Personality Disorders Flashcards by Laura Lazzari

What is a personality disorder?

When personality traits are persistently disabling/distressing

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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

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What are the three types of personality traits?

A
B
C

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Describe type A

Odd / eccentric

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Describe type B

Dramatic/emotional

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Describe type C

Anxious (avoidant), dependsnt, anankastic

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What are psychological theories behind PD?

Attachment theory
Defense mechanisms (acting out, splitting, projection, passive aggression)

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What are psych interventions for PD?

CBT
Dialectical behavioural therapy (DBT)
Cognitive analyticall therapy (CAT)
metallisation based therapy (MBT)

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What are examples of trait A PD?

Paranoid
Schizoid
Schizotypal

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What are examples of trait B PD

Histrionic
EUPD
Dissocial

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What are the general traits of EUPD?

AEIOU

Affective instability
Explosive behaviour 
Impulsiveness
Outburst of anger
Unable to plan or consider consequences

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What are the two types of EUPD?

Impulsive

Borderline

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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

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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

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How do we make PD dx?

MULTIPLE follow up interviews with patients
Questionnaires (e.g. SAPAS)
OR semi-structured interviews

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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