Personality Disorders Flashcards
What is a personality disorder?
When personality traits are persistently disabling/distressing
How do you qualify something as a PD?
3Ps
PERSISTENT - emerge in childhood/adolescence into adulthood
PERVASISVE - occur in most / all areas of life
PATHOLOGICAL - cause distress, affect relationships, impair occupational/social functioning
What are the three types of personality traits?
A
B
C
Describe type A
Odd / eccentric
Describe type B
Dramatic/emotional
Describe type C
Anxious (avoidant), dependsnt, anankastic
What are psychological theories behind PD?
Attachment theory Defense mechanisms (acting out, splitting, projection, passive aggression)
What are psych interventions for PD?
CBT
Dialectical behavioural therapy (DBT)
Cognitive analyticall therapy (CAT)
metallisation based therapy (MBT)
What are examples of trait A PD?
Paranoid
Schizoid
Schizotypal
What are examples of trait B PD
Histrionic
EUPD
Dissocial
What are the general traits of EUPD?
AEIOU
Affective instability Explosive behaviour Impulsiveness Outburst of anger Unable to plan or consider consequences
What are the two types of EUPD?
Impulsive
Borderline
What are the features of impulsive EUPD?
LOSE IT
Lacks impulse control
Outbursts/treats of violence
Sensitive to criticism
Emotional instability. (mood swing)
Inability to plan
Thoughtless of consequence
What are features of borderline PD?
SCARS
Self image unclear (and sexuality confused) Chronic feeling of emptiness Abandonment fear Relationships intense, unstable Suicidal behaviour/self harm
How do we make PD dx?
MULTIPLE follow up interviews with patients
Questionnaires (e.g. SAPAS)
OR semi-structured interviews
What are medical treatments for PD?
Generally not recommended
- antidepressants to treat depression secondary to PD
- Atypical antipsychotic QUETIAPINE may be prescribed
- Mood stabiliser may help with fluctuation
- Sedative during crisis
What is important to set with a PD patient?
BOUNDARIES
What should you not believe if a PD patient tells you?
COMPLIMENTS
They will be exaggerated, and push you to give them preferential tx
This means once you do something they don’t like they will treat you like CRAP
How should you treat a PD patient?
The SAME as EVERYONE else
Should you admit PD patient onto MHU?
If possible, NO
If risk assessment shows risk is high, admit for SHORT PERIOD ONLY
What is the appropriate therapy for the PD patient in long-term?
PSYCHOLOGICAL THERAPY IN THE COMMUNITY
What are fts of HISTRIONIC personality disorder
Actors
attention seeking concerned with appearance theatrical open to suggestions racy, seductive shallow affect
What are fts of DISSOCIAL/ANTISOCIAL PD
Serial killer
FIGHTS
Forms but cannot maintain relationship Irresponsible Guiltless, lact of remorse Heartless (callous about feelings of others) Temper lost easily SOmeone elses fault
What are Type C personality disorders
Anakastic
Anxious
Dependent
Anakastic
DETAILED Doubtful Excessive detail Tasks not completed Adheres to rules Inflexible LLikes own way Excludes pleasures and relationshiops Dominated by intrusive thoughts
What are features of anxious PD
AFRAID
Avoids social contact Fears Rejections / criticism Restricted lifestyle Apprehensive Inferiority DOes't get involved unless sure of acceptance
What are features of dependent PD
SUFFER
Subordinate Undemanding Feels helpless Fears abondonment Encourages others to make decisions Reassurance needed
How do you manage PD
Psychotherapy:
- Dialectical behavioural therapy DBT
- Cognitive analytical therapy CAT
- mentalisation
+ ART THERAPY
How does DBT work
Type of CBT for people who experience intense emotion
Treats EUPD
Focuses on changing unhelpful behaviours and accepting who you are
How does mentalisation based therapy work
Teaches to think about thinking
- take a step back and scrutinise your own thoughts and impulses
- Recognise other poeples thought patterns and recognise that your interpretation may not be correct
how do you give contacts to crisis manage a PD pt
- community mental healrth nurse
- out of hours social worker
- crisis resolution team
What is insomnia
difficulty getting to sleep / maintaining sleep for 3 or more nights of the week for 3 or more months
How do you investigate insomnia
sleep diary /actigraph
Exclude potential causes (depression/anxiety)
How do you manage insomnia
Advise sleep hygiene, don’t drive when tired
CBT-I for insombnia
Consider short acting benzo (e.g. lorazepam) or Z drug (zopiclone) - lowest possible dose and shortest time possible
How does dialectical based therapy work
based on CBT
understand and accept your difficult feelings. learn skills to manage them.
describe scarlet fever rash
There is a blanching punctate rash SPARING the face
what is initial management of hirschprung’s
bowel irrigation - to allow passage of meconium
once diagnosis is confirmed - anorectal pullthrough
