Personality Disorders Flashcards
Personality disorder in the medical setting leads to better or worse outcomes in health status?
Worse outcomes, higher rates of healthcare use and complicates the task of diagnosing
Goals of management of personality disorder?
Develop working relationship with patients
Avoid chronic difficulties in the doctor-patient relationship
You will probably not cure the personality disorder - so relax.
Frequent mood swings, angry outbursts, anxiety sufficient to cause difficulty making friends, need to be center of attention, feeling of being widely cheated or taken advantage of, difficulty delaying gratification, not feeling there is anything wrong with their behavior, externalizing and blaming the world for their behaviors and feelings.
These are all associated with?
Personality disorder.
T/F people with personality disorder frequently seek help.
False- frequently do not seek help.
Ego syntonic vs Ego dystonic
Ego syntonic - patients do not view throughts and behavioral as unacceptable
Ego dystonic - patient distressed by their symptoms.
No medications treat any personality disorder in total but what can help determine what medication to give?
Clustering symptoms
Best that can be achieved is treatment of symptoms.
Cognitive perceptual organization can be treated with?
atypical antipsychotics or SSRIs
Impulsivity/aggression can be treated with?
Antipsychotics, B-blockers (esp children), lithium, carbamazepine (tegretol), phenytoin.
Mood instability treated with?
Mood stabilizer
Consider SSRI or other antidepressant
Atypical antipsychotic
Anxiety/inhibition treated with?
SSRI or related antidepressant
Benzodiazepine for short term symptom control, Longer acting
Schizoid personality disorder is?
Patterns of indifference to others
Diminished range of emotional experience and expression
Socially isolated. 3.1% or 6.5% in the US
Schiztoypal personality disorder is?
Peculiar patterns of behavior
Perceptual and cognitive disturbance.
Unusual speech, distinguished from psychosis
Approximately 3% of the general population
What does detachment apply to?
Applies to schizoid and schizotypal. These patients usually choose to be alone.
Respect for their need for privacy and distance is important, while providing adequate time for necessary medical care.
You should minimize conflict which is poorly tolerated by the patient
What strategy should you use for detachment?
Use low-key approach focusing on technical aspects of treatment.
Patient will probably reject Dr’s personal over involvement or social supports.
What do schizotypal need that schizoid do not?
Schizotypal may need help with reality testing and also may need antipsychotics.
What disorder is this?
Suspicious of other’s motives
Overly reactive to minor slights or insults
Takes extraordinary precautions to avoid being exploited or injured
4.4% (9.2 million)
Paranoid personality disorder
What should you do in the treatment of suspiciousness paranoid PD?
Carefully informing inherently mistrustful patients about hospital procedures and providing exact details of medical procedures, including comprehensive information about risks and benefits.
Check to see if the patient has ever abruptly terminated treatment in the past and for what reasons.
You should acknowledge that if the patient believes that he or she might be harmed by those responsible for medical care, tension and guardedness are logic consequent feeling
Counteract the patients fear of disrespect and being intruded upon by being low-key, friendly, and not overly intimate in questions.
Cluster A includes?
Paranoid personality disorder - pattern of distrust and suspiciousness that others motives are interpreted as malevolent
Schizoid personality disorder - a pattern of detachment from social relationships and a restricted range of emotional expression
Schizotypal personality disorder - a pattern of acute discomfort in close relationships, cognitive and perceptual distortions, and eccentricities of behavior.
Name the disorder
Irresponsible and antisocial behavior prior to age 15.
Disregard and violation of others’ rights
May be charging, lack guilt, and a good majority are in prison.
Can be called moral insanity.
Antisocial personality disorder.
Manipulativeness antisocial PD might try to manipulate you and have a hidden agenda. How should you handle this?
Set clear limits and communicate in non punitive manner.
Insistence on providing only clearly medically indicated treatments and a request for psychiatric consultation if malingering seems to be present.
Narcissistic personality disorder have a pattern of?
Pattern of gradiosity
Exaggerated sense of self-importance
Preoccupation with achievement and unable to empathize with others.
50-75% are MALES
There’s a high rate of what with BPD?
70-75% have a history of at least one self-injurious act
Rates of completed suicide are about 9%.
How should you manage BPD clinically?
Be aware that co-morbid BPD may complicate accurate diagnosis of major depression and substance abuse
Remain emotionally and neutral and avoid responding to provocation.
Acknowledge the patient’s anger, frustration, or annoyance.
Respond to strong emotional outbursts with a verbal recognition of patient’s feeling and request for appropriate behavior.
Only ___ out of 10 complete psychotherapy
1
50% drop out within 6 months and 75% within a year.
