Shared Flashcard Set

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Clinical Medicine Personality Disorders Month 4 Week 1
Clinical Medicine Personality Disorders Month 4 Week 1
35
Medical
Graduate
07/31/2018

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Cards

Term
What is personality?
Definition
Personality refers to individual differences in characteristic patterns of thinking, feeling and behaving.
“characteristic patterns”
- How you act and feel over time: TRAITS
- How you act and feel under certain circumstances: STATES
Term
5 personality traity
Definition
openness (imagination, feelings, actions, ideas). conscientiousness (competence, self-discipline, thoughtfullness, goal-driven), extroversion (sociability, asserviteness, emotional expression), agreeableness (cooperative, trustworthy, good-natured), neuroticism (tendency toward unstable emotions)
Term
NEUROTIC
Definition
• traits are not extreme
• able to work
• coherent stable sense of self
• able to make and keep relationships
• able to consider others’ perspectives
• resilient under stress
Term
PSYCHOTIC
Definition
• traits may be extreme
• difficulty working
• trouble making and/or keeping relationships
• trouble imaging others’ perspectives
• impulsive attempts to manage overwhelming emotions in the face of stress
Term
How can you assess personality?
Definition
• Self-reports
What kind of person are you?
What makes you unique, different from other people? [ ask same about other loved ones]
• Collateral reports What kind of person is X?
How have things been going at her job, with people she knows? Ask direct care staff (e.g. nurses in the hospital).
• Observation
How does X act? How do you feel interacting with X?
Term
What is a personality disorder?
Definition
A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or
problems functioning, and lasts over time • Trait model / DSM Alternative Model
• Diagnostic and Statistical Manual (official psychiatric diagnosis list) • Personality Organization model
Term
DSM steps
Definition
step 1: assess impairment in personality functioning, self: identity, self-direction. interpersonal: empathy, intimacy -> step 2 assess pathological personality traits (negative affectivity, detabchment, antagonism, disinhibition, psychotism) -> step 3a: apply criteria A and B for specific personality disorders- antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, schizotypal -> step 3b: apply criteria A and B for personality disorder-trait specified- moderate or greater impairment in personality functioning. one or more pathological personality traits (domains or facets) -> Step 4: apply other inclusion and exclusion criteria. inflexibility and pervasiveness: stability and early onset- other mental disorder, sustance and medical exclusions, agea nd cultural exclusions
Term
Cluster A
Definition
ODD-ECCENTRIC
Paranoid Schizoid Schizotypal
Term
Cluster B
Definition
DRAMATIC-ERRATIC
Borderline Narcissistic Histrionic Antisocial
Term
Cluster C
Definition
ANXIOUS-FEARFUL
Avoidant
Dependent Obsessive-compulsive
Term
Paranoid:
Definition
a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent.
Term
Schizoid:
Definition
lack of interest and detachment from social relationships, apathy, and restricted emotional expression.
Term
Schizotypal:
Definition
extreme discomfort interacting socially, and distorted cognitions and perceptions.
Term
Borderline:
Definition
pervasive pattern of abrupt mood swings, instability in relationships, self-
image, identity, behavior and affect, often leading to self-harm and impulsivity.
Term
Narcissistic:
Definition
pervasive pattern of grandiosity, need for admiration, and a perceived or real lack of empathy.
Term
Histrionic:
Definition
pervasive pattern of attention-seeking behavior and excessive emotions.
Term
Antisocial:
Definition
pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behavior.
Term
Avoidant:
Definition
pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation.
Term
Dependent:
Definition
pervasive psychological need to be cared for by other people.
Term
Obsessive-compulsive:
Definition
characterized by rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships
Term
Personality organization
Definition
• Traits: how extreme?
• Work? What kind? How does it go?
• Sense of self (stable?)
• Ability to make and keep relationships
• Ability to consider others’ perspectives
• Emotions and behaviors under stress
Term
BPD epidemiology:
Definition
• Prevalence:
• Heritability 55-68% (SCZ 85%, MDD 45%).
Rates of remission and recovery after inpatient admission
1-5% in the general population 10-20% in psychiatric settings

• 50X more suicide attempts
• 5-10% complete suicide
• Remission (no longer meeting criteria) is common
• Recovery is less common:
• Remission and
• 1+ emotionally sustaining relationship
• Full time work or school
Term
Affective BPD symptoms
Definition
• Changeable mood from minute to minute, hour to hour
• Depressed, anxious mood
• Emptiness
Term
impulsive BPD symptoms
Definition
• Aggression • Driving
• Sex
• Alcohol/Drugs
• Financial • Self-harm
Term
cognitive BPD symptoms
Definition
• Odd ideas
• Magical ideas
• Paranoia
• Hearing voices
Term
interpersonal BPD symptoms
Definition
• Difficult relationships with lots of ups and downs
• Strongly conflicted relationships
• Other symptoms come and go with
interpersonal problems
Term
People with BPD feel ___ how to test
Definition
ostracized, Cyberball: a social ball tossing game
Term
People with BPD see most faces as
Definition
angry
People with BPD:
• Quickly notice and pay more attention to angry faces
• Judge ambiguous (only partly angry) faces to be angry
• Have more trouble
distinguishing more detail about negative faces
Term
amgydala in BPD
Definition
hyperactive
The amygdala is more active
in people with BPD than in people without BPD
• All the time
• When seeing faces
Also, pre-frontal cortex (PFC)- amygdala connectivity is decreased in BPD.
Term
social behavior in BPD
Definition
amygdala doesn't signal effectively, in game doesn't increase money to get partner to keep playing
Term
Possible levels of awareness of partner irritability in BPD
Definition
Social behavior is impaired:
ignorant optimistic realistic pessimistic fatalistic
Term
Psychopharmacology for BPD:
Definition
• Data is recent, inconclusive, practice guidelines still recommend no meds • Polypharmacy is common, and inversely related to improvement
• Meds may work for the expected symptom clusters:
affect regulation- mood stabilizer, anti-depressant, anti-psychotic, placebo
impulsivity- mood stabilizer, anti-psychotic
psychotic-like symptoms- anti psychotic
Term
Considerations in Psychopharmacology: for BPD
Definition
Treating symptoms
• Symptoms can be debilitating
• Symptoms fluctuate as part of the disease
Maintaining safety
• Impulsivity–many medications are risky in overdose
• Suicidality and self-harm
• Co-morbidities: PTSD, panic disorder, substance use disorders...
Meaning of medications
• Adding and decreasing medications can trigger strong feelings of being
judged to be sick, having help withdrawn etc...
Term
Psychotherapy for BPD:
Definition
• Good Psychiatric Management (JohnGunderson,PaulLinks,LoisChoi-Kain)
• Dialectical Behavioral Therapy (MarshaLinehan)
• Transference-focused Psychotherapy (OttoKernbergandCornellgroup)
• Mentalization Based Treatment (PeterFonagyandAnthonyBateman)
Term
Practical approaches: for BPD
Definition
• Consider your own personality: https://sapa-project.org/survey/report.php
• What is your patient’s personality?
• Managing patients with personality disorders
-- acknowledge patient strengths
-- acknowledge your limitations, set clear expectations
-- describe problems in factual, non-judgmental terms
-- refer to appropriate treatment (esp. case management)
-- referrals for caregivers and loved ones
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