Personality Disorders

Question 1

Personality disorder in the medical setting leads to better or worse outcomes in health status?

Answer 1

Worse outcomes, higher rates of healthcare use and complicates the task of diagnosing

Question 2

Goals of management of personality disorder?

Answer 2

Develop working relationship with patients

Avoid chronic difficulties in the doctor-patient relationship

You will probably not cure the personality disorder - so relax.

Question 3

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?

Answer 3

Personality disorder.

Question 4

T/F people with personality disorder frequently seek help.

Answer 4

False- frequently do not seek help.

Question 5

Ego syntonic vs Ego dystonic

Answer 5

Ego syntonic - patients do not view throughts and behavioral as unacceptable

Ego dystonic - patient distressed by their symptoms.

Question 6

No medications treat any personality disorder in total but what can help determine what medication to give?

Answer 6

Clustering symptoms

Best that can be achieved is treatment of symptoms.

Question 7

Cognitive perceptual organization can be treated with?

Answer 7

atypical antipsychotics or SSRIs

Question 8

Impulsivity/aggression can be treated with?

Answer 8

Antipsychotics, B-blockers (esp children), lithium, carbamazepine (tegretol), phenytoin.

Question 9

Mood instability treated with?

Answer 9

Mood stabilizer
Consider SSRI or other antidepressant
Atypical antipsychotic

Question 10

Anxiety/inhibition treated with?

Answer 10

SSRI or related antidepressant

Benzodiazepine for short term symptom control, Longer acting

Question 11

Schizoid personality disorder is?

Answer 11

Patterns of indifference to others
Diminished range of emotional experience and expression

Socially isolated. 3.1% or 6.5% in the US

Question 12

Schiztoypal personality disorder is?

Answer 12

Peculiar patterns of behavior

Perceptual and cognitive disturbance.

Unusual speech, distinguished from psychosis

Approximately 3% of the general population

Question 13

What does detachment apply to?

Answer 13

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

Question 14

What strategy should you use for detachment?

Answer 14

Use low-key approach focusing on technical aspects of treatment.

Patient will probably reject Dr’s personal over involvement or social supports.

Question 15

What do schizotypal need that schizoid do not?

Answer 15

Schizotypal may need help with reality testing and also may need antipsychotics.

Question 16

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)

Answer 16

Paranoid personality disorder

Question 17

What should you do in the treatment of suspiciousness paranoid PD?

Answer 17

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.

Question 18

Cluster A includes?

Answer 18

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.

Question 19

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.

Answer 19

Antisocial personality disorder.

Question 20

Manipulativeness antisocial PD might try to manipulate you and have a hidden agenda. How should you handle this?

Answer 20

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.

Question 21

Narcissistic personality disorder have a pattern of?

Answer 21

Pattern of gradiosity

Exaggerated sense of self-importance

Preoccupation with achievement and unable to empathize with others.

50-75% are MALES

Question 22

There’s a high rate of what with BPD?

Answer 22

70-75% have a history of at least one self-injurious act

Rates of completed suicide are about 9%.

Question 23

How should you manage BPD clinically?

Answer 23

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.

Question 24

Only ___ out of 10 complete psychotherapy

Answer 24

1

50% drop out within 6 months and 75% within a year.

Question 25

Histrionic personality disorder - overlap between histrionic and borderline

Answer 25

This is a pervasive pattern of excessive emotionality and attention seeking.

Self-centered - demanding - vain - constantly seek approval

Emotions are shallow and easily aroused.

Question 26

People with histrionic disorder may attempt to?

Answer 26

Distract themselves from their inner anxiety about medical illness by creating an atmosphere of inappropriate familiarity with medical staff

A respectful and professional manner, without abbreviating time spent with the patient.

Question 27

Cluster B includes?

Answer 27

Narcissistic personality disorder - pattern of grandiosity, need for admiration, and lack of empathy

Antisocial personality disorder - pattern for disregard for, and violation of, the rights of others

Borderline personality disorder - is a pattern of instability in interpersonal relationships, and affects, and marked impulsivity.

Histrionic - pattern of excessive emotionality and attention seeking.

Question 28

Pattern of grandiosity, need for admiration, lack of empathy

Answer 28

Narcissistic personality disorder

Question 29

A pattern of disregard for, and violation of, the rights of others

Answer 29

Antisocial personality disorder

Question 30

Is a pattern of instability in interpersonal relationships, self image, and affects, marked impulsivity.

Answer 30

Borderline PD

Question 31

Pattern of excessive emotionality and attention seeking

Answer 31

Histrionic personality disorder

Question 32

Avoidant personality disorder is a pattern of?

Answer 32

Pattern of social discomfort, fear of negative evaluation, timidity

Tendency towards social isolation, very sensitive to criticism.

Question 33

Dependent personality disorder is a pattern of?

Answer 33

Pattern of dependent or submissive behavior: need for advise and support

Anxious and helpless when alone.

Easily hurt by criticism

Question 34

Dependent personality tend to be agreeable?

Answer 34

True, they stay involved with others - unlike avoidant - and frequent in mental health clinics

Question 35

Dependency and overdamndingness: what is it?

Answer 35

Dependent and borderline PD

Combined empathic recognition of the patient’s need for reassurance and anxiety about being alone with limit setting, clarity, consistency, and structure.

Question 36

Obsessive compulsive disorder differs from OCD how?

Answer 36

They get joy out of keeping things in order. They are ego-syntonic

Question 37

Obsessive compulsive disorder can be described as?

Answer 37

Perfectionism and inflexibility

Set ambitious, obtainable standards, they are preoccupied with rules and efficiency.

Emotionally restricted, moralistic, judgemental, intolerant of others emotionality and imperfection

Question 38

How should you respond to OCPD?

Answer 38

Respect patient’s need to be in control

Provide complete information, including test results as quickly as possible.

Engage the patient to participate in planning and scheduling steps toward medical stability.

Question 39

Cluster C includes?

Answer 39

Dependent personality disorder - pattern of submissive and clinging behavior related

Avoidant personality disorder - is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation to an excessive need to be taken care of.

Obsessive-compulsive- pattern of preoccupation with orderliness, perfectionism, and control