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Psychiatry > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Patients with personality disorders lack _____ about their problems; their symptoms are ego-(dystonic/syntonic).

They are Axis ____ diagnoses.

A

insight

ego-syntonic

Axis II

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2
Q

What is the DSM-IV criteria for a personality disorder?

A
  • Pattern of behavior/inner experience that deviates from the person’s culture & is manifested in 2 or more of the following ways:
    • Cognition
    • Affect
    • Personal relations
    • Impulse control
  • The pattern:
    • Is pervasive and inflexible in a broad range of situations
    • Is stable and has an onset no later than adolescence or early adulthood
    • Leads to significant stress in functioning
    • Is not accounted for by another mental/medical illness or by use of a substance
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3
Q

Each personality disorder is present in ___% of the population.

Personality disorders are divided into ______.

A

1%

3 clusters

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4
Q

Cluster A

A

Schizoid, Schizotypal, Paranoid

  • Patients seem eccentric, peculiar or withdrawn
  • Familial association w/ psychotic disorders
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5
Q

Cluster B

A

Antisocial, Borderline, Histrionic, Narcissistic

  • Patients seem emotional, dramatic or inconsistent
  • Familial association with mood disorders
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6
Q

Cluster C

A

Avoidant, Dependent, Obsessive-compulsive

  • Patients seem anxious or fearful
  • Familial association w/ anxiety disorders
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7
Q

Personality disorder not otherwise specified (NOS)

A

Includes disorders that do not fit into clusters A, B or C (including passive-aggressive personality disorder)

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8
Q

What is the etiology of personality disorders?

A
  • Biological, genetic, psychosocial factors
  • Prevalence in monozygotic twins is several times higher than dizygotic twins
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9
Q

How are personality disorders treated?

A
  • Difficult to treat
  • Few patients aware they need help
  • Disorders tend to be chronic, life-long
  • Pharmacologic treatment limited usefulness except treating coexisting symptoms of depresison, anxiety, etc.
  • Psychotherapy & group therapy most helpful
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10
Q

What is the pneumonic for personality disorder clusters?

A
  • Cluster A: mad
  • Cluster B: bad
  • Cluster C: sad
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11
Q

What is the DSM-IV criteria for Paranoid Personality Disorder (PPD)?

A
  • General distrust of others, beginning in early adulthood & present in a variety of contexts
  • At least 4 of the following:
    • Suspicion (w/o evidence) that others are exploiting or deceiving him/her
    • Preoccupation with doubts of loyalty or trustworthiness of acquaintances
    • Reluctance to confide in others
    • Interpretation of benign remarks as threatening or demeaning
    • Persistence of grudges
    • Perception of attacks on his/her character that are not apparent to others; quick to counterattack
    • Recurrence of suspicions regarding fidelity of spouse or lover
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12
Q

Paranoid Personality Disorder

  • Prevalence: ___%
  • Men vs Women
  • Familial incidence
A
  • Prevalence: 0.5 - 2.5%
  • Men >> women
  • Higher incidence in family members of schizophrenics
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13
Q

What is included in the differential diagnosis of PPD?

A

Paranoid schizophrenia

  • Unlike patients w/ schizophrenia, patients with PPD do not have any fixed delusions and are not frankly psychotic
  • May have transient psychosis under stressful situations
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14
Q

What is the course & prognosis of patients w/ PPD?

A
  • Some patients may eventually be diagnosed w/ schizophrenia
  • Chronic course
  • Lifelong marital & job-related problems
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15
Q

How is PPD treated?

A

Psychotherapy

Antianxiety medications

Short course of antipsychotics (transient psychosis)

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16
Q

What is the DSM-IV criteria for Schizoid Personality Disorder?

A
  • A pattern of voluntary social withdrawal & restricted range of emotional expression, beginning in early adulthood & present in a variety of contexts.
  • 4 or more of the following must be present:
    • Neither enjoying nor desiring close relationships (including family)
    • Generally choosing solitary activities
    • Little (if any) interest in sexual activity w/ another person
    • Taking pleasure in few activities (if any)
    • Few close friends or confidants (if any)
    • Indifference to praise or criticism
    • Emotional coldness, detachment or flattened affect
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17
Q

Schizoid Personality Disorder

  • Prevalence: ___%
  • Men vs. Women
  • Familial incidence
A
  • Prevalence: 7%
  • Men 2x more than women
  • No increased incidence in families w/ hx of schizophrenia
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18
Q

What is the differential diagnosis for Schizoid Personality Disorder?

A
  • Paranoid schizophrenia
    • Unlike pts w/ schizophrenia, patients w/ SPD do not have any fixed delusions, although these may exist transiently in some pts
  • Schizotypal personality disorder
    • Pts w/ SPD do not have the same eccentric behavior or magical thinking seen in pts w/ schizotypal personality disorder
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19
Q

What is the course and treatment for Schizoid Personality Disorder?

A
  • Chronic course, not always lifelong
  • Treatment similar to paranoid personality disorder
    • Psychotherapy; group therapy
    • Low-dose antipsychotics (short course) if transiently psychotic
    • Anti-depressants if comorbid major depression is diagnosed
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20
Q

What is the DSM-IV criteria for Schizotypal Personality Disorder?

A
  • Pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions & discomfort w/ close relationships, beginning by early adulthood & present in a variety of contexts. 5 or more of the following must be present:
    • Ideas of reference (excluding delusions of reference)
    • Odd beliefs or maginal thinking, inconsistent w/ cultural norms
    • Unusual perceptual experiences (bodily illusions)
    • Suspiciousness
    • Inappropriate or restricted affect
    • Odd of eccentric appearance or behavior
    • Few close friends or confidants
    • Odd thinking or speech (vague, stereotyped, etc)
    • Excessive social anxiety
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21
Q

What types of magical thinking & odd behaviors are characteristic of Schizotypal Personality Disorder?

A
  • Magical thinking
    • Belief in clairvoyance or telepathy
    • Bizarre fantasies or preoccupations
    • Belief in superstitions
  • Odd behaviors
    • Involvement in cults or strange religious practices
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22
Q

Schizotypal Personality Disorder

  • Prevalence: ___%
  • Familial incidence
A
  • Prevalence: 3.0%
  • Monozygotic >>> dizygotic twins
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23
Q

What is the differential diagnosis for Schizotypal Personality Disorder?

A
  • Paranoid schizophrenia
    • Unlike pts w/ schizophrenia, pts w/ schizotypal personality disorder are not frankly psychotic (but can become transiently under stress)
  • Schizoid personality disorder
    • Do not have the same eccentric behavior seen in pts w/ schizotypal personality disorder
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24
Q

What is the course and treatment for Schizotypal Personality Disorder?

A
  • Chronic, pts may develop schizophrenia
  • Psychotherapy is treatment of choice
  • Short course of low-dose antipsychotics if necessary (transient psychosis)
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25
Q

What is the DSM-IV criteria for Antisocial Personality Disorder?

A
  • Pattern of disregard for others & violation of the rights of others since age 15.
  • Patients must be at least 18 years old
  • Hx of behavior as child/adolescent must be consistent w/ conduct disorder
  • 3 or more of the following should be present:
    • Failure to conform to social norms by committing unlawful acts
    • Deceitfulness/repeated lying/manipulating others for personal gain
    • Impulsivity/failure to plan ahead
    • Irritability & aggressiveness/repeated fights or assaults
    • Recklessness & disregard for safety of self or others
    • Irresponsibility/failure to sustain work or honor financial obligations
    • Lack of remorse for actions
26
Q

Antisocial Personality Disorder

  • Prevalence: ___%
  • What SES has higher incidence?
  • Genetic component
A
  • Prevalence
    • Men 3%, Women 1%
  • Poor urban areas & prisoners
  • 5x increased risk among 1st degree relatives
27
Q

What is the differential diagnosis of Antisocial Personality Disorder?

A

Drug abuse

  • Necessary to ascertain which came first
  • Pts who began abusing drugs before their antisocial behavior may have behavior attributable to the effects of their addiction
28
Q

What is the course & treatment of Antisocial Personality Disorder?

A
  • Chronic course
  • Some improvement of symptoms as the pt ages
  • Many pts have somatic complaints
  • Co-existence of substance abuse and/or major depression is common
  • Treatment
    • Psychotherapy
    • Pharmacotherapy for anxiety/depression (caution: highly addictive)
29
Q

What is the acronym for Borderline Personality Disorder?

A

IMPULSIVE

  • Impulsive
  • Moody
  • Paranoid under stress
  • Unstable self image
  • Labile, intense relationships
  • Suicidal
  • Inappropriate anger
  • Vulnerable to abandonment
  • Emptiness
30
Q

What is the DSM-IV criteria for Borderline Personality Disorder?

A
  • Pervasive pattern of impulsivity & unstable relationships, affects, self-image, and behaviors, present by early adulthood & in a variety of contexts
  • At least 5 of the following must be present:
    • Desperate efforts to avoid real or imagined abandonment
    • Unstable, intense interpersonal relationships
    • Unstable self-image
    • Impulsivity in at least 2 potentially harmful ways (spending, sexual activity, substance use, etc.)
    • Recurrent suicidal threats or attempts or self-mutilation
    • Unstable mood/affect
    • General feeling of emptiness
    • Difficulty controlling anger
    • Transient, stress-related paranoid ideation or dissociative symptoms
31
Q

Borderline Personality Disorder

  • Prevalence: ___%
  • Women vs. Men
  • Suicide rate: ___%
A
  • Prevalence: 1-2%
  • Women 2x more than men
  • Suicide rate: 10%
32
Q

What is the differential diagnosis for Borderline Personality Disorder?

A

Schizophrenia

  • Unlike pts with schizophrenia, pts w/ borderline personality disorder do not have frank psychosis
  • May have transient psychosis, however, if decompensate under stress
33
Q

What is the course of Borderline Personality Disorder?

A
  • Stable, chronic course
  • High incidence of coexisting major depression and/or substance abuse
  • Increased risk of suicide
    • Patients will make suicide gestures and kill themselves by accident
34
Q

How is Borderline Personality Disorder treated?

A
  • Psychotherapy is the treatment of choice
    • Behavior therapy
    • Cognitive therapy
    • Social skills training
  • Pharmacotherapy
    • Psychotic or depressive symptoms
35
Q

What is the DSM-IV criteria for Histrionic Personality Disorder?

A
  • Pattern of excessive emotionality & attention seeking, present by early adulthood and in a variety of contexts
  • At least 5 of the following must be present:
    • Uncomfortable when not the center of attention
    • Inappropriately seductive or provocative behavior
    • Uses physical appearance to draw attention to self
    • Has speech that is impressionistic and lacking in detail
    • Theatrical & exaggerated expression of emotion
    • Easily influenced by others or situation
    • Perceives relationships as more intimate than they actually are
36
Q

Pharmacotherapy has been shown to be more useful in __________ disorder than in any other personality disorder.

A

Borderline personality disorder

37
Q

Histrionic Personality Disorder

  • Prevalence: ___%
  • Women vs. Men
A
  • Prevalence: 2-3%
  • Women >> Men
38
Q

What is the differential diagnosis for Histrionic Personality Disorder?

A

Borderline Personality Disorder

  • Patients w/ BPD are more likely to suffer from depression & to attempt suicide
  • HPD pts are generally more functional
39
Q

What is the course & treatment for Histrionic Personality Disorder?

A
  • Chronic course, some improvement of symptoms with age
  • Psychotherapy is the treatment of choice
  • Pharmacotherapy to treat associated depressive or anxious symptoms
40
Q

Histrionic patients often use the defense mechanism of ______.

A

Regression (revert to childlike behaviors)

41
Q

What is the DSM-IV criteria for Narcissistic Personality Disorder (NPD)?

A
  • Pattern of grandiosity, need for admiration, & lack of empathy beginning by early adulthood and present in a variety of contexts.
  • 5 or more of the following must be present:
    • Exaggerated sense of self-importance
    • Preoccupied w/ fantasies of unlimited money, success, brilliance, etc.
    • Believes that he/she is “special” or unique and can associate only with other high-status individuals
    • Needs excessive admiration
    • Has sense of entitlement
    • Takes advantage of others for self-gain
    • Lacks empathy
    • Envious of others or believes others are envious of him/her
    • Arrogant or haughty
42
Q

What is the prevalence of Narcissistic Personality Disorder?

A

<1%

43
Q

What is the differential diagnosis for Narcissistic Personality Disorder?

A

Antisocial personality disorder

  • Both types of pts exploit others
  • But, NPD pts want status & recognition, while antisocial pts want material gain or simply the subjugation of others
  • Narcissistic pts become depressed when they don’t get the recognition they think they deserve
44
Q

What is the course & treatment for Narcissistic Personality Disorder?

A
  • Chronic course
  • Higher incidence of depression & midlife crisis
    • High value on youth & power
  • Psychotherapy is treatment of choice
  • Antidepressants or lithium if needed
    • For mood swings if comorbid mood disorder is diagnosed
45
Q

Patients with avoidant personality disorder _____ companionship but are extremely _____ and easily _____.

A

desire, shy, injured

46
Q

What is the DSM-IV criteria for avoidant personality disorder?

A

A pattern of social inhibition, hypersensitivity & feelings of inadequacy since early adulthood, w/ at least 4 of the following:

  • Avoids occupation that involves interpersonal contact due to a fear of criticism and rejection
  • Unwilling to interact unless certain of being liked
  • Cautious of intrapersonal relationships
  • Preoccupied w/ being criticized or rejection in social situations
  • Inhibited in new social situations b/c he/she feels inadequate
  • Believes he or she is socially inept and inferior
  • Reluctant to engage in new activities for fear of embarrassment
47
Q

Avoidant Personality Disorder

  • Prevalence: ___%
  • Men vs. Women
A
  • Prevalence: 1-10%
  • Sex ratio unknown
48
Q

What is the differential diagnosis for Avoidant Personality Disorder?

A
  • Schizoid personality disorder
    • Pts w/ APD desire companionship but are extremely shy
    • Pts w/ schizoid have no desire for companionship
  • Social phobia
    • Fear & avoidance of social situations
    • Personality disorder if integral part of personality and evident before adulthood
    • Social phobia: fear of embarrassment in setting
    • APD: fear of rejection & sense of inadequacy
  • Dependent personality disorder
    • APD pts cling to relationships but slow to get involved; dependents more aggressive
49
Q

What is the course of Avoidant Personality Disorder?

A
  • Course usually chronic
  • Difficult during adolescence, when attractiveness & socialization are important
  • Increased incidence of associated anxiety & depressive disorders
50
Q

How is Avoidant Personality Disorder treated?

A
  • Psychotherapy
    • Assertiveness therapy most effective
  • Beta blockers
    • Control autonomic symptoms of anxiety
  • SSRIs
    • Major depression
51
Q

What is the DSM-IV criteria for Dependent Personality Disorder?

A

A pattern of submissive & clinging behavior due to excessive need to be taken care of. At least 5 of the following must be present:

  • Difficulty making everyday decisions w/o reassurance from others
  • Needs others to assume responsibilities for most areas of his/her life
  • Cannot express disagreement b/c of fear of loss of approval
  • Difficulty initiating projects b/c of lack of self-confidence
  • Goes to excessive lengths to obtain support from others
  • Feels helpless when alone
  • Urgently seeks another relationship when one ends
  • Preoccupied w/ fears of being left to take care of self
52
Q

Dependent Personality Disorder

  • Prevalence: ___%
  • Women vs. Men
A
  • Prevalence: 1%
  • Women >>> Men
53
Q

What is the differential diagnosis for Dependent Personality Disorder?

A
  • Avoidant personality disorder
  • Borderline & histrionic personality disorder
    • DPD: long-lasting relationship w/ one person on whom they are dependent
    • Borderline/Histrionic: dependent on other people but unable to maintain a long-lasting relationship
54
Q

What is the course of Dependent Personality Disorder?

A
  • Usually chronic course
  • Symptoms decrease w/ age and/or therapy
  • Pts prone to depression, particularly after loss of person on whom they are dependent
55
Q

How is Dependent Personality Disorder treated?

A
  • Psychotherapy is the treatment of choice
  • Pharmacotherapy
    • Treat associated symptoms of anxiety or depression
56
Q

What is the DSM-IV criteria for Obsessive-Compulsive Personality Disorder (OCPD)?

A

Pattern of preoccupation w/ orderliness, control & perfectionism at the expense of efficiency, present by early adulthood & in a variety of contexts. At least 4 of the following must be present:

  • Preoccupation w/ details, rules, lists and organization such that the major point of the activity is lost
  • Perfectionism that is detrimental to completion of task
  • Excessive devotion to work
  • Excessive consientiousness & scrupulousness about morals & ethics
  • Will not delegate tasks
  • Unable to discard worthless objects
  • Miserly
  • Rigit & stubborn
57
Q

Obsessive Compulsive Personality Disorder

  • Prevalence: ___%
  • Men vs. Women
  • Family incidence
A
  • Prevalence unknown
  • Men >> women
  • Most often in the oldest child
  • Increased incidence in 1st degree relatives
58
Q

What is the differential diagnosis for OCPD?

A
  • OCD
    • Pts w/ OCPD don’t have recurrent obsessions or compulsions in OCD
    • Symptoms of OCPD are ego-syntonic rather than ego-dystonic
  • Narcissistic personality disorder
    • Both personalities involve assertiveness & achievement
    • NPD pts motivated by status, OCD pts motivated by the work itself
59
Q

What is the course for pts with OCPD?

A
  • Unpredictable course
  • Some pts later develop obsessions or compulsions (OCD), some develop schizophrenia or MDD, others may improve or remain stable
60
Q

How is OCPD treated?

A
  • Psychotherapy is treatment of choice
  • Group therapy & behavior therapy may be useful
  • Pharmacotherapy may be used to treat associated symptoms as necessary
61
Q

What does Personality Disorder Not Otherwise Specified (NOS) include?

A
  • Passive-aggressive personality disorder
  • Depressive personality disorder
  • Sadomasochistic personality disorder
  • Sadistic personality disorder
62
Q

Describe pts with Passive-Aggressive Personality Disorder

How is it treated?

A
  • Stubborn, inefficient procrastinators
  • Alternate btwn compliance & defiance
  • Passively resist fulfillment of tasks
  • Frequently make excuses for themselves & lack assertiveness
  • Attempt to manipulate others to do their chores, errands, etc.
  • Frequently complain about their own misfortunes
  • Treatment: psychotherapy

Psychiatry (18 decks)

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