Personality Disorders

Question 1

PDs are often thought to be ‘untreatable’ by definition

Answer 1

True

Question 2

Personality disorders types

Answer 2

Antisocial
Avoidant
Borderline
Dependent
Histrionic
Narcissistic
Obsessive-compulsive
Paranoid
Schizoid
Schizotypal

Question 3

Antisocial is more common in men

Answer 3

true

Question 4

Antisocial PD is characterised by

Answer 4

Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;

Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;

Impulsiveness or failure to plan ahead;

Irritability and aggressiveness, as indicated by repeated physical fights or assaults;

Reckless disregard for safety of self or others;

Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;

Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Question 5

Avoidant PD is characterised by

Answer 5

Unwillingness to be involved unless certain of being liked

Preoccupied with ideas that they are being criticised or rejected in social situations

Restraint in intimate relationships due to the fear of being ridiculed
Reluctance to take personal risks doe to fears of embarrassment

Views self as inept and inferior to others

Social isolation accompanied by a craving for social contact

Question 6

Borderline PD is characterised by?

Answer 6

Unstable interpersonal relationships which alternate between idealization and devaluation

Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)

Recurrent suicidal behaviour

Affective instability

Chronic feelings of emptiness

Difficulty controlling temper

Quasi psychotic thoughts

Question 7

Borderline PD is DRIVEN by?

Answer 7

Efforts to avoid real or imagined abandonment

Question 8

Avoidant PD is DRIVEN by

Answer 8

Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.

Question 9

Dependent PD features

Answer 9

Difficulty making everyday decisions without excessive reassurance from others

Need for others to assume responsibility for major areas of their life

Difficulty in expressing disagreement with others due to fears of losing support

Lack of initiative

Unrealistic fears of being left to care for themselves

Urgent search for another relationship as a source of care and support when a close relationship ends

Extensive efforts to obtain support from others

Unrealistic feelings that they cannot care for themselves

Question 10

Histrionic PD is driven by?

Answer 10

Need to be the centre of attention

Question 11

Histrionic PD features?

Answer 11

Inappropriate sexual seductiveness

Rapidly shifting and shallow expression of emotions

Suggestibility

Physical appearance used for attention seeking purposes

Impressionistic speech lacking detail

Self dramatization

Relationships considered to be more intimate than they are

Question 12

Narcissistic PD

Answer 12

Grandiose sense of self importance
Preoccupation with fantasies of unlimited success, power, or beauty
Sense of entitlement
Taking advantage of others to achieve own needs
Lack of empathy
Excessive need for admiration
Chronic envy
Arrogant and haughty attitude

Question 13

Obsessive-compulsive PD

Answer 13

Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness

Question 14

Paranoid pd

Answer 14

Hypersensitivity and an unforgiving attitude when insulted

Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character

Question 15

Schizoid PD

Answer 15

Indifference to praise and criticism

Preference for solitary activities

Lack of interest in sexual interactions

Lack of desire for companionship

Emotional coldness
Few interests
Few friends or confidants other than family

Question 16

Schizotypal PD

Answer 16

Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect

Question 17

Schizotypal PD speech is always incoherent

Answer 17

false

Odd speech without being incoherent

Question 18

PDs are often thought to be ‘untreatable’ by definition

Answer 18

true

Question 19

PD approach to mx

Answer 19

however, a number of approaches have been shown to help patients, including:
psychological therapies: dialectical behaviour therapy

Question 20

Somatisation disorder is?

Answer 20

multiple physical SYMPTOMS present for at least 2 years

patient refuses to accept reassurance or negative test results

Question 21

Illness anxiety disorder (hypochondriasis) is?

Answer 21

persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results

Question 22

Conversion disorder- patient deliberately feigns sx

Answer 22

false

the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)

Question 23

Conversion disorder is

Answer 23

typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 24

Dissociative disorder is?

Answer 24

dissociation is a process of ‘separating off’ certain memories from normal consciousness

in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor

Question 25

new term for multiple personality disorder

Answer 25

dissociative identity disorder (DID) - the most severe form of dissociative disorder

Question 26

Factitious disorder is?

Answer 26

also known as Munchausen’s syndrome

the intentional production of physical or psychological symptoms

Question 27

Malingering is?

Answer 27

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 28

One of the most popular models of grief divides it into 5 stages.

Answer 28

Denial: this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual. Occasionally people may focus on physical objects that remind them of their loved one or even prepare meals for them
Anger: this is commonly directed against other family members and medical professionals
Bargaining
Depression
Acceptance

Question 29

Features of atypical grief reactions include:

Answer 29

delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins

prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months

Question 30

Chronic insomnia may be diagnosed if a person has trouble falling asleep or staying asleep at least

Answer 30

three nights per week for 3 months or longer.

Question 31

Insomnia ix

Answer 31

Diagnosis is primarily made through patient interview, looking for the presence of risk factors.
Sleep diaries and actigraphy may aid diagnosis. Actigraphy is a non-invasive method for monitoring motor activity.
Polysomnography is not routinely indicated. It may be considered in patients with suspected obstructive sleep apnoea or periodic limb movement disorder, or when insomnia is poorly responsive to conventional treatment.

Question 32

Insomnia mx

Answer 32

Short-term management of insomnia:
Identify any potential causes e.g. mental/ physical health issues or poor sleep hygiene.
Advise the person not to drive while sleepy.
Advise good sleep hygiene: no screens before bed, limited caffeine intake, fixed bed times etc.
ONLY consider use of hypnotics if daytime impairment is severe.

Question 33

There is good evidence for the efficacy of hypnotic drugs in short-term insomnia. However, there are many adverse effects

Answer 33

daytime sedation, poor motor coordination, cognitive impairment and related concerns about accidents and injuries. In addition, tolerance to the hypnotic effects of benzodiazepines may be rapid (within a few days or weeks of regular use).

Question 34

The hypnotics recommended for treating insomnia are

Answer 34

short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).
Diazepam is not recommended but can be useful if the insomnia is linked to daytime anxiety.
Use the lowest effective dose for the shortest period possible.
If there has been no response to the first hypnotic, do not prescribe another. You should make the patient aware that repeat prescriptions are not usually given.
It is important to review after 2 weeks and consider referral for cognitive behavioural therapy (CBT).

Other sedative drugs (such as antidepressants, antihistamines, choral hydrate, clomethiazole and barbiturates) are not recommended for managing insomnia.