Personality disorders (diagnosis and management) Flashcards
What is personality?
A cluster of relatively predictable patterns of thinking, feeling and behaving that is generally consistent across time, space and context
What are the components of the 5 factors model of personality?
OCEAN; Openness Conscientiousness Extraversion Agreeableness Neuroticism
What is a personality disorder according to ICD10?
Individuals characteristic and enduring patterns of inner experience and behaviour deviate markedly as a whole from the culturally expected and accepted range
PERVASIVE behaviour that is inflexible, maladaptive or dysfunctional
Personal distress and/or adverse impact on the social environment
What are personality disorders manifested in?
Cognition
Affectivity
Impulse control
Interpersonal functioning
At what age can you diagnose a personality disorder?
18
What differentiates personality traits from personality disorders?
Only a disorder IF;
Pervasive
Causes distress
Cause impairment of functioning in most areas
What rating scales are used in personality disorder diagnosis?
Zanarini Rating Scale for BPD
Personality Assessment Schedule
Personality Disorder Questionnaire
Minnesota multiphasic personality inventory
Borderline personality questionnaire
International personality disorder examination (IPDE)
What proportion of the general population have a personality disorder?
10.6%
Cluster A personality disorders?
Paranoid
Schizoid
Schizotypal
Cluster B personality disorders?
Antisocial
Emotionally unstable; impulsive or borderline
Histrionic
Narcissistic
Cluster C personality disorders?
Avoidant
Dependent
Obsessive-Compulsive
Differences between ICD10 and DSM5 in terms of personality disorder classification?
Narcissistic and schizotypal NOT present in ICD10
Diagnostic criteria for paranoid personality disorder?
4 of:
Excessive sensitivity to setbacks
Tendency to bear grudges
Suspicious and tendency to misconstrue the neutral/ friendly actions of others as hostile/ contemptuous
Combative and tenacious sense of personal rights out of keeping with actual situation
Recurrent suspicious, without justification, regarding sexual fidelity of partner
Persistent self-referential attitude, associated particularly with excessive self-importance
Preoccupation with unsubstantiated conspiratorial explanations of events in the world at large
Diagnostic criteria for schizoid personality disorder?
4 of:
Few activities provide pleasure
Emotional coldness, detachment, or flattened affectivity
Limited capacity to express warm feelings for others as well as anger
Indifferent to either praise or criticism of others
Little interest in having sexual experiences with another person
Almost always chooses solitary activities
Excessive preoccupation with fantasy/ introspection
Neither desired not has any close friends or confiding relationships
Marked insensitivity to prevailing social norms
Diagnostic criteria for schizotypal personality disorder?
5 or more of:
Ideas of reference
Odd beliefs or magical thinking inconsistent with subcultural norms
Unusual perceptual experiences, including bodily illusions
Odd thinking and speech (vague, circumstantial, metaphorical, elaborate or stereotyped)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behaviour or appearance that is odd, eccentric or peculiar
Lack of close friends or confidants other than 1st degree relatives
Excessive social anxiety
Diagnostic criteria for dissocial personality disorder?
3 of:
Callous unconcern for feelings of others
Irresponsible and disregard for social norms/ rules/ obligations
Incapacity to maintain enduring relationships, though no difficulty to establish them
Very low tolerance to frustration and low threshold for aggression/ violence
Incapacity to experience guilt, or to profit from adverse experience, particularly punishment
Marked proneness to blame others
Is dissocial personality disorder the same as psychopathy?
NO
Diagnostic criteria for impulsive emotionally unstable personality disorder?
3 of;
Tendency to act unexpectedly, without consideration of consequences
Quarrelsome behaviour and conflicts with others, especially when impulsive acts are thwarted/ criticized
Liability to outbursts of anger or violence
Difficulty in maintaining any course of action that offers no immediate reward
Unstable mood
Diagnostic criteria for borderline emotionally unstable personality disorder?
Meets criteria for impulsive PLUS 2 of;
Disturbances in and uncertainty about self-image, aims and internal preferences
Intense and unstable relationships; leading to emotional crises
Excessive efforts to avoid abandonment
Recurrent threats or acts of self-harm
Chronic feelings of emptiness
Diagnostic criteria for histrionic personality disorder?
4 of:
self-dramatization, theatricality or exaggerated expression of emotions
Suggestilbe
Shallow/ labile affectivity
Continually seeks excitement and activities in which the subject is centre of attention
Inappropriately seductive in appearance or behaviour
Overly concerned with physical attractiveness
Diagnostic criteria for narcissistic personality disorder?
5 of:
Grandiose logic of self-importance
Fixation with fantasies of infinite success, control, brilliance, beauty of idyllic love
A credence that he/she is extraordinary and exceptional and can only be understood by, or should connect with, other extraordinary or important people
Desire for unwanted admiration
Sense of entiltement
Interpersonally oppressive behaviour
No form of empathy
Resentment of others
Display of egotistical and conceited behaviour
Diagnostic criteria for anankastic (OCD) personality disorder?
4 of:
Excessive doubt and caution
Preoccupation with details, rules, lists, order, organization or schedule
Perfectionim that interferes with task completion
Excessive conscientiousness
Undue preoccupation with productivity to the exclusion of pleasure/ interpersonal relationships
Pedantic, excessive adherence to social conventions
Rigidity and stubbornness
Unreasonable insistence that others submit to exactly his or her way of doing things
Diagnostic critera for anxious personality disorder?
4 of:
Persistent pervasive feelings of tension/ apprehension
Belief that oneself is socially inept/ inferior to others
Excessive preoccupation about being criticized/ rejected in social situations
Unwillingness to get involved with people unless certain of being liked
Restrictions in lifestyle because of need to security
Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection
Diagnostic criteria for dependent personality disorder?
Encouranging or allowing others to make most of one’s important life decisions
Subordination of one’s own needs to those of others on whom one is dependent, and undue compliance with their wishes
Unwillingness to make even reasonable demands on the people one depends on
Feeling uncomfortable or helpless when alone
Preoccupation with fears of being left to take care of oneself
Limited capacity to make everyday decisions without an excessive amount of advice/ reassurance
Is there good quality evidence for treatment of personality disorders?
No; treat co-morbidities
Is pharmacological treatment of personality disorders recommended?
No; not recommended by NICe or licenced
In what personality disorders can antipsychotics be used?
Paranoid, schizoid and schizotypal
Reduce suspiciousness
Borderline; if paranoid or hearing voices
What antipsychotics are used in personality disorders?
Quetiapine
Olanzapine
Haloperidol
When are ADs used in personality disorders?
Mood and emotional difficulties in cluster B (dissocial, emotionally unstable, histrionic and narcissistic)
Can help impulsivity and aggression in borderline and dissocial
Reduce anxiety in cluster C (anankastic, avoidant and dependent)
When are mood stabilisers used in personality disorders?
Unstable mood and impulsivity in people with emotionally unstable or borderline personality diisorders
What mood stabilizer is used in personality disorders?
Lamotrigine
When and what will BZD are used in PDs?
Short term sedative as part of a larger care plan
Diazepam
Zopiclone (sleep)
Specific treatment for avoidant personality disorder?
Social skills training
Evidence for ADs
What psychological treatment is used in emotionally unstable personality disorders?
Dialectical Behavioural Therapy (DBT)
Goal of DBT?
Learning to accept and regulate emotions
Balance between self acceptance and making positive changes in life
How long does DBT last?
6 months - 1 year
4 principles of DBT?
Mindfulness
Regulation of emotions
Distress tolerance
Interpersonal effectiveness
Goal of mentalization based therapy?
To better understand and control your impulses, emotions and behaviours and improve relationships
What is STEPPS?
CBT based skills training programme
Focus on stabilisation
20 weeks; includes homework
When should you consider inpatient care in those with personality disorders?
Management of an acute increased suicide risk
Changes to medication cannot be managed in community
Clarification and treatment of comorbid diagnosis
Which medications have an evidence base for treatment of EUPD?
Lamotrigine
Topiramate; anger and aggression
ADs
Olanzapine and haloperidol
