Personality Disorders + Schizophrenia Flashcards
Cluster A PDs
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Cluster B PDs
Borderline Personality Disorder
Narcissistic Personality Disorder
Histrionic Personality Disorder
Antisocial Personality Disorder
Cluster C PDs
Avoidant Personality Disorder
Dependant Personality Disorder
Obsessive-Compulsive Personality Disorder
Definition of PD
Chronic maladaptive behaviour + interpersonal problems
>2:
- cognition
- affectivity
- interpersonal function
- impulse control
General management
Clearly establish limits such as appt length
Look for medical + psych diagnosis with new symptoms
Limit use of benzos
Reflect + acknowledge own emotional responses
Address behaviours in a direct but non-threatening manner, co-create realistic goals, establish and maintain boundaries, continue relationship unless there is a risk
Sx management of anxiety, hostility + sensitivity
mesoridazine (phenothiazine)
haloperidol (APs)
thiothixene (APs)
Sx of Paranoid
SUSPECT
Spousal infidelity
Unforgiving
Suspicious of others
Perceives attacks
Enemy
Confiding in others is feared
Threats perceived
Sx of Schizoid
DISTANT
Detached
Indifferent
Sexual experiences of little interest
Tasks done alone
Absence of friends
Meither desires or enjoys relationships
Takes pleasure in few activities
Sx of Schizotypal
ME PECULIAR
Magic thinking/ odd beliefs
Experiences unusual perceptions
Paranoid ideation
Eccentric behaviour
Constricted affect
Unusual thinking/ speech
Lacks close friends
Ideas of reference
Anxiety in social situations
R/O psychotic
Sx of Antisocial
CORRUPT
Conforming to law lacking
Obligations ignored
Reckless disregard for safety
Remorseless
Underhanded
Planning insufficient
Temper
Sx of Histrionic
ACTRESS
Appearance focused
Centre of attention
Theatrical
Relationships considered more intimate than they are
Easily influenced
Seductive behaviours
Shallow emotions
Speech (vague)
Sx of Borderline
AM SUICIDE
Abandonment
Mood instability
Suicidal
Unstable/ intense relationships
Impulsivity
Control of anger
Identity disturbance
Dissociative
Emptiness
Sx of Narcisstic
SPEEECIAL
Special
Preoccupied with fantasies
Envious
Entitlement
Excess admiration required
Conceited
Interpersonal exploitation
Arrogant
Lacks empathy
Sz of Avoidant
AVOIDER
Avoids social type of work
Views self as inept
Occupied with fear or criticism
Inhibited in new relationships
Don’t get involved when uncertain of being liked
Embarrassment prevents new activities
Restraint within intimate relationships
Sx of Dependent
RELIANCE
Reassurance required
Expressing disagreement difficult
Life responsibilities assumed by others
Initiating projects difficult
Alone
Nurturance - needs support
Companionship sought
Exaggerated fears of being left alone
Sx Obsessive compulsive
OBSESSOR
Obsessed over details
Both miserly with self and others
Shows perfectionism that interferes with task completion
Excessively devoted to work
Super consciousness
Supervision required for delegated tasks
Object hoarder
Rigidity
Ix for psychosis
Hemoglobin
White Blood Cell Count
Platelets
Creatinine
Fasting/Random Glucose
Blood Urea Nitrogen
Sodium
Potassium
Calcium
Albumin
Magnesium
TSH
AST
ALT
Alkaline Phosphotase
GGT
Vitamin B12
Ferritin
PTH
Urine Toxicology
Serum Toxicology
Fasting Lipids (if considering starting antipsychotic medications)
DSM-V criteria schizophrenia
> 2 symptoms present for 1 month
- delusions
- hallucinations
- disorganized thinking/ speech
- negative symptoms
- disorganised or catatonic behaviour
Complications of schizophrenia
Decreases lifespan by 15 years
Increased risk of CAD, DM, HTN, emphysema
Suicide risk
45% have SU disorder
Ix of schizophrenia
CBC, lytes, renal, liver, TSH, FBG, lipids
Hepatitis, syphilis, HIV
Monitoring for schizophrenia
Every 3 months
S+S
Functional impairment
Suicidal/ aggressive thoughts
SU
FBG, lipids, BMI + BP
Management of schizophrenia
Family intervention
CBT offered to those that have not responded to AP
Social skills training
AP trial for min 2 weeks - once improvement seen, hold dose
Offer maintenance at lower dose for 2-5 years
Ongoing management for schizophrenia
Positive + negative sx
Function + ADLs
Ideation of harm to self or others
Med compliance + SE
Substance use
Capacity
Psychosocial supports
Approach to psychotic pts
Clearly communicate limits of confidentiality
Enquire about substance use
Ensure early treatment + FU
Determine if they meet criteria for involuntary treatment
Sx control for lability, rejection, impulsivity, self-mutilation
SSRI
Sx control for behavioural dyscontrol
carbamazepine
Sx control for aggression
lithium
Sx control for explosive behaviour
oxazepam
1st episode of schizophrenia
2nd gen AP, maintain for 18mo, treat comorbid depression w/ SSRI, offer housing, family counselling, vocational rehab, financial support, admission, detox, referral to SW, check bHCG
Negative sx of schizophrenia
flat affect, social withdrawal, anhedonia, avolition, poverty of speech
Rx for NMS
stop offending med, IV NS, cooling blankets, ice packs, DVT prophylaxis
Classes of meds to treat NMS
benzos for agitation, skeletal muscle relaxant (dantrolene), dopamine agonist (bromocriptine)
