
Q

features of dependent PD?

A

pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation
beginning early adulthood and present with 5 of the following:
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2.Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
7.Urgently seeks another relationship as a source of care and support when a close relationship ends.
8.Is unrealistically preoccupied with fears of being left to take care of himself or herself.

20
Q

features of obsessive compulsive PD?

A

pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control at the expense of flexibility, openness and efficiency
beginning by early adulthood and present with 4 of the following
1. Is preoccupied with details, rules, lists, order, organisation, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.

21
Q

what is the difference between antisocial PD and psychopathy?

A

antisocial PD is mainly based on behaviour
psychopathy describes a set of deficits in emotional and cognitive functioning
most prisoners have antisocial PD but only 15% have psychopathy
most psychopaths aren’t in prison

22
Q

factor 1 psychopathy?

A

interpersonal/affective

  • interpersonal = superficial charm, grandiosity, pathological lying and conning/manipulating
  • affective = lack of remorse, shallow affect, callous/lack of empathy, wont accept responsibility for actions
23
Q

factor 2 psychopathy?

A

social deviance

  • lifestyle = need for stimulation, parasitic lifestyle, no realistic long term goals, impulsive and irresponsible
  • antisocial = poor behaviour control (early), juveline delinquency, revocation of release, criminal versatility
24
Q

what should be the focus of treatment in PD?

A

co-morbidities (depression, anxiety etc)

there isnt much evidence to guide treatment for the actual PD

25
Q

which PDs are non-resposive?

A

cluster A - schizoid and paranoid
cluster B - histrionic and dissocial
cluster C - anankastic and avoidant

26
Q

how is avoidant PD managed?

A

social skills training

some evidence for antidepressants

27
Q

how is emotionally unstable PD managed?

A

main psychological treatment = DBT (dialectical behavioural therapy)
package of groups, firm boundaries and managing interpersonal issues
combination of behavioural approaches with buddhist concepts such as acceptance and mindfulness
hard work for patient/teams (high drop out rate)

28
Q

main effect of emotionally instable PD treatment?

A

reduction in suicidal behaviour

29
Q

what is mentalisation?

A

increasingly popular method of emotionally unstable PD management but not much evidence about it
process by which we interpret our own actions as meaningful based on our own internal mental states
impaired ability to mentalise is supposed to affect ability to regulate emotions and maintain relationships

30
Q

drug treatment in emotionally unstable PD?

A

focused on co-morbid conditions
MAOIs may be effective in co-morbid depression
antipsychotics (olanzipine or haloperidol) may have a role
mood stabilisers (lamotrigine or topiramate)

31
Q

how can antisocial PD be managed?

A

psychologically - CBT

pharmacological - generally no drugs should be used

Psychiatry (36 decks)

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