Pyschiatry Flashcards
What characterises a PD (personality disorder)
Lifelong, persistent, maladaptive behaviour that - characterises individual, deviates from norm, arises in late childhood/early adolescence
How should a PD manifest?
More than one of:
1) cognition
2) Affectivity
3) Occupational performance
4) Impulse control
5) Interpersonal relationship
What are the class A PDs?
Paranoid/delusional, Schizoid/socially withdrawn, Schizotypical/distorted reality
Sx of paranoid PD?
V sensitive, distrusts loyalty, holds grudges, suspicious, unsubstantiated conspiratorial explanations, will not confide in others, will perceive attacks on their characters
Sx of Schizoid?
No pleasure from any activities, emotionally cold, indifferent to praise, disinterest in sexual activity, few interests, prefers solitary activities
Sx of Schizotypal?
Social deficit, social anxiety, vague, unusual perceptions, inappropriate affect, odd beleiefs and magical thinking, paranoid ideation & suspiciousness, lack of close friends, ideas of reference
Rx for Class A PD?
Not likely to seek, but psychodynamic/group therapy
What are class B PDs?
Histrionic. Borderline, Narcissistic, Antisocial
Sx of Histrionic?
Self dramatization, attention seeking, preoccupied with physical appearance, shallow/liable affectivity, inappropriate sexual seductiveness
Sx of Borderline?
Act without regard, anger outbursts, unstable and intense relationships, quarrelsome, self harm & suicidal behavior, impulsivity eg spending/sex/substance abuse
Sx of Narcissistic?
Grandiosity, ‘special/unique’, requires excess admiration, lack of empathy, sensitive, chronic envy, arrogant & haughty attitude
Sx of Antisocial?
More common in men. unconcern for others’ feelings and social norms, incapacity to experience guilt, prone to blame others, impulsivity, irritability & aggressiveness, irresponsibility, lack of remorse
Rx of class B?
psychodynamic/group therapy/CBT but antisocial often not responsive
What are class C PDs?
Avoidant/anxious, Dependant/asthenic, Anakastic/obsessional
Sx of Avoidant?
Tense, preoccupied with sense of rejection, needs security, avoids social/occupational activities, unwillingness ot get involved, views self as inept & inferior to others
Sx of Dependant?
Allows others to make decisions, preoccupied with worry of inability of self care, needs reassurance, uncomfortable/helpless left alone
Sx of Anakastic/Obsessive-compulsive?
Obsessive doubt, perfectionism, obsessed with rules and order, excessive conscientiousness, stubborn, meticulous, scrupulous & rigid about etiquettes of morality, ethics or values
Rx of Class C PD?
Psychotherapy/CBT with:
- social skills training for anxious
- assertiveness techniques for dependant
- insight orientated
Drugs for PD?
Antipsychotics for impulsivity and intense angry affect
MAOIs for borderline PD to alleviate abnormal mood
What is a delusion?
Disordered thought where a belief is held firmly and cannot be reasoned by rational argument.
- Not within normal educational or cultural or social background held with convivtion - knowledge
self referential and held without insight
- Overvalued idea - false/exaggerated belief sustained beyond logical reason but with less rigidity than a delusion
Delusional perception: delusional belief arising from perception eg traffic lights change - god is talking to me
What are paranoid delusions?
Persecutory: organisation out to get them
Grandiose : Self importance, inflated self esteem, special powers
Self-referential: things are referencing you
Nihilistic: Delusion they are have nothing and are dead inside eg Cotard syndrome - belief they are already dead - associated with major depressive disorder
Religious: To do with God and religion
Misidentification: Family member/friend replaced by imposter (capgras delusion)
Fregoli: Where you think various people you meet are the same people
Intermetamorphasis: 2 People in the environment swap identities with each other whilst maintaining the same appearance
Subjective doubles: Belief that a dopple-ganger is carrying out independent actions
Infestation: skin is infected with parasites causing itching
Unusual delusions?
Egomaniac - man (or woman) of higher social status eg celebrity is in love with them Morbid jealousy (Othello syndrome) - delusion that partner is being unfaithful
What are hallucinations?
False sensory perception in the absence of an external stimulus. Maybe organic, drug-induced or associated with mental disorder.
Describe auditory hallucinations
Hearing voices - 2nd (yourself) or 3rd person, repeating thoughts (thought echo), several voices discussing patient