Treatment of Personality Disorder

Question 1

What personality disorders are there little treatment guidance available for?

Answer 1

Schizoid, paranoid, histrionic, dissocial, anankastic and avoidant

Question 2

Is pharmacological treatment of personality disorder recommended?

Answer 2

No = can impede development of responsibility and functioning, sometimes used to reduce symptoms

Question 3

How are low dose antipsychotics used to treat PD?

Answer 3

Can reduce suspiciousness in cluster A disorders
Help with paranoia in borderline PD
Examples = quetiapine, olanzapine

Question 4

How are antidepressants used to treat PD?

Answer 4

Aid mood/emotional difficulties of cluster B disorders
Some SSRIs reduce aggression in borderline and antisocial PD
Reduce anxiety in cluster C disorders

Question 5

How are mood stabilisers used to treat PD?

Answer 5

Help with unstable mood and impulsivity in emotionally unstable and borderline PD
Example = lamotrigine

Question 6

What drugs may be used to treat PD in short time during a crisis?

Answer 6

Diazepam and zopiclone

Question 7

What drugs are used to treat difficulties with impulse control?

Answer 7

1st line = SSRI

2nd and 3rd line = olanzipine, sodium valproate, low dose antipsychotic, carbamazepine

Question 8

What drugs are used to treat affective dysregulation?

Answer 8

1st line = SSRI or mirazepine
2nd line = mirazepine or another SSRI
3rd line = olanzipine, sodium valproate, low dose antipsychotic, carbamazepine

Question 9

What drugs are used to treat cognitive perceptual symptoms?

Answer 9

1st line = low dose antipsychotic

2nd line = different low dose antipsychotic

Question 10

How is avoidant PD treated?

Answer 10

Social skills training and antidepressants

Question 11

What is the main psychological treatment of emotionally unstable PD?

Answer 11

Dialetical behavioural therapy = goal is to learn to accept and regulate emotions

Question 12

What are some features of using dialetical behavioural therapy to treat emotionally unstable PD?

Answer 12

Finds balance between acceptance and making positive changes in life
Lasts 6 months to 1 year

Question 13

What approaches are used in dialetical behavioural therapy?

Answer 13

Individual sessions, skills training in groups and telephone crisis coaching

Question 14

What are some features of individual session of dialetical behavioural therapy?

Answer 14

Learning new skills to replace harmful behaviour

Aims to reduce suicidal behaviour and therapy interfering behaviour

Question 15

What is covered in dialetical behavioural therapy group skills training?

Answer 15

Mindfulness, distress tolerance, interpersonal effectiveness, emotional regulation

Question 16

What does telephone crisis coaching for emotionally unstable PD help with?

Answer 16

Coping with an immediate crisis

Question 17

What are some other therapy options available for emotionally unstable PD?

Answer 17

Mentalisation based therapy, STEPPS, inpatient care or pharmacological treatment?

Question 18

What are some features of mentalisation based therapy for emotionally unstable PD?

Answer 18

Get patient to focus on what is going on in their mind and what might be going on in other people’s mind
Goal is to better understand and control impulses
Psychodynamically orientated

Question 19

What is STEPPS?

Answer 19

CBT based skills training programme = focus on stabilisation, lasts 20 weeks, includes homework, significant others involved as part of reinforcement team

Question 20

When should you consider admitting a patient with emotionally unstable PD?

Answer 20

To manage an acute increase in suicide risk
When changing medication can’t be managed in the community
To clarify and treat co-morbid diagnosis

Question 21

What pharmacological treatments may be used for emotionally unstable PD?

Answer 21

Topiramate = helps anger and aggression
Phenelzine = helps hostility
Olanzapine = helps but causes weight gain

Question 22

Is pharmacological treatment of antisocial PD recommended?

Answer 22

No = not to be done routinely

Question 23

What are some psychological interventions for antisocial PD?

Answer 23

Group based cognitive and behavioural interventions = addresses impulsivity and antisocial behaviour