Psychiatric Disorders Flashcards
What is EUPD?
A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability. The ability to plan is minimal and outburst of intense anger may lead to violence or “behavioural explosions
What are the characteristics of the borderline type of EUPD?
- Characteristics of emotional instability present, in addition to the patients own self-image, aims and internal preferences (including sexual) are often unclear or disturbed. There are often chronic feelings of emptiness. A liability to become involved in unstable and intense relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-help (although these may occur without obvious precipitants)
What are the characteristics of the unstable type of EUPD?
- Emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.
How do you manage EUPD?
Develop a crisis plan
- identify potential triggers
- specify self-management strategies that are likely to be effective
- psychotherapy
- mood stabilisers or second generation antipsychosis
What are the characteristics of paranoid personality disorder?
o Excessive sensitiveness to setbacks and rebuffs
o Tendency to bear grudges persistently, e.g. refusal to forgive insults and injuries or slights
o Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous
o A combative and tenacious sense of personal rights out of keeping with the actual situation
o Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner
o Tendency to experience excessive self-importance, manifest in a persistent self referential attitude
o Preoccupation with unsubstantiated “conspiratorial” explanations of events both immediate to the patient and in the world at large
What are the characteristics of schizoid personality disorder?
o Few, if any, activities provide pleasure
o Emotional coldness, detachment or flattened affect
o Limited capacity to express either warm, tender feelings or anger towards others
o Apparent indifference to praise or criticism
o Little interest in having sexual experiences with another person
o Almost invariable preference for solitary activities
o Excessive preoccupation with fantasy and introspection
What are the characteristics of dissocial personality disorder?
o Callous unconcern for the feelings of others
o Gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations
o Incapacity to maintain enduring relationships, though having no difficulty establishing them
o Very low tolerance to frustration and a low threshold for discharge of aggression, including violence
o Incapacity to experience guilt or to profit from experience, particularly punishment
o Marked proneness to blame others, or to offer plausible rationalisations that has brought the patient into conflict with society
What are the characteristics of histrionic personality disorder?
o Self-dramatization, theatricality, exaggerated expression of emotions
o Suggestibility, easily influenced by others or by circumstances
o Shallow and labile affectivity
o Continual seeking for excitement and activities in which the patient is the centre of attention
o Inappropriate seductiveness in appearance or behaviour
o Over-concern with physical attractiveness
Associated features may include ego-centricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt and persistent manipulative behaviour to achieve own needs.
What are the characteristics of anankastic personality disorder?
o Feelings of excessive doubt and caution
o Preoccupation with details, rules, lists, order, organisation, or schedule
o Perfectionism that interferes with task completion
o Excessive pedantry and adherence to social conventions
o Rigidity and stubbornness
o Unreasonable insistence by the patient that others submit to exactly his or her way of doing things or unreasonable reluctance to allow others to do things
o Intrusion of insistent and unwelcome thoughts or impulses
What are the characteristics of anxious avoidant personality disorder?
o Persistent and pervasive feelings of tension and apprehension
o Belief that one is socially inept, personally unappealing, or inferior to others
o Excessive preoccupation with being criticised or rejected in social situations
o Unwillingness to become involved with people unless certain of being liked
o Restrictions in lifestyle because of the need to have physical security
o Avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection
What are the characteristics of dependent personality disorder?
o Encouraging or allowing others to make most of ones important life decisions
o Subordination of one’s own needs to those of others on whom one is dependent and undue compliance with their wishes
o Unwillingness to make even reasonable demands on the people one depends on
o Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself
o Preoccupation with dears of being abandoned by a person with whom one has a close relationship and of being left to care for oneself
o Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others
What is generalised anxiety disorder?
A syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate
What are the symptoms of GAD?
A feeling of dread, restlessness/feeling on edge, being easily fatigued, irritability, muscle tension, sleep disturbance for at least 6 months
What are the autonomic symptoms of GAD?
Palpitations or pounding heart Accelerated heart rate Sweating Trembling or shaking Dry mouth (not due to medication or dehydration)
What are the chest and abdomen symptoms of GAD?
Difficulty breathing
Feeling of choking
Chest pain or discomfort
Nausea or abdo distress (churning in stomach etc.)
What are the GAD symptoms that involve mental state?
Feeling dizzy, unsteady, faint or light-headed
Feeling that objects are unreal (derealisation) or that the self is ‘not really here’ (depersonalisation)
Feeling of losing control, ‘going crazy’ or passing out
Fear of dying
What are the general symptoms of GAD?
Hot flushes or cold chills
Numbness or tingling sensations
Muscle tension or aches and pains
Restlessness and inability to relax
Feeling keyed up, on edge, or mentally tense
A sensation of a lump in the throat or difficulty in swallowing
What is the management of GAD?
- Identify, assess, educate and monitor
- low intensity psychological support, non-facilitated or guided self help
- CBT/applied relaxation or drug treatment
- Specialist drug and/or psychological treatment, multi-agency teams, crisis intervention, outpatient or inpatient care
What is the pharmacological management for GAD?
Sedative antihistamines/benzodiazepines (RAPID RESPONSE)
SSRI/venlafaxine = first line
Switch SSRI if no response after 12 weeks
Pregabalin can be considered if SSRIs untolerated
Name SSRI’s that are suitable for GAD?
Setraline
Esciltalopram
Citalopram
Paroxetine
