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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Pts eccentric, peculiar, withdrawn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
Q

Tx obsessive compulsive personality disorder

A

Psychotherapy is tx of choice

Pharm prn

26
Q

Personality disorder NOS

A

Passive aggressive personality disorder

Depressive personality disorder

27
Q

Dissociative amnesia vs dementia

A

Dissociative amnesia - CANNOT recall common personal info but can remember obscure details

Opposite is true for dementia memory loss

28
Q

Dissociative amnesia

A

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
Q

Types of dissociative disorders

A 
Amnesia
Fugure
Identity disorder
Depersonalization disorder
Dissociative disorder NOS
30
Q

Transient global amnesia vs. dissociative disorders

A

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
Q

Abreaction

A

Strong reaction from pts when retrieving traumatic memories

32
Q

Dissociative fugue

A

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
Q

Dissociative fugue vs amnesia

A

Pts with dissociative fugue are not aware that they have forgotten anything

34
Q

Dissociative identity disorder

A

> =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
Q

Depersonalization disorder

A

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
Q

Ataque de nervios

A

Culturally bound trance disorder common in PR

Convulsive mvmts
fainting
crying
visual problems

37
Q

Primary gain

A

Sx as an unconscious defense against unacceptable internal conflicts

Eg conversion disorder, factitious disorder

38
Q

Secondary gain

A

Sx that provide unconscious external benefits

Ex: malingering

39
Q

Somatization disorder

A

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
Q

Tx somatizaiton disorder

A

Regularly scheduled visits w/ single PCP

  • limits medical workups
  • address psych issues slowly
41
Q

Conversion disorder

A

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
Q

Hypochondriasis

A

> 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
Q

Body dysmorphic disorder

A

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
Q

Pain disorder

A

can have real med condition but pain symptoms are far in excess of dz pathology

MDD can exacerbate sx

45
Q

Tx pain disorder

A

SSRIs
biofeedback
hypnosis
psychotherapy

NOT analgesics

46
Q

Factitious disorder

A

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
Q

Factitious vs malingering vs somatoform

A

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
Q

Munchhausen syndrome

A

factitious DO w/ predominantly physical complaints

By proxy - making someone else sick to get attention

49
Q

Malingering

A
  • 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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