Personality Disorders + Somatisation

Question 1

classification

Answer 1

A: ‘MAD’; schizoid, paranoid, schizotypal
B: ‘BAD’; histrionic, narcissistic, antisocial, emotionally unstable (2)
C: ‘SAD’; anankastic, anxious/avoidant, dependent

Question 2

features

Answer 2

pervasive
persistent (adolescent)
pathological
*primary too

Question 3

paranoid PD (0.7-4.4; M>F)

Answer 3

SUSPECT

sensitive
unforgiving
suspicious
possessive/jealous
excessive self-importance
conspiracy theories
tenacious sense of rights

Question 4

schizoid PD (0.7-4.9; M>F)

Answer 4

ALL A LINE

anhedonic
limited emotional range
little sexual interest
activities alone
lacks relationships
indifferent to praise/criticism
normal social conventions ignored
excessive fantasy world 

(think negative symptoms and fantasy)

Question 5

schizotypal PD (1.6-3.9; M>F)

Answer 5

‘eccentric’ , inconventional, fashion and speech
social anxiety: negatively thought of
paranoia, superstition, misinterpretation

Question 6

dissocial/antisocial PD (0.6-4.5; M»F)

Answer 6

FIGHTS
fleeting relationships
irresponsible
guiltless
heartless
temper: easily lost
someone else's fault - no responsibility

SOCIAL
short relationships
others to blame
cops
irritable and short-tempered
aggressive
lack of guilt

Question 7

narcissitic PD (0.1-6.2; M>F)

Answer 7

gradiose
self-important
needs attention and admiration
never their fault

Question 8

histrionic PD (0.4-2.9; F>M)

Answer 8

ACTORS

attention seeking
concerned with appearance
theatrical
open to suggestion
racy and seductive
shallow affect

Question 9

EUPD (1.2-5.9; M=F)

Answer 9

AEIOU

affective instability
explosive behaviours
impulsive
outbursts of anger
unable to plan/consider consequences

Question 10

borderline EUPD

Answer 10

SCARS

self-image unclear
chronic 'empty' feeling
abandonment fears
relationships intense and unstable
suicide attempts and self harm

may have fleeting psychosis

Question 11

anakastic PD (1.2-7.9; M>F)

Answer 11

DETAILED

doubtful
excessive detail
tasks not completed
adheres to rules
inflexible
likes own way
excludes pleasure and relationships
dominated by intrusive thoughts

Question 12

anxious/avoidant PD (1.0-5.2; M=F)

Answer 12

AFRAID

avoids social contact
fears rejection/criticism
restricted lifestyle
apprehensive
inferiority
doesn't get involved unless sure of acceptance

Question 13

dependent PD (0.3-0.6)

Answer 13

SUFFER

subordinate
undemanding
feel helpless when alone
fears abandonment
encourages others to make decisions
reassurance needed

Question 14

PD epidemiology

M/M: MH, altered presentation, physical health, relationships

Answer 14

10% community
20% 1o; C commonest
30% psych OPD; B commonest
40% IP; B commonest
40-80% DSH
50-80% prisoners; B commonest

Question 15

PD aetiology

Answer 15

genetics: MZ > DZ
FHX: schizo = ^cluster A risk; BPD and depression
childhood: temperament/attachment, trauma/abuse (B)
neurochemical imbalance (aggro/impulsive)
maladaptive defence mechanisms

Question 16

PD assessment

can use self-rating Qs
exclude other MH first (Dx heirarchy)

Answer 16

personal history; 3Ps; self/others description
impact: mood, social, work, function
morality, attitude, standards, relationhips
coping with stress, triggers
hobbies, interests
comorbidity incl. substances

Question 17

PD management - crisis

Answer 17

calm, non-threatening, empathy
triggers/distress/stressors
stimulate reflection/problem solving
?ST meds: single, minimal
review and update crisis plan

Question 18

DBT (CBT-based; balance contradictions)

acceptance and change
BPD, DSH/SI, substance, ED, relationships

Answer 18

therapy, group skills, telephone crises, therapist consult group

1) here and now; reduce harmful behaviour; practical
2) explore; experiences, understanding emotions
3) maintenance; relapse prevention; goals

Question 19

somatisation - features

Answer 19

psych distress expressed as physical Sx with medical help-seeking

abn illness behaviour: Dr too often/too little, not taking advice, too many meds, denial, long duration, not trying to get better

Question 20

somatisation - types

Answer 20

somatisation: general innocent
hypochondriacal: specific innocent
factitious/Munchausen’s: general fake
malingering: specific fake
conversion: unconscious; paralysis/blindness
dissociative: separating from normal conscious

Question 21

somatisation - management

Answer 21

don't dismiss; rule out organic then stop Ix
psychoeducation, engagement
liaison and supervision
regular appt, stop 'dr shopping'
treat comorbidities

Question 22

Impulsive EUPD

Answer 22

LOSE IT

lacking impulse control
outbursts/threats of violence
sensitivity to criticism and being let down
emotional instability
inabilty to plan ahead
thoughtless re: consequences

Question 23

PD management ST/LT

Answer 23

DDx: organic/substances
comorbidity
risk and setting, ?Ax/MHA

modify maladaption (PT; years)
40% BPD disengage from PT
DBT best; therapeutic communities, specialist units
coping strategies and education

Sx: APD, ADD, mood (aggro/impulsive)

Question 24

PD management (general)

Answer 24

boundaries important; know limits; splitting common
MDT + CPA
reliable, non-jedgmental, consistent (no promises)
encourage autonomy and responsibility
admission trap (dependence, disempowers)
T/CT; endings/ transitions

Question 25

prognosis:

Answer 25

high suicide rate; esp. cluster B
less with age: 78-99% BPD remission at 16y
schizotypal/OC-like stable over type; ?schizophrenia
risk of other MH; more severe, worse prognosis

Question 26

personality vs. traits

Answer 26

thoughts, feelings, behaviours; consistent (time/situation)

strengths and weakness in different settings; form personality
neuroticism, extraversion, openness, agreeableness, conscientiousness