Pysch Persnality DOs

Question 1

Cluster A

Answer 1

→ CLUSTER A: Social Detachment: weird, odd, eccentric behavior

Paranoid, Schizoid, Schizotypal

Question 2

Cluster B

Answer 2

→ CLUSTER B: Dramatic, Emotional, Erratic

Antisocial, Borderline, Histrionic, Narcissistic

Question 3

Cluster C

Answer 3

→ CLUSTER C: Anxious or fearful
Avoidant, Obsessive-compulsive

Question 4

Patient will present as → a 33-year-old female says that her coworkers are planning to have her fired and they often ridicule her when she is not there. She is attempting to pursue legal action to get her coworkers reprimanded for this behavior as she knows that they have an intention to harm her in some way

Answer 4

Paranoid Personality DO

Question 5

Paranoid Personality DO

Answer 5

Paranoid Personality Disorder:
→ Disease Presentation:
Paranoid personality disorder is characterized by persistent feelings of suspiciousness and mistrust of other people

→ DSM-5:
Persistent mistrust/suspicion in others
Unsuccessful intimate relationships because of suspiciousness
Blame their own difficulties and problem on others
Interpretation of others motives as malevolent

→ Treatment:
1st Line: CBT
SSRIs (anxiolytics)

Question 6

Patient will present as → a 50-year-old male who lives alone in a cabin on several acres of land. He rarely interacts with his family or community other than when he comes to town once a month to pick up supplies

Answer 6

Schizoid Personality

Question 7

Schizoid Personality Disorder

Answer 7

Schizoid Personality Disorder:
→ Disease Presentation:
Patients tend to have emotional aloofness, indifferent to praise or criticism, without bizarre or idiosyncratic thinking

→ DSM-5:
VOLUNTARY social withdrawal and anhedonic introversion
MC in MEN
Detachment from social relationships and restricted range of expression of emotions in interpersonal settings
Lack of emotions

→ Treatment:
Patients like the way they are and usually do not want treatment
1st Line: CBT

Question 8

Patient will present as → a 47-year-old female has recently quit her job in order to start a small business. She claims that the spirits have told her to sell trinkets each of which has a unique power. She is known for dressing oddly and due to her strange behavior has trouble making friends.

Answer 8

Schizotypal Personality Disorder

Question 9

Schizotypal Personality Disorder

Answer 9

Schizotypal Personality Disorder:
→ Disease Presentation:
Odd eccentric behavior and discomfort with social relationships

→ DSM-5:
Eccentric behavior, magical thoughts, odd beliefs, distorted perceptions
ABLE TO FUNCTION in society, but struggle maintaining relationships
ODD beliefs/magical thinking
Unusual perceptual experiences
Odd thinking/speech
Paranoid/suspicious
Lack close friends
Distorted cognition reasoning
Chronic social anxiety
Social anhedonia

→ Treatment:
CBT

Question 10

Patient will present as → a 26-year-old male with an extensive criminal record assaults an elderly man in an attempt to rob his bicycle. During the interview, he is polite and has a normal affect and describes with excitement how he hit the old man with a wooden baseball bat prior to robbing him.

Answer 10

Antisocial Personality DO

Question 11

Antisocial Personality DO

Answer 11

Antisocial Personality Disorder: “Sociopath”
→ Disease Presentation:
Sociopath - a lack of remorse and no concern for others
** <18 yrs old = Conduct DO **

→ DSM-5:
Disregard for and violation of the rights of others with LACK OF REMORSE
Sets fires
Tortures animals
Bed Wetting
History of CD since age of 15 !!!!
Impulsive, deceitful, violate the law
Failure to conform to the social norms

→ Treatment:
CBT

Question 12

Patient will present as → a 25-year-old female doctoral student comes to your office for a checkup. When you enter the room she is visibly upset and states that all of the office staff are incompetent and that you’re the only medical provider who has ever understood her despite only having one brief clinical encounter. When you tell her that you cannot prescribe her the pain medication she requested, she states that you are incompetent and abruptly leaves the appointment

Answer 12

Borderline Personality DO

Question 13

Borderline Personality DO

Answer 13

Borderline Personality Disorder:
→ Disease Presentation:
Black and white perception, unstable interpersonal relationship

→ DSM-5:
Instability of interpersonal relationships, self-image, and emotions
Hypersensitive to rejection, impulsivity, impairment
SPLITTING = black and white thinking “I love you - I hate you”
Affective lability, anger, avoidance
Suicidal, impulsive, self-harming behavior
Early Adulthood

→ Treatment:
CBT

Question 14

Patient will present as → a 27-year-old female who arrives at your office in a short skirt and a very revealing top. At the beginning of the interview, she flirts with you and asks you if you like her dress. You overheard her yelling into her cell phone in the waiting room which later turned to tears. She describes her flu symptoms as if she’s “dying.”

Answer 14

Histrionic Personality DO

Question 15

Histrionic Personality DO

Answer 15

Histrionic Personality Disorder:
→ Disease Presentation:
Attention-seeking dramatic seductive behaviors

→ DSM-5:
Pervasive overly emotional, dramatic, seductive, attention-seeking
CENTER OF ATTENTION + Dramatic
Superficially emotionality and sexuality to draw attention
Controls and manipulates others
Childlike behaviors (temper tantrums, outbursts, accusations)
Provoke a reaction: Guilt, sympathy
Seductive/Physical appearance + SHALLOW

→ Treatment:
CBT

Question 16

Patient will present as → a 45-year-old male lawyer is being worked up for low back pain. He demands that he sees the chief neurosurgeon and won’t let any staff in the room. He says he knows “very important people” and that there will be “trouble” if he waits longer than 5 minutes in the waiting room.

Answer 16

Narcissistic Personality DO

Question 17

Narcissistic Personality DO

Answer 17

Narcissistic Personality Disorder:
→ Disease Presentation:
Concerned what others think of them and need admiration

→ DSM-5:
GRANDIOSE thought + Entitlement
Lacks Empathy
Reacts to criticism with RAGE
Needs to be admired
High value on youth and power, don’t like aging
Arrogant + Believes others envy them
Superficial relationships
Fluctuates between Grandiose and Vulnerable states (controlling)

→ Treatment:
CBT

Question 18

Patient will present as → a 47-year-old female office manager who refuses to attend the annual holiday party because she is afraid her coworkers will not like her. She would like to meet people but feels to shy to initiate a conversation.

Answer 18

Avoidant Personality DO

Question 19

Avoidant Personality Disorder:

Answer 19

Avoidant Personality Disorder:
→ Disease Presentation:
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts.

→ DSM-5:
Pervasive pattern of social inhibition due to an intense fear of rejection BUT LONG TO HAVE A RELATIONSHIP WITH OTHERS
Prefer to be alone due to fear BUT desire relationships
Inferiority complex + fear of rejection
Avoid activities

→ Treatment:
CBT

Question 20

Patient will present as → a 29-year-old female who arrives at your office after a break-up with her boyfriend. She always did everything he wanted and cannot understand how he could not want to be with her. According to her, the boyfriend said she was “too clingy” and asked him to make every decision for her.

Answer 20

Dependent Personality DO

Question 21

Dependent Personality DO

Answer 21

Dependent Personality Disorder:
→ Disease Presentation:
Submissive and clingy with an excessive need to be taken care of resulting from a low self-esteem

→ DSM-5:
Inability responsibility, dependent or submissive, needly, clingy behavior
Fear of being alone and abandonment
Difficult making day to day decisions
Fear of separation
Pessimistic look on life

→ Treatment:
CBT

Question 22

Patient will present as →a 23-year-old female PA student is struggling with her studies because she must read every reading assignment at least 2-3 times. She takes meticulous notes which she color codes and works poorly in groups because she cannot delegate tasks

Answer 22

Obsessive-Compulsive Personality Disorder

Question 23

Obsessive-Compulsive Personality Disorder

Answer 23

Obsessive-Compulsive Personality Disorder:
→ Disease Presentation:
Patients tend to be preoccupied with order, perfectionism, and control
→ DSM-5:
Preoccupied with ORDER, PERFECTIONISM and CONTROL
Ego-syntonic: NOT AWARE OF THEIR BEHAVIOR
Fail to complete tasks in a timely matter due to them wanting to do them in a very specific way
Stiff, rigid, formal with constricted affect
Successful professional with poor personal skills bc they can’t function with others
→ Treatment:
CBT

Question 24

Patient will present as → a 26-year-old PA student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette’s syndrome. He is started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective.

Answer 24

Obsessive-Compulsive Disorder:

Question 25

Obsessive-Compulsive Disorder:

Answer 25

Obsessive-Compulsive Disorder:
→ Disease Presentation:
Focus on obsessions repetition of compulsive behaviors
** Pathophysiology: abnormal communication between the basal ganglia and the orbitofrontal cortex, and the anterior cingulate gyrus **
→ DSM-5:
OBSESSIONS:
recurrent intrusive thoughts that CAUSE DISTRESS/IMPAIRMENT
COMPULSIONS:
Performance of REPETITIVE actions (rituals) to neutralize the obsessions
Hand washing, not losing control
TIME CONSUMING >1 hr a day!
Can be associated with Tourette’s Disorder (verbal tics)
Ego-DYSTONIC: inconsistent with one’s beliefs/attitudes
4 Types: Contamination (cleaning), Doubt/Harm, Precision/Symmetry, Intrusive Thoughts

→ Treatment:
CBT: Exposure/response prevention
HIGH DOSE SSRIs:
Clomipramine (1st Line TCS)

Question 26

Patient will present as → a 24-year-old male with a history of acne presents with concerns about acne scarring on his face. On exam, you notice very few scattered pustules but no noticeable scarring. You recommend the use of topical benzoyl peroxide cream and send him home. The patient returns for a follow-up three months later, this time very concerned. He reports that he is having trouble sleeping at night because of concern over his appearance. He feels people are staring at him because of his acne. He is very self-conscious, has been avoiding social events, and has trouble approaching girls. He is having trouble concentrating in class, which is now affecting his grades. He washes his face at least six times per day and admits to spending several hours each day in front of the mirror. He is requesting something stronger for his acne and heard from a friend about Accutane. Again on the exam, you notice only very mild comedomes but no visible scarring.

Answer 26

Body Dysmorphic Disorder

Question 27

Body Dysmorphic Disorder:

Answer 27

Body Dysmorphic Disorder:
→ Disease Presentation:
A beautiful woman is noted to complain that her hands are too big, yet they appear well-formed and appropriate

→ DSM-5:
Preoccupied with an imagined defect in personal appearance/exaggerated distortion of a minor flaw
Face, hair, skin, breasts, genitals
MDD, GAD, OCD
Stereotypes of beauty
Repetitive behaviors:
Mirror checking, skin picking, excessive grooming, seeking reassurance, comparing others
Causes distress/impairment

→ Treatment:
1st line: SSRI
CBT

Question 28

Hoarding Disorder - Trichotillomania -
Excoriation

Answer 28

Hoarding Disorder:
→ Attachment to things and cannot get rid of them
→ CBT
Trichotillomania:
→ Hair Pulling
→ CBT
Excoriation:
→ Skin Picking