Personality Disorders and LD Flashcards by Rachel Eggleton

What is personality?

Collection of characteristics or traits that develop as you grow up and that makes each of us individual

Governs the way we think, feel and behave

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What age is it generally accepted our personality is developed?

Late teens / early 20s

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What shapes our personality?

1) Genetics - we share personality traits with out parents and close family members
2) Neurophysiology
3) Childhood experiences - trauma, violence and attachment issues

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What is the ICD-10 definition of a disorder?

“A severe disturbance in the characterological constitution and behavioural tendencies of the individual usually involving several areas of the personailty. Nearly always associated with considerable social and personal disruption”

Usually it is said that it is not resulting from organic change to the brain or resulting from another medical health disorder

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What is a personailty disorder?

Abnormal, persistent and extreme variation from the normal range of one or more personality traits causing the individual and/or society to suffer

Associated with considerable personal distress and social disruption
Usually manifest since childhood or adolescence
Not resulting from disease or damage to the brain
Increases vulnerability to metal illness and worsens the prognosis

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From what age can a personality disorder be diagnosed?

Over 18yrs

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List some types of personality disorder listed in ICD-10 and DSM-5 (10)

1) Paranoid
2) Schizoid
3) Schizotypal
4) Dissocial (ICD) vs antisocial (DSM)
5) Emotionally unstable (ICD) vs borderline (DSM)
6) Histrionic
7) Narcissistic (DSM)
8) Anankastic (ICD) vs obsessive-compulsive (DSM)
9) Anxious (ICD) vs avoidant (DSM)
10) Dependent

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Outline the features of a schizoid personality disorder

Preferring to be alone
Don’t like relationships
Low libido

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How common are personality disorders?

Approx 10% population and 50% of psychiatric pt

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How may personality disorders present?

Diverse presentation but some features shared:

1) Impulsive
- Self harm, promiscuity, stress intolerance and problems with relationships
2) Unstable mood
3) Intense anger and violent outbursts
4) Disturbance of self image and chronic feelings of emptiness
5) Intense and unstable relationships
6) Suicidal threats and self harm
7) Paranoia
8) Antisocial behaviours
- Irritable, callous, failure to accept responsibility
9) Obsessions and compulsions
- Rigid, stubborn, pedantic

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What is the most most common personality disorder diagnosis?

Emotionally unstable personality disorder (EUPD)

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What is thought to be the aetiology of EUPD?

Genetic predisposition and a bad experience during childhood

This leads to an underlying mood dysregulation which can cause problems with:

Difficulty tolerating stress (which can lead to DSH)
Problems with inter-personal relationships
Problems regulating mood
Problems with sense of self

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Personality disorders can be split into clusters A, B and C. Which are included in cluster A?

Temperament = odd, eccentric, aloof, suspicious

1) Paranoid
2) Schizoid
3) Schizotypal

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Describe a paranoid personality disorder

Suspicion and distrust
Sensitivity to criticism, bears grudges
Self-importance

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Describe a schizotypal personality disorder

Emotionally cold and detached
Social isolation
Lack of “life enjoyment”

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What personality disorders are included cluster B?

Temperament = dramatic, emotional, erratic

1) Borderline
2) Narcissistic
3) Histrionic
4) Antisocial

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Describe an antisocial personality disorder

Callous, unstable relationships
Easily frustrated
Impulsive
Failure to learn or accept responsibility
Lack of guilt

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Describe a borderline / emotionally unstable personality disorder

Multiple, turbulent relationships, easily frustrated
Impulsive
Intense mood
Esp seen in young women

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Describe a histrionic personality disorder

Exaggerated, theatrical expression
Attention seeking
Vain
Shallow, labile mood
Brief crushes

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Describe a narcissistic personality disorder

Grandiose self-importance
Exaggerates abilities
Exploits others, arrogant
Expects praise and respect

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What personality disorders are included in cluster C?

Temperament = anxious, fearful

1) Anxious
2) Dependent
3) Anakastic / obsessional

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Describe an anxious personality disorder

Tension and apprehension
Avoid personal contact
Fear of rejection

Describe an anakastic / obsessional personality disorder

Preoccupation with detail
Inflexible
Humourless

Describe a depended personality disorder

Encourages others to make decisions

Excessive need to be cared for

What is assessments help to confirm the diagnosis of a personality disorder

Collateral history Alcohol / drug history Childhood history - determine whether the problem has been longstanding (required for diagnosis) Psych history - screen for depression / anxiety (commonly co-exist)

What is the management of personality disorders?

Help individual find a lifestyle that suits them Consistency of care Education insight - prevent shifting of blame over to others Psychological treatment - DBT Medication - SSRIs for emotionally unstable group - Antipsychotics

What is DBT?

Dialectical behavioural therapy A form of CBT which helps people to recognise their triggers and reactive states and then helps them to implement strategies for coping with specific types of event All about identifying two opposing opinions and trying synthesis and compromise between two ideas

How long do people usually stay in DBT counselling?

2 years

What are the key features of DBT? (DICE)

Distress intolerance Interpersonal effectiveness Cognitive mindfulness Emotional regulation

What is the criteria of learning / intellectual disability? (3)

1) IQ <70 2) Loss of adaptive social functioning 3) Onset before age of 18 (during development) - ie cannot acquire it later in life

What is the IQ ranges of learning disabilities classified as: 1) Mild 2) Moderate 3) Severe 4) Profound

1) Mild = 50-69 2) Moderate = 35-49 3) Severe = 20-34 4) Profound = <20

Broadly describe a mild LD

Sensory or motor deficits are slight and there is a reasonable level of independence

Broadly describe a moderate LD

Generally people understand things well but they find it difficult to express themselves (Better receptive than expressive language)

Broadly describe a severe LD What often accompanies this?

Increased sensory and motor deficits 50% have epilepsy

Broadly describe a profound LD What is their developmental age?

Increased need and vulnerability Developmental age approx 12 months - need constant care

What is the most common genetic cause of LD?

Downs syndrome 1 in 800 live births

Other than LD, what other health risks are implicated in Down's syndrome?

``` AVSD Cataracts Hypothyroidism Chest infection Transient leukaemia Epilepsy Dementia ```

What is the most common inherited cause of LD?

Fragile X syndrome

What is the genetic basis of fragile X syndrome?

FMR1 mutation which causes too many repeats of CGG

What peri-natal causes may lead to a LD?

Birth asphyxia Maternal - placental insufficiency due to smoking / alcohol Brith trauma - cord prolapse / compression, placental abruption Difficulties due to premature birth Infections in peri-natal period

What is the leading preventable cause of LD?

Fetal alcohol syndrome

What is fetal alcohol spectrum disorder?

An umbrella term for several diagnoses that are all related to prenatal exposure to alcohol Not itself a clinical diagnosis but describes a full range of disabilities that may result from prenatal alcohol exposure 25-30% have LD

What are the key features of fetal alcohol syndrome?

1) Growth retardation 2) Characteristic facial features 3) CNS abnormalities / dysfunction

Describe the facial characteristic features of fetal alcohol syndrome

``` Low nasal bridge Indistinct philtrum Micrognathia Epicanthal folds Short palpebral fissures Flat midface and short nose Thin upper lip ```

Are these considered to be learning difficulties: 1) People who develop an impairment after the age of 18 2) People who suffer brain injury in accidents after the age of 18 3) People with complex medical conditions which develop after the age of 18 eg Huntington's Chorea, AD?

All = no

List some conditions which are linked with LD (ie not direct causes but are associated)

1) Cerebral palsy 2) Autistic spectrum disorder 3) Epilepsy 4) Prader-Willi syndrome - Usually mild and IQ in range of 50-85 5) Tuberous sclerosis - (Rare genetic disorder where non-cancerous tumours grow on the brain) - 50% have LD

What % of those with autism have a LD?

55%

Outline some areas in which those with autism have difficulties (6)

1) Social interaction 2) Verbal and non-verbal communication 3) Restricted and repetitive behaviours 4) Unusual sensory perceptions 5) Physical clumsiness 6) Dietary restrictions

What % of the total population develop a mental health problem in their lifetime? And what % of those with a LD will develop a mental health problem in their lifetime?

16-25% of total population 24-40% of people with LD

What mental health conditions most commonly seen in LD?

Depression Anxiety Dementia

What biological factors increase vulnerabilities of those with LD?

``` Genetic vulnerability Brain damage Infection Physical disability Sensory impairment Tumours Medical / physical treatment ```

What psychosocial factors increase vulnerabilities of those with LD?

``` Small circle of friends Limited opportunity for social outings Reduced employment opportunities Lack of finance Lack of support Exploitation (financial and sexual) ```

What is a common cause of LD esp in those with trisomy 21?

Hypothyroidism

Why may those with LD suffering from depression may be more difficult to treat?

May be difficult to encourage them to access talking therapies Antidepressant medication takes longer to work