Test 3 - Personality Disorders Flashcards
implications of personality d.o
complicate task of diagnosing/managing comorbidities
poorer tx outcomes and health status
higher rates of health care use and cost
4 goals of personality d.o management
- recognize it
- develop working relationship w. pt
- avoid chronic difficulties in pt-provider relationship
- build rapport → relax
t/f: you will likely not cure personality d.o
t!
characteristics of personality d.o (8)
frequent mood swings
angry outbursts
anxiety → difficulty making friends
center of attention
feel cheated/taken advantage of
difficulty delaying gratification
lack of awareness about behavior
externalizing/blaming world for behavior/feelings
rigid/inflexible personality
axis II is same same
personality d.o → outdated terminology
__% of population > 18 yo meet criteria for pd
14.9
most personality d.or are ego __
syntonic
egosyntonic definition
pt do not view thoughts/behaviors as unacceptable
egodystonic definition
pt distressed by sx
most mental disorders are ego__
dystonic
is there any pharm to treat personality d.o as a whole
no! → just symptomatic tx
what helps determine pharm for personality disorders
clustering symptoms
tx for personality d.o is based on __
and not __
symptom profile
type of d.o
regardless of dx, you should __ to determine pharm
cluster symptoms
4 symptom clusters for personality d.o
cognitive/perceptual organization
impulsivity/aggression
mood instability
anxiety/inhibition
pharm for cognitive perceptual organization cluster
atypical antipsychotics
+/- SSRIs
pharm for impulsivity aggression cluster (4)
antipsychotics
beta blockers
lithium
carbamazepime (tegretol)
pharm esp effective in kids w. impulsivity/aggression
beta blockers
phenytoin may reduce __ violence
but likely has no effect on __ violence
impulsive/aggressive
premeditated
what class of drug is phenytoin
anticonvulsant
pharm for mood instability cluster (3)
mood stabilizers
SSRI or other antidepressant
atypical antipsychotic
pharm for anxiety/inhibition (2)
SSRI or related antidepressant
bensodiazepine
best pharm for short term relief of anxiety/inhibition cluster
benzodiazepine
benzodiazepine might be effective for __
but NOT __
borderline personality d.o
xanax
pharm for borderline personality d.o
longer acting benzo
personality disorders have __ onset
gradual
patterns of indifference to others
diminished range of emotional experience/expression
socially isolated
schizoid personality d.o
schizoid personality is __tonic
and really only a d.o bc
syn
difficult for friends/family
prevalence of shcizoid personality d.o
3.1% of americans
peculiar patterns of behavior
perceptual and cognitive disturbance
unusual speech
schizotypal personality d.o
how do you distinguish schizotypal personality d.o from psychosis
schizotypal pt is egodystonic
incidence of schizotypal personality d.o
3%
schizoid PLUS schizotypal
detachment
disorder characterized by choice to be alone, need for privacy, poor tolerance of conflict
detachment
considerations of care for detached pt (4)
respect need for privacy/distance
provide adequate time for care
minimize conflict
low-key approach
focus on technical aspects of care
detached pt may reject (2)
provider’s personal over involvement
social support
__ testing might be helpful for schizotypal pt
reality
possible pharm for schizotypal pt (depending on sx)
antipsychotics
suspicion of other’s motives
overly reactive to minor slights/insults
extraordinary precautions to avoid being exploited/injured
paranoid personality d.o
prevalence of paranoid personality d.o
4.4%
tx considerations for suspicious paranoid pd (8)
carefully informing mistrustful pt about procedures
exact details of procedures
comprehensive info regarding risk/benefit
hx regarding abrupt termination of care
empathizing w. tension/guardedness
counteract fears of disrespect/intrusion
low-key, friendly approach
not overly intimate
cluster a disorders are characterized as
odd/eccentric
3 cluster a disorders
schizoid pd
schizotypal pd
paranoid pd
pattern of distrust and suspiciousness that others’ motives are interpreted as malevolent
paranoid pd
pattern of detachment from social relationships and a restricted range of emotional expression
schizoid personality d.o
acute discomfort in close relationships, cognitive or perceptual distortions, eccentricities of behavior
schizotypal pd
irresponsible and antisocial behavior beginning prior to 15 yo
disregard/violation of others’ rights
antisocial pd
onset of antisocial pd must be prior to __ yo
but dx can not be made until pt is __ yo
15
18
personality traits of antisocial pd (3)
charming
manipulative
lack of guilt
high incidence of antisocial pd in
prisons
antisocial pd is characterized by __ insanity
moral
you may only be able to dx antisocial pd from __
bc pt is often a __
hx provided by others
poor historian
prevalence of antisocial pd
3.6%
care considerations for antisocial pd
manipulative
hidden agenda
set clear limits
communicate in nonpunitive manner
insistence on clearly medically indicated tx
psychiatric consult if malingering present
hidden agenda ex of antisocial pd pt (2)
avoiding criminal justice
drug seeking
pattern of grandiosity
exaggerated sense of self importance
preoccupation w. achievement
unable to empathize w. others
narcissistic pd
incidence of narcissistic pd
< 1%
narcissistic pd is more prevalent in
males
instability in mood and interpersonal relationships
intense, unstable relationships
splitting
rapid mood changes
+/- rage
identity disturbance
deficits in impulse control
borderline pd
prevalence of borderline pd
2% of gen pop
borderline pd is mc in
females → 75%
ex of impulse control deficit in borderline pd
wrist slashing
drugs
__ is almost pathomneumonic for borderline pd
fear of abandonment
70-75% of borderline pd pt have hx of
at least 1 self injurious act
rate of successful suicide in bpd
9%
rf for suicidal behavior in bpd (5)
older age
prior suicide attempts
antisocial personality
impulsive actions
depressive moods
bpd may complicate accurate dx of
mdd
substance abuse
tx considerations for bpd (10)
remain emotionally neutral
avoid responding to provocation
acknowledge anger, frustration, annoyance
verbally recognize pt’s feelings
request appropriate behavior
actively structure consult
schedule pt w. abandonment issues or somatization for brief, frequent visits
supportively confront medical noncompliance
conduct pe w. nurse present
support psychotherapy
if provider feels frustrated leaving pt consult, there is a high likelihood of
bpd
t/f: there is a low rate of psychotherapy completion in bpd
T! →
50% drop out w.in 6 mo, 75% w. in 1 year
psychoactive substance use is associated w. (2)
bpd
histrionic pd
pervasive pattern of excessive emotionality/ attention seeking
self-centered, demanding, vain, constantly seeking approval
shallow emotions, easily aroused
histrionic pd
prevalence of histrionic pd
1.8%
why might histrionic pd pt create atmosphere of inappropriate familiarity w. medical staff
an attempt to distract themselves from inner anxiety rt medical illness
tx consideration for histrionic pd
respectful professional manner w.o abbreviating time spent w. pt
cluster b pd are characterized by (2)
emotional
erratic
dramatic
4 cluster b pd’s
narcissistic
antisocial
bpd
histrionic
pattern of grandiosity
need for admiration
lack of empathy
narcissistic pd
pattern of disregard for, and violation of, rights of others
antisocial pd
pattern of instability in interpersonal relationships, self-image, and affects
marked impulsivity
bpd
pattern of excessive emotionality and attention seeking
histrionic pd
social discomfort
fear of negative evaluation
timidity
tendency toward social isolation
very sensitive to criticism
avoidant pd
avoidant pd is similar to __
but more extreme
social anxiety
dependence and submissive behavior
need for advice/support
anxious/helpless when alone
easily hurt by criticism
agreeable
dependent pd
unlike avoidant, dependent pd tends to
stay involved w. others
dependent pd pt’s can frequently be found in
mental health clinics
dependency combined w. overdemandingness
dependent pd
PLUS
bpd
tx considerations for dependent + bpd
empathetic recognition of need for reassurance and anxiety of being alone
PLUS
limit-setting, clarity, consistency, structure
perfectionism
inflexibility
ambitious, unobtainable standards
preoccupied w. rules and efficiency
emotionally restricted
moralistic, judgmental, intolerant of others emotionality and imperfection
obsessive compulsive pd
obsessive compulsive pd is ego__
syntonic
tx considerations for obsessive compulsive pd
respect need to be in control
provide complete info/test results asap
encourage pt participation in planning/scheduling steps toward medical stability
cluster c pd are characterized by (2)
anxious
fearful
3 cluster c pd
dependent pd
avoidant pd
obsessive-compulsive pd
pattern of submissive/clinging behavior
dependent pd
pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative eval, excessive need to be taken care of
avoidant pd
pattern of preoccupation w. orderliness, perfectionism, control
obsessive compulsive pd
odd
eccentric
cluster a
dramatic
emotional
erratic
cluster b
anxious
fearful
cluster c
