PTSD and Personality Disorders Flashcards
What is PTSD?
A severe psychological disturbance following a traumatic event characterised by the involuntary re-experiencing of elements of the event, with symptoms of hyper-arousal, avoidance and emotional numbing.
How is a traumatic event defined?
The event must have involved actual or threatened death/serious injury, or threat to the physical integrity of self/others. The person’s response must have involved intense fear, helplessness or horror.
Risk factors for PTSD?
1) Precipitating event - serious accident, hostage, terrorism, natural disaster, abuse and assault (physical/sexual)
2) Occupation - police, medical, military
3) Refugee/asylum seekers
4) Previous psychiatric history
What is the clinical presentation of PTSD?
1) Persistent symptoms of psychological sensitivity and arousal
2) Difficulty concentrating
3) Irritability/outbursts of anger
4) Sleep disturbances
5) Persistant re-experiencing of elements of the stressor through flashbacks and nightmares
6) Inability to recall either partially or completely some aspects of the stressor
Diagnosis of PTSD?
1) Clinical - symptoms arise within 6 months of traumatic event, and are present for at least 1 month with impairment or distress to social/occupational function.
Treatment of PTSD?
1) Trauma focused CBT, psychodynamic psychotherapy
2) Eye movement desensitisation and reprocessing (EMDR) - reduces anxiety
3) Medication 2nd line - combination therapy with SSRI (Paroxetine), TCA’s (Amitriptyline)
COMBO PAROXETINE AND AMITRIPTYLINE THIRD LINE
What is personality disorder?
- Starting in childhood or adolescence and continuing into adulthood, persistent and pervasive disorders of inner experience and behaviour that causes impairment to social and occupational function. Many people with substance misuse have personality disorders.
What is cognition, affect and behaviour?
Cognition - way of perceiving and thinking about self and others.
Affect - Range, intensity and appropriateness of emotional response.
Behaviour - Interpersonal, social and occupational functioning.
How does Type A personality disorder present?
1) Odd/Eccentric - ‘mad’:
Paranoid (male predominance) - suspicious and distrusts others, holds grudges, preoccupied with conspiracy.
Schizoid (male predominance) - Emotionally cold and detached, lives in a fantasy, lack of interest in others.
Schizotypical (male predominance) - Strange appearance and behaviours, odd relationships, anxious an misunderstood, odd beliefs.
How does Type B personality disorder present?
Dramatic or Emotional ‘bad’ -
1) Emotionally unstable (Female predominance):
Borderline type: Feeling of emptiness, intense and unstable relationships, unclear identity, suicidial threats and self-destructive behaviour.
Impulsive type: Inability to control anger or plan, lack of impulse control, unpredictable + aggressive behaviour.
2) Anti Social (Female predominance): Irritable and aggressive, lack of concern for others, lack of remorse, unable to maintain relationships
3) Histrionic (M): Shallow, dramatic, attention-seeking, self-centred, manipulative, seductive, very concerned with appearance.
4) Narcissistic (M): Self-importance, grandiose, lacks empathy, needs admiration and power seeking.
How does Type C personality disorder usually present?
Anxious or avoidant ‘sad’:
1) Anankastic (OCD) (M): Perfectionist needing order and control, doubtful and indecisive, sensitive to criticism.
2) Avoidant and anxious: Shy, timid, low self-esteem, wants close relationships but no social risks and avoids social situations.
3) Dependent: Fear of rejection and separation, clingy and excess need for care, helpless outside a relationship.
Treating Personality Disorder?
1) Monitoring
2) Psychological and practical support - help with finance, childcare and housing
3) Psychotherapy - CBT, dialectical (DBT), psychodynamic phsychotherapy.
4) Medical - for comorbidities - antipsychotics for paranoia, borderline and schizotypal, antidepressants for impulsivity , anxiousness, self-harming,
anticonvulsants and lithium for impulsivity and instability.
