Personality Disorders Flashcards
What is personality?
Cluster of relatively predictable patterns of thinking, feeling and behaving that is consistent across time, space and context
Describe the five factor model of personality
Openness Conscientiousness Extraversion Agreeabilness Neuroticism
Define a personality disorder
Individuals characteristic and enduring patterns of inner experience and behaviour deviate markedly as a whole from the culturally expected and accepted range
What is the criteria for the diagnosis of a personality disorder?
More than one of - cognition, affectivity, impulse control, interpersonal functioning
Must be - pervasive, cause personal distress, stable/long duration and not explained by another mental disorder
What percentage have genetic influence?
60%
What percentage of the population are affected by a personality disorder?
10%
What percentage of psychiatric inpatients have a personality disorder?
54%
Name the three classifications of personality disorder
- Cluster A (odd and eccentric)
- Cluster B (dramatic and emotional)
- Cluster C (anxious and avoidant)
What conditions come under cluster A?
Paranoid
Schizoid
Schizotypal
Describe paranoid PD
4 of
- excessive sensitivity to set backs
- tendency to bear grudges
- tendency to misconstrue neutral/friendly actions
- combative/tenacious sense of personal rights out with social situation
- recurrent suspicious self referential attitude
- preoccupation with conspitatorail explanation
Describe Schizoid PD
4 of
- few activities provide pleasure
- emotional coldness
- detachment
- limited capacity to express warm feelings
- indifferent to praise/criticism
- no interest in sexual experience
- solitary activities
- preoccupation with fantasy
- no close friends
- insensitive to social norms
Describe Schizotypal PD
5 of
- ideas of reference
- odd beliefs or magical thinking
- unusual perceptual experiences
- odd thinking and speech
- suspicious/paranoid ideation
- inappropriate/constricted affect
- peculiar behaviour
- lack of close friends
- excessive social anxiety
What disorders are classed as cluster B?
Dissocial
Emotionally unstable and borderline
Histrionic
Narcissistic §
Describe Dissocial PD
3 of
- callous unconcern for feeling of others
- irresponsible and disregard for social norms
- incapacity to maintain enduring relationships
- low tolerance to frustration and violence
- incapacity to experience guilt
- marked process to blame others
What is the difference between dissocial PD and psychopathy?
Psychopathy has deficits in emotional and cognitive function
Describe emotionally unstable PD
3 of
- tendency to act unexpectedly without consideration of consequences
- quarrelsome behaviour
- liability of outbursts
- unstable mood
- difficult to maintain course of action of no reward
In addition to emotionally unstable what is need for a diagnosis of borderline PD?
Uncertainty of self image, intense and unstable relationships, excessive efforts to avoid abandonment, recurrent threats/acts of self harm, chronic feeling of emptiness
Describe Histrionic PD
4 of
- self dramatisation
- suggestible shallow/labile affect
- seek excitement/activities where they are at the centre
- inappropriately seductive
- only concerned with physical attractiveness
Describe Narcissistic PD
5 of
- grandiose
- fixation of fantasies of infinite success
- credence they are exceptional and should only connect with important people
- unwarranted administration
- no empathy
- sense of entitlement
- resentment for those who are restful towards them
- egotistical attitude
- interpersonally oppressive behaviour
What disorders are within cluster C?
Anakastic, anxious, dependent
Describe anakastic PD
4 of
- feelings of excessive doubt and caution
- preoccupation with organisation, rules, lists
- perfectionism
- conscientiousness
- scrupulousness
- preoccupation with productivity - exclusion of pleasure and relationships
- pedantic/stubborn
- reluctant to let others do things
Describe anxious PD
4 of
- persistent pervasive feelings of tension
- belief that one is socially inept
- excessive preoccupation about being criticised
- unwilling to be involved unless they are liked
- restricted lifestyle due to security
- avoidance of situations due to fear of rejection
Describe dependent PD
4 of
- encouraging/allowing others to make most of important life decisions
- subordination of one’s own needs to those of others who they are dependent on
- unwilling to make reasonable demands of people
- uncomfortable or helpless when alone (inability to care for themself)
- preoccupation of fear of being left alone
- limited capacity to make decisions without reassurance
Can you treat personality disorder?
No cure - can impair functioning or development but can treat comorbidities
When can anti-psychotics be used?
Cluster A and borderline if paranoid
- haloperidol, quetiapine, olanzapine
When can anti-depressants be used?
Cluster B, borderline,dissocial, anxiety in cluster C
- SSRI
When can mood stabilisers be used?
Unstable/impulsive disorders, borderline
- lamotrigine
Can benzodiazepines be used in PD?
Only for short term sedation
How is avoidant PD be managed?
Social skills training
How is emotionally unstable PD managed?
Dialectical Behavioural Therapy
Describe dialectical behavioural therapy
6 months to 1 year of therapy - aim to learn to accept and regulate emotions individual and group sessions.
What are the four pillars of dialectical behavioural therapy?
- mindfulness
- regulate emotions
- tolerate distress
- interpersonal effectiveness
What is metallisation based therapy?
Individual and group sessions, focus on what is going on in your mind and other peoples. In order to better understand and control behaviour
What does STEPPS stand for?
Systems Training for Emotional Predictability and Problem Solving
Describe STEPPS
CBT based focus on stabilisation as an add on to usual treatment - 20 weeks plus homework, involvement of significant others as reinforcement team
Is impatient care recommended in PD?
No
Only used if acute increase in suicide, changes to medication and clarification/treatment comorbid diagnosis
72 hours recommended no more than 2 weeks
How is antisocial PD managed?
Group based approach to address thoughts and behaviour - impulsivity, antisocial, interpersonal
Which drugs are used in patients with difficulties with impulse control?
1st line SSRI
2nd/3rd line Olanzaping, sodium valproate, carbamazepine, low dose antipsychotic
What drugs are used in affective dysregulation?
1st/2nd line SSRI/Mirtazepine
3rd line - Olanzaping, sodium valproate, carbamazepine, low dose antipsychotic
What drugs are used in cognitive perceptual symptoms?
Low dose antipsychotic
Can any drugs be used in patients with interpersonal difficulties?
No
