Personality Disorders and LD Flashcards
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
What age is it generally accepted our personality is developed?
Late teens / early 20s
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
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
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
From what age can a personality disorder be diagnosed?
Over 18yrs
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
Outline the features of a schizoid personality disorder
Preferring to be alone
Don’t like relationships
Low libido
How common are personality disorders?
Approx 10% population and 50% of psychiatric pt
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
What is the most most common personality disorder diagnosis?
Emotionally unstable personality disorder (EUPD)
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
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
Describe a paranoid personality disorder
Suspicion and distrust
Sensitivity to criticism, bears grudges
Self-importance
Describe a schizotypal personality disorder
Emotionally cold and detached
Social isolation
Lack of “life enjoyment”
What personality disorders are included cluster B?
Temperament = dramatic, emotional, erratic
1) Borderline
2) Narcissistic
3) Histrionic
4) Antisocial
Describe an antisocial personality disorder
Callous, unstable relationships Easily frustrated Impulsive Failure to learn or accept responsibility Lack of guilt
Describe a borderline / emotionally unstable personality disorder
Multiple, turbulent relationships, easily frustrated
Impulsive
Intense mood
Esp seen in young women
Describe a histrionic personality disorder
Exaggerated, theatrical expression Attention seeking Vain Shallow, labile mood Brief crushes
Describe a narcissistic personality disorder
Grandiose self-importance
Exaggerates abilities
Exploits others, arrogant
Expects praise and respect
What personality disorders are included in cluster C?
Temperament = anxious, fearful
1) Anxious
2) Dependent
3) Anakastic / obsessional
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
