Personality Disorders + Somatisation Flashcards
classification
A: ‘MAD’; schizoid, paranoid, schizotypal
B: ‘BAD’; histrionic, narcissistic, antisocial, emotionally unstable (2)
C: ‘SAD’; anankastic, anxious/avoidant, dependent
features
pervasive
persistent (adolescent)
pathological
*primary too
paranoid PD (0.7-4.4; M>F)
SUSPECT
sensitive unforgiving suspicious possessive/jealous excessive self-importance conspiracy theories tenacious sense of rights
schizoid PD (0.7-4.9; M>F)
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)
schizotypal PD (1.6-3.9; M>F)
‘eccentric’ , inconventional, fashion and speech
social anxiety: negatively thought of
paranoia, superstition, misinterpretation
dissocial/antisocial PD (0.6-4.5; M»F)
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
narcissitic PD (0.1-6.2; M>F)
gradiose
self-important
needs attention and admiration
never their fault
histrionic PD (0.4-2.9; F>M)
ACTORS
attention seeking concerned with appearance theatrical open to suggestion racy and seductive shallow affect
EUPD (1.2-5.9; M=F)
AEIOU
affective instability explosive behaviours impulsive outbursts of anger unable to plan/consider consequences
borderline EUPD
SCARS
self-image unclear chronic 'empty' feeling abandonment fears relationships intense and unstable suicide attempts and self harm
may have fleeting psychosis
anakastic PD (1.2-7.9; M>F)
DETAILED
doubtful excessive detail tasks not completed adheres to rules inflexible likes own way excludes pleasure and relationships dominated by intrusive thoughts
anxious/avoidant PD (1.0-5.2; M=F)
AFRAID
avoids social contact fears rejection/criticism restricted lifestyle apprehensive inferiority doesn't get involved unless sure of acceptance
dependent PD (0.3-0.6)
SUFFER
subordinate undemanding feel helpless when alone fears abandonment encourages others to make decisions reassurance needed
PD epidemiology
M/M: MH, altered presentation, physical health, relationships
10% community 20% 1o; C commonest 30% psych OPD; B commonest 40% IP; B commonest 40-80% DSH 50-80% prisoners; B commonest
PD aetiology
genetics: MZ > DZ
FHX: schizo = ^cluster A risk; BPD and depression
childhood: temperament/attachment, trauma/abuse (B)
neurochemical imbalance (aggro/impulsive)
maladaptive defence mechanisms
PD assessment
can use self-rating Qs
exclude other MH first (Dx heirarchy)
personal history; 3Ps; self/others description
impact: mood, social, work, function
morality, attitude, standards, relationhips
coping with stress, triggers
hobbies, interests
comorbidity incl. substances
PD management - crisis
calm, non-threatening, empathy triggers/distress/stressors stimulate reflection/problem solving ?ST meds: single, minimal review and update crisis plan
DBT (CBT-based; balance contradictions)
acceptance and change
BPD, DSH/SI, substance, ED, relationships
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
somatisation - features
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
somatisation - types
somatisation: general innocent
hypochondriacal: specific innocent
factitious/Munchausen’s: general fake
malingering: specific fake
conversion: unconscious; paralysis/blindness
dissociative: separating from normal conscious
somatisation - management
don't dismiss; rule out organic then stop Ix psychoeducation, engagement liaison and supervision regular appt, stop 'dr shopping' treat comorbidities
Impulsive EUPD
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
PD management ST/LT
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)
PD management (general)
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
prognosis:
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
personality vs. traits
thoughts, feelings, behaviours; consistent (time/situation)
strengths and weakness in different settings; form personality
neuroticism, extraversion, openness, agreeableness, conscientiousness
