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MHD > Psych 14 - Personality d/o's > Flashcards

Psych 14 - Personality d/o's Flashcards

1
Q

Define personality.

A

The characteristics of an individual that are enduring, pervasive and distinctive.
- Consists of a person’s typical thoughts, core beliefs, behavior, emotional traits, temperament, and interpersonal style that assist the individual to cope with, and adapt to, internal/external demands and stressors.

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2
Q

What is a personality disorder (PD), per DSM V criteria?
What are the 3 P’s?
__ of __ patterns must be present: (list them)

When does it usually manifest by?
What must be present in order to dx someone under age 18?

A

Enduring pattern of inner experience and behavior that deviates markedly from an individual’s CULTURE. Causes clinically significant impairment in social, occupational or other important areas of fcning.
- Pattern lacks flexibility, and is pervasive, pernicious, and persistent (the 3 Ps).

Pattern manifests in 2 or > areas of functioning:

  1. Cognition (perception about themselves, others, events)
  2. Affectivity (range, intensity, lability, & appropriateness of emotional response)
  3. Interpersonal functioning
  4. Impulse control
  • Onset by adolescence or early adulthood; childhood manifestations possible. If PD is diagnosed before the age of 18 years, features must be present for at least 1 year.
  • Not due to drugs or medical condition
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3
Q

What is the 1st-aid way of remembering the 3 PD clusters?

A

Weird, Wild, and Worried (A, B, and C)

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4
Q

List the 3 PD’s seen in the “A” cluster.

Generally describe this cluster.

A

A (weird- “accusatory, aloof, awkward”)

  • Paranoid
  • Schizoid
  • Schizotypal

Odd / eccentric presentation. Characterized by social withdrawal & deviant modes of social functioning.

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5
Q

List the 4 PD’s seen in the “B” cluster.

Generally describe this cluster.

A

B (wild- “bad to the bone”)

  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic

Dramatic / emotional. Characterized by poor impulse control & excessive emotionality.

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6
Q

List the 3 PD’s seen in the “C” cluster.

Generally describe this cluster.

A

C (worried- “cowardly, compulsive, clingy”)

  • Avoidant
  • Obsessive-compulsive
  • Dependent

Anxious / fearful. Characterized by heightened sensitivity to social rejection, focus on conformity.

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7
Q

What are PD’s that don’t fit into categories A, B, or C called?

A

Mixed PD; PDs not yet classified

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8
Q

What childhood factors (2) are linked to a huge increased risk of developing a PD?

A

Abuse and neglect

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9
Q

List psych & medical conditions that are commonly co-morbid w/PDs.

A

MDD, GAD, substance-abuse
- More negative prognosis w/these

Pain conditions, obesity, risky behaviors, chronic fatigue, more use of medical system, etc.

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10
Q

How do pts w/PD’s commonly present to physicians?

A

W/ physical complaints

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11
Q

Describe a typical course of PD, throughout life (read).

A

Variability in symptoms is not unusual; for example, borderline PD may 1st present during adolescence, be quite symptomatic during early adulthood, attenuate during mid‐life, and recur during times of crises regardless of age.

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12
Q

List some “indicators” that you may be dealing w/a PD. (read)

A
  1. Pt or significant other reports, he/she has “always been that way”.
  2. There is a high degree of chaos in the pt’s personal life.
  3. Pts p/w atypical problems that don’t fit easily into other dx’s.
  4. The pt has poor insight into how his/her behavior impacts others, and blames others
    for his/her problems.
  5. Poor compliance with medical care.
  6. You have noticeable reactions to the patient’s behavior (countertransference), including feelings of
    frustration, anger, helplessness, depletion, rescue fantasies, anxiety, and inadequacy.
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13
Q

Describe paranoid PD.

A
  • Pervasive mistrust and suspiciousness
  • Reluctant to confide in others, fears info will be used against them
  • Angry, defensive, socially isolated.
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14
Q

Paranoid PD: More common M or F?

More common w/fam h/o _______ or _______.

A

Males

Schizophrenia, delusional disorder

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15
Q

Describe schizoid PD.

A
  • Loners.
  • Emotionally detached.
  • Indifferent to the world.
  • Restricted range of emotional expression.

(me)

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16
Q

Schizoid PD: More common M or F?

More common w/fam h/o _______ or _______.

A

Males

Schizophrenia, schizotypal PD

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17
Q

Describe schizotypal PD.

A

Eccentricities.
- Odd beliefs, magical thinking, superstitious.
- Speech: metaphorical, over elaborate.
Marked social anxiety, isolated except for 1st degree relatives

(Joe Rogan)

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18
Q

Pt’s w/ fam h/o ________ are more at risk for schizotypical PD.

What part of the brain is abnl in this dz?

A

Schizophrenia

Temporal cortex

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19
Q

Cluster A PD pts often use “projection.” Describe how this would manifest.

A

Acting as if one’s feelings/thoughts are rooted in other person. Manifests as mistrust, anger, hostility, leads to conflicts / confrontations.

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20
Q

How do some cluster A PD pts have schizoid fantasies?

A

Withdrawal into the world of imagination and excessive daydreaming to avoid social interaction and associated anxiety.

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21
Q

What type of life problems do cluster A PD pts have?

A
  • Low stress tolerance.
  • Interpersonal issues conflict with social norms (work, relationship problems, etc)
  • Low adherence to medical care.
22
Q

How should you manage pts w/cluster A PD?

A
  • Be aware of counter-transference (uneasiness, anger; schizoid and schizotypal). PD patients test your patience, cause frustration.
  • They have trust issues (use actions over words)
  • *Avoid confrontation, don’t challenge them
23
Q

What distinguishes cluster A PD’s from schizophrenia, delusional DO, and mood DO w/psychotic features?

A

Presence of chronic psychotic sx

24
Q

Describe antisocial PD.

A
  • Disregard for and violation of the rights of others (since at least 15 y/o).
  • Socially irresponsible behaviors.
  • Lack empathy and remorse.
    (Can be glib and charming)

(Michael)

25
Q

How old must pt be to dx antisocial PD?

If they are less than this age, what can they be dx’d with?

A

18

< 18 = conduct disorder

26
Q

Is antisocial PD more common in M or F?

What parts of the brain are a/w antisocial PD?

A

Males

Serotonin dysfunction, frontal lobe dysfunction, low autonomic arousal and reactivity are some of the associated findings.

27
Q

Describe borderline PD.

Borderline pts have increased risks of what?
What types of sx emerge under stress?

A 
Pervasive pattern of instability:
- Interpersonal relationships.
- Identity or self‐image.
- Marked anger, rage, fear.
Impulsivity. (addictions)
- Fear of abandonment, struggle with feelings of emptiness. CUTTERS!
  • Increased rates of suicidal behavior and self injury (completed suicides in 8‐10%). Using suicide as a threat.
  • Under stress, paranoid ideation and dissociative symptoms emerge.

(Sarah)

28
Q

Is borderline PD more common in M or F?

A

Females

29
Q

Describe histrionic PD.

A
  • Dramatic w/ excessive emotionality.
  • Attention-seeking.
  • Entertaining…”the life of the party”.
  • Poor frustration tolerance.
30
Q

Is histrionic PD more commonly dx’d in M or F?

A

Females (under-dx’d in men?)

31
Q

Describe narcissistic PD.

A
  • Pathological sense of self‐importance.
  • Sense of entitlement, see self as “special”, and believe they are best understood by other high status people.
  • Lack empathy and are arrogant.
  • Interpersonally exploitative
  • Fragile self‐esteem; criticism evokes anger

(Aram, Trump)

32
Q

What is a co-morbidity more a/w antisocial PD?

A

ADHD

33
Q

Neurobiological correlates of antisocial and borderline PDs; dysregulation of ___________ and __________ systems.

A

Serotinergic and dopaminergic

(e.g., serotonergic activity is reduced in impulsive aggression).

34
Q

What PD pts have generally smaller amygdalas on fMRI?

A

Borderline PD

35
Q

List and describe the 5 behavior patterns of cluster B pts:

A
  • Controlling (manipulation of people/events to reduce inner tension)
  • Acting out (dealing with conflicts / stress through actions rather than talking -> impulsive behavior)
  • Splitting (compartmentalizing emotions, behavior, and people into all good / all bad categories)
  • Self-injury (emotionally numbing)
  • Somatization (expressing emotional distress thru physical sx)
36
Q

Which PD may have the greatest deal of trouble accepting help from others?

A

Narcissistic

37
Q

W/cluster B PD’s, verbalize your intention to help the patient and attempt to satisfy ___________ requests.

A

reasonable

38
Q

Describe avoidant PD.

A
  • Socially inhibited and feel inadequate.
  • Hypersensitive to negative evaluation.
  • Avoid interpersonal contact, avoid conflict.
  • Low self esteem

(Lina)

39
Q

Is avoidant PD more common in M or F?

A

M = F

40
Q

Describe dependent PD.

A
  • Submissive behavior
  • Go to great lengths to obtain nurturance & support.
  • Want others to assume responsibility for major areas of his/her life.
  • Feels unable to care for him/herself.
  • Low self‐efficacy.

(Briana)

41
Q

Describe obsessive-compulsive PD. (NOT OCD)

A
  • Perfectionism, inflexibility and high need for mental/interpersonal control.
  • Preoccupied with rules, efficiency, details and procedures.
  • Over conscientious, micromanagers.
42
Q

Is OC-PD more common in M or F?

A

Males (x2 dx)

43
Q

List and describe the 4 behavior patterns of cluster C pts:

A
  • Inhibition (of emotions and thoughts in order to avoid conflicts)
  • Avoidance (of people and situations to reduce anxiety)
  • Somatization (expressing emotional distress through physical symptoms)
  • Intellectualization (isolation of feelings from thoughts)
44
Q

Describe some things to keep in mind while managing cluster C PD pts.

A
  • Countertransference (overprotective, frustrated, angry)
  • Verbalize your willingness to care for avoidant and dependent pts
  • Avoid power struggles w/OC-PD (provide explanations)
45
Q

Avoidant PD may overlap w/_______________.

A

Social phobia

46
Q

OC-PD is egos-_____________, OCD is ego-____________.

A
  • Egosyntonic (unaware because part of person’s personality)

- Egodystonic (aware of problem and don’t like it)

47
Q

List 2 therapeutic techniques for treating PD’s.

A

CBT, DBT (cognitive; dialetic)

48
Q

What PD cluster(s) have psychotic agents proven efficacious for?

A

Cluster A and B

49
Q

What PD cluster(s) have SSRIs proven efficacious for?

Can be augmented w/long-acting __________. If rage is prominent, add an ___________.

A 
Cluster B (can be augmented w/long-acting benzo like clonazepam. If rage is prominent, add an antipsycotic).
Cluster C (can be augmented w/long-acting anxiolytic- benzo like clonazepam)
50
Q

Do antidepressants have an effect on impulsive behavior?

A

No

51
Q

What effects do mood stabilizers have in PD’s?

A
  • Very large effect on impulsive-behavior and anger
  • Large effect on anxiety
  • Moderate effect on depression
52
Q

Take home pts (read)

A
  • Most patients with PD seek behavioral health services at urging of family or employer
  • Strive for empathy and to understand the pt’s behavior
  • While behavior is maladaptive, patient’s goal is to minimize internal distress, and meet personal needs
  • Survival mechanism
  • Don’t personalize the patient’s behavior
  • Refer patients for psychotherapy and consider evidence based psychopharm for targeted symptoms

MHD (20 decks)

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