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Psychiatry > Personality disorders + Dissociative Disorders + Somatoform and Factitious Disorders > Flashcards

Personality disorders + Dissociative Disorders + Somatoform and Factitious Disorders Flashcards

1
Q

ego-syntonic

A

psychological term referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s ideal self-image

OCD is ego dystonic

OCPD is ego syntonic

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2
Q

Personality disorder criteria

A

Pattern of behavior that deviates from person’s culture and is manifested in 2 or more of following ways - CAPRI:

  • Cognition
  • Affect
  • Personal Relations
  • Impulse Control

Pattern is

  • pervasive + inflexible
  • onset no later than adolescence/early adulthood
  • significant distress in functioning
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3
Q

Cluster A personality disorder

A

Schizoid
Schizotypal
Paranoid

Pts eccentric, peculiar, withdrawn

Familial assoc w/ psychotic disorders

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4
Q

Cluster B personality disorders

A

Antisocial
Borderline
Histrionic
Narcissistic

Pts emotional, dramatic, or inconsistent

Familial assoc w/ mood disorders

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5
Q

Cluster C personality disorders

A

Avoidant
Dependent
Obsessive compulsive

Pts seem anxious or fearful

Familial assoc w/ anxiety disoders

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6
Q

Paranoid personality disorder

  • description / criteria
  • defense mechanism
A

General distrust of others

In contrast to paranoid schizophrenia, they do not have fixed delusions and ARE NOT frankly psychotic

Lifetime prevalence = 0.5-2.5%

Defense mechanism: PROJECTION

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7
Q

Tx Paranoid personality disorder

A

Best tx is psychotherapy

- can use antianxiety or short course of antipsychotics for short term psychosis

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8
Q

Schizoid personality disorder

  • description / criteria
  • defense mechanism
A

Voluntary social withdrawal
NO DESIRE for close relationships
Emotionally cold

NO increase in incidence of schizoid personality disorder in families with hx of schizophrenia

Lifetime prevalence 7.5%

Defense mechanism: FANTASY

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9
Q

Tx schizoid personality disorder

A

Psychotherpay (#1)

Short course of low dose antipsychotics

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10
Q

Schizotypal personality disorder

  • description / criteria
  • defense mechanism
A

Eccentric behavior, odd beliefs or magical thinking

Individual will usually present without any crazy reason; will learn of their eccentric thinking after start talking to them

Vs paranoid schizophrenia, they are not frankly psychotic

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11
Q

Tx schizotypal personality disorder

A

Psychotherapy

Short low dose antipsychotics

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12
Q

Antisocial personality disorder

  • description / criteria
  • defense mechanism
A

Onset of conduct disorder before 15 - Disregard for and violation of other’s rights

Need to be at least 18 years old - this is the adult ONLY personality disorder

Sx: CONDUCT
Caparciousness
Oppressive
Non confrontational
Deceitful
Unlawful
Carefree
Temper

Can remit with age

Ddx drug abuse - if abuse drugs before antisocial behavior began, may be drugs causing behavior

Defense mechanism:
ACTING OUT
DENIAL

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13
Q

Tx antisocial personality disorder

A

Dialectical behavior therapy and behavioral therapy best choice

Psychotherapy usually NOT helpful

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14
Q

Borderline personality disorder

  • description / criteria
  • defense mechanism
A

Impulsive + unstable relationships

Sx = Miss Diana
Mood reactivity
Interpersonal relationships
Suicidal behavior or gestures
Self image disturbance
Dissociative sx
Impulsivity
Anger
Nothingness
Abandonment Issues

Can remit with age

vs. Schizophrenia - do not have frank psychosis
vs. bipolar II - mood swings in borderline are triggered by perceived environmental triggers. Not characterized by spending lots of $ or heightened sexual activity

Defense mechanism: 
SPLITTING
PASSIVE AGGRESSION
DISSOCIATION
REGRESSION
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15
Q

Tx borderline personality disorder

A

DBT (dialectal behavior therapy) - Psychotherapy #1 choice

Pharm to tx psychotic or depressive sx prn

Personality disorder that responds best to pharm

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16
Q

Histrionic personality disorder

  • description / criteria
  • defense mechanism
A

Attention seeking
Sexually provacative behavior
Emotionality (excessive)
Use physical appearance to draw attention to self
Perceives relationships are more intimate than they actually are
100% external locus of control
Will often prompt you for approval

Vs. borderline - histrionic are generally more functional; less likely to suffer from depression, brief psychotic episodes

Defense mechanism:
DISSOCIATION
REGRESSION
SOMATIZATION

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17
Q

Tx histrionic personality disorder

A

Psychotherapy

Pharm for depressive or anxious sx

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18
Q

Narcissistic personality disorder

  • description / criteria
  • defense mechanism
A

Need for admiration - often fishing for complements
Lack of empathy
Takes advantage of others for self gain
Irritated and anxious when not center of attention
Low self esteem

vs Antisocial - narcissistic want status and recognition while antisocial want material gain or subjugation of others. Narcissistics become depressed when don’t get recognition they think they deserve

Defense mechanism:
Denial

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19
Q

Tx narcissistic personality disorder

A

Psychotherapy
Group therapy to help learn empathy

Antidepressants or lithium prn

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20
Q

Avoidant personality disorder

  • description / criteria
  • defense mechanism
A

Social inhibition + hypersensitivity
Fear rejection
Desire friends but extremely shy and easily injured
Integral part of personality since childhood (vs social phobia more in adulthood)

Defense mechanism = AVOID

21
Q

Tx avoidant personality disorder

A

Psychotherapy, including assertiveness training

Beta blockers to control autonomic sx of anxiety
SSRIs for MDD

22
Q

Dependent personality disorder

  • description / criteria
  • defense mechanism
A

Submissive + clingy
Need to be taken care of
Obsessive about approval
Needs to start in early adulthood

May remit with age

vs. borderline and histrionic - Dependent usually have long lasting relationship with 1 person on whom dependent
Borderline + histrionic often dependent on other ppl but can’t maintain long lasting relationship

Defense Mechanism:
IDEALIZATION

23
Q

Tx dependent personality disorder

A

Psychotherapy

Pharm for sx of anxiety or depression

24
Q

Obsessive compulsive personality disorder

  • description / criteria
  • defense mechanism
A

Constricted affect
Preoccupation w/ orderliness + control + perfectionism
No insight
Get so preoccupied with unimportant details that often can’t complete simple tasks in timely fashion
Often successful professionally but have poor interpersonal skills

No obsessions or compulsions

Men > women

Defense Mechanism:
UNDOING

25
Tx obsessive compulsive personality disorder
Psychotherapy is tx of choice Pharm prn
26
Personality disorder NOS
Passive aggressive personality disorder Depressive personality disorder
27
Dissociative amnesia vs dementia
Dissociative amnesia - CANNOT recall common personal info but can remember obscure details Opposite is true for dementia memory loss
28
Dissociative amnesia
Amnesia is the ONLY dissociative symptom present New memory formation is still ok Sx cause significant distress or impairment in daily functioning Most common dissociative disorder Usually resolves after minutes to day; recurrences uncommon women > men, younger > older
29
Types of dissociative disorders
``` Amnesia Fugure Identity disorder Depersonalization disorder Dissociative disorder NOS ```
30
Transient global amnesia vs. dissociative disorders
Transient global amnesia will have difficulty recalling recent events but memory for more temporally distant events, like identity, is still ok Identity usually not ok in dissociative d/o
31
Abreaction
Strong reaction from pts when retrieving traumatic memories
32
Dissociative fugue
Sudden unexpected travel away from home + inability to recall one's identity or past Can assume new identity once get to new location Unaware of amnesia, will not remember time of fugue after nap out of it Predisposed by EtOH, MDD, head trauma, epilepsy Lasts hrs - several days
33
Dissociative fugue vs amnesia
Pts with dissociative fugue are not aware that they have forgotten anything
34
Dissociative identity disorder
>=2 distinct identities ID takes control of person's behavior can't recall another's behavior Sx similar to borderline, psychosis, or malingering Avg onset 6; avg dx age = 30 Worst prognosis of all dissociative DO Tx: hypnosis, drug assisted interviewing, psychotherapy
35
Depersonalization disorder
persistent or recurrent experiences of being detached from one's body relaity testing intact women > men adolescents > adults Severe stress is predisposing factor Tx: antianxiety or SSRI drugs if comorbid anxiety or depression
36
Ataque de nervios
Culturally bound trance disorder common in PR Convulsive mvmts fainting crying visual problems
37
Primary gain
Sx as an unconscious defense against unacceptable internal conflicts Eg conversion disorder, factitious disorder
38
Secondary gain
Sx that provide unconscious external benefits Ex: malingering
39
Somatization disorder
Onset < 30 yo - At least 4 pain symptoms involving multiple sites - at least 2 GI sx - sexual or repro symptoms other than pain - 1 pseudoneuro sx such as blindness, deafness, weakness, seizures, LOC, or impaired balance Sx not intentionally produced
40
Tx somatizaiton disorder
Regularly scheduled visits w/ single PCP - limits medical workups - address psych issues slowly
41
Conversion disorder
At least 1 neuro sx Psych stressors assoc w/ initiation or exacerbation of sx Not feigned, can't be explained by med condition or substance Common sx: - shifting paralysis - blindness - mutism - paresthesias - seizures - globus hystericus Women > men Most pts spontaneously rcover Tx: insight oriented psychotherapy, hypnosis
42
Hypochondriasis
> 6 mo - preoccupation w/ fear of having or contracting serious dz - persists despite med eval adn reassurance - impairs function Men = women (only somatoform not higher incidence in women) Tx: regularly scheduled visits w/ 1 PCP; SSRI for comorbid anxiety and depression - CBT most useful psychotherapy
43
Body dysmorphic disorder
Preoccupation with >=1 perceived physical defects Defects are no observable or appear slight to others Repetitive behavior or mental acts performed in response to preoccupation Significant distress or impairment Specify insight (good, poor, absent/delusional beliefs) Tx: explore pt thoughts about the problem - educate about variety of nonsurgical tx existing (psychotherapy, meds (SSRIs), psych referral)
44
Pain disorder
can have real med condition but pain symptoms are far in excess of dz pathology MDD can exacerbate sx
45
Tx pain disorder
SSRIs biofeedback hypnosis psychotherapy NOT analgesics
46
Factitious disorder
Intentionally produce med or psych sx to assume role of sick patient Primary gain is prominent feature Intentional production of signs and sx NO external incentives Tx - collateral, avoid early confrontation, repeated and long term hosp common
47
Factitious vs malingering vs somatoform
Somatoform - Pts believe they are ill and do not intentionally produce sx Factitious - Intentionally produce sx for primary gain (motivation is internal, like sympathy from doc) malignering - Intentionally produce sx for secondary gain (motivation is external, like money)
48
Munchhausen syndrome
factitious DO w/ predominantly physical complaints By proxy - making someone else sick to get attention
49
Malingering
- pretend sx to achieve personal gain - usually uncooperative, refuse to accept good prognosis - sx improve once desired objective obtained Men > women

Psychiatry (9 decks)

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