• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Lecture 3 Personality Disorders 1
 

Lecture 3 Personality Disorders 1

on

  • 6,035 views

 

Statistics

Views

Total Views
6,035
Views on SlideShare
6,031
Embed Views
4

Actions

Likes
2
Downloads
385
Comments
0

1 Embed 4

http://www.slideee.com 4

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Lecture 3 Personality Disorders 1 Lecture 3 Personality Disorders 1 Presentation Transcript

  • INTRODUCTION TO MEDCINE II PSYCHIATRY PERSONALITY DISORDERS INSTRUCTOR: JIMMY SANTANA, P.A. - C
  • PDs Characteristics
    • Presence of long-standing, rigid, unsuitable pattern of relating to others
    • Presence of personality characteristics that cause social and occupational impairment
    • Lack of insight
    • Failure to seek psychological help unless compelled by others
    • Absence of frank psychosis
  • Personality Disorder Clusters
    • There are three clusters
    • Cluster A:
        • Patient is eccentric and/or fears social relationships
        • Includes:
          • Paranoid personality disorder
          • Schizoid personality disorder
          • Schizotypal personality disorder
    • Cluster B
        • Patient is emotional, erratic, and/or dramatic
        • Includes:
          • Histrionic personality disorder
          • Narcissistic personality disorder
          • Antisocial personality disorder
          • Borderline personality disorder
    • Cluster C
        • Patient is fearful and/or anxious
        • Includes:
          • Avoidant personality disorder
          • Obsessive-compulsive personality disorder
          • Dependent personality disorder
  • Epidemiology
    • Personality disorder is prevalent in @ 1% of population
    • Schizoid personality disorder may be less common
    • More common (slightly) are
      • Dependent personality disorder
      • Schizotypal personality disorder
      • Histrionic personality disorder
    • Symptoms must be present by early adulthood for diagnosis
    • Antisocial personality disorder can not diagnosed until 18 years of age
    • Relatives of patients with personality disorders may have other psychiatric disorders:
      • Schizoid, Schizotypal and Parannoid – schizophrenia
      • Paranoid - delusional disorder (persecutory type)
      • Antisocial – substance abuse and somatization disorders
      • Borderline -- Mood disorders, substance abuse and antisocial personality disorder
      • Avoidant -- anxiety disorder
    • The patients with PDs have excessive use of maladaptive or inappropriate defense mechanisms
    • Prognosis for these patients is that the disease is chronic and lifelong
    • Medication for these patients are not useful except in borderline personality disorder
    • Medication is usually for symptoms associated with depression and anxiety
    • It is important to remember that PD patients have a high potential for addiction THEREFORE--- BE CAUTIOUS WHEN PRESCRIBING MEDICATIONS
  • PARANOID PERSONALITY DISORDER
    • PATIENT WITH THIS DISORDER ARE:
      • SUSPICIOUS
      • MISTRUSTFUL
      • LITIGIOUS
      • ATTRIBUTES RESPONSIBILTY FOR PROBLEMS TO OTHERS
    • DEFENSE MECHANISM USED ARE
      • PROJECTION
      • DENIAL
    • TYPICAL PATIENT PRESENTATION
    • 50 YEAR-OLD OFFICE WORKER TELLS YOU THAT HE HAS NEVER BEEN PROMOTED BECAUSE HIS CO-WORKERS FREQUENTLY CLAIM HIS IDEAS AS THEIR OWN. WHEN HE IS FIRED FOR POOR PERFORMANCE, HE FILES A LAWSUIT AGAINST THE COMPANY
  • Schizoid Personality Disorder
    • These patients have a life long pattern of voluntary social withdrawal
    • Similar to delusional disorder and schizophrenia but without frank psychotic symptoms
    • In the young can be mistaken for mild autistic disorder
    • TYPICAL PATIENT PRESENTATION
    • 48 YEAR-OLD MAN IS CONTENT LIVING ALONE IN AN ISOLATED CABIN, GROWING HIS OWN FOOD, AND RARELY HAVING CONTACT WITH OTHERS
  • SCHIZOTYPAL PERSONALITY DISORDER
    • THESE PATIENTS HAVE:
      • PECULIAR APPEARANCE
      • MAGICAL THINKING
      • ODD THOUGHT PATTERNS AND BEHAVIOR WITHOUT PSYCHOSIS
      • MAJOR DEPRESSION COULD BE FOUND (CO-MORBIDEDLY) IN THESE PATIENTS
    • DENIAL AND PROJECTION ARE USED AS DEFENSE MECHANISMS
    • DDX:
      • DELUSIONAL DISORDER
      • SCHIZOPHRENIA
      • MOOD DISORDER WITH PSYCHOSIS
    • TYPICAL PATIENT PRESENTATION
    • 35 YEAR-OLD MALE PATIENT TELLS YOU THAT HE NEVER STEPS ON CRACKS IN THE SIDEWALK TO AVOID “BREAKING HIS MOTHER’S BACK”(MAGICAL THINKING). HE SEEMS ODD, SAYS THAT HE OFTEN FEELS UNCOMFORTABLE IN SOCIAL SITUATIONS AND HAS FEW FRIENDS
  • HISTRIONIC PERSONALITY DISORDER
    • THESE PATIENTS ARE:
      • EXTROVERTED
      • EMOTIONAL
      • DRAMATIC
      • SEXUALITY PROVOCATIVE (LIFE OF THE PARTY)
      • INABILITY TO MAINTAIN INTIMATE RELATIONSHIPS
      • “ DON JUAN” BEHAVIOR IN MEN
    • DEFENSE MECHANISM:
      • REPRESSION
      • REGRESSION
      • SOMATIZATION
    • DDX:
    • BORDERLINE PD : SHOULD INCLUDE CHRONIC FEELINGS OF BOREDOM, EMPTINESS AND SUICIDAL BEHAVIORAL
    • NARCISSISTIC PD: SHOULD INCLUDE FEELINGS OF SUPERIOITY
    • DEPENDENT PD: NO FLAMBOYANCE OR AN OVERLY EMOTIONAL STATE
    • HYPOMANIC EPISODE IN BIPOLAR II OR CYCLOTHYMIC DISORDER: SYMPTOMS REMIT WHEN THE EPISODE ENDS
    • TYPICAL PATIENT PRESENTATION
    • 25 YEAR-OLD FEMALE PATIENT COMES TO YOUR OFFICE DRESSED IN A LOW – CUT BLOUSE AND VERY SHORT SKIRT AND BRINGS A GIFT FOR YOU. SHE FISHES FOR COMPLIMENTS FROM THE OFFICE STAFF AND TELLS YOU THAT YESTERDAY SHE “ALMOST BLED TO DEATH” WHEN SHE CUT HER FINGER.
  • Narcissistic Personality Disorder
    • These patients are:
      • Grandiose
      • Envious
      • Has sense of special entitlement
      • Lack empathy
    • Defense Mechanism:
      • Denial
      • Displacement
      • Poor ego functioning
    • DDX:
      • Histrionic PD and Borderline PD [ include emotionality and instability]
      • Obsessive – Compulsive PD [includes feelings of imperfection]
    • TYPICAL PATIENT PRESENTATION
    • 40 YEAR – OLD MALE PATIENT TELLS YOU THAT BECAUSE YOU ARE A DOCTOR, YOU CAN UNDERSTAND THAT HE IS “ BETTER THAN MOST PEOPLE.” HE THEN ASKS TO BE REFERRED TO A PHYSICIAN WHO GRADUATED FROM AN IVY LEAGUE SCHOOL.
  • ANTISOCIAL PERSONALITY DISORDER
    • THESE PATIENTS ARE:
      • ALSO KNOWN AS SOCIOPATHS OR PSYCHOPATH
      • UNWILLING TO CONFORM TO SOCIAL NORMS
      • FAIL TO LEARN FROM EXPERIENCES
      • ASSOCIATED WITH CONDUCT DISORDER IN CHILDHOOD
      • CRIMINALITY IN ADULTHOOD
    • DEFENSE MECHANISM:
      • INADEQUATE SUPEREGO FUNCTIONING
    • DDX:
      • SUBSTANCE ABUSE
      • CRIMINAL BEHAVIOR
      • NARCISSISTIC PD
      • PARANOID PD
      • HYPOMANIC EPISODE IN BIPOLAR II OR CYCLOTHYMIC DISORDERS
    • TYPICAL PATIENT PRESENTATION
    • A 29 YEAR- OLD MAN TELLS YOU THAT HE HAS STOLEN VALUABLE ITEMS FROM FRIENDS AND FAMILY ON MANY OCCASSIONS WITH NO INTENTION OF RETURNING THEM AND WITHOUT CONCERN FOR THE PEOPLE HE STOLE FROM. HE HAS BEEN UNEMPLOYED ON AND OFF FOR MANY YEARS AND HAS BEEN ARRESTED ON A VARIETY OF MINOR CHARGES.
  • BORDERLINE PERSONALITY DISORDER
    • THESE PATIENTS ARE:
      • UNSTABLE BEHAVIOR AND MOOD
      • BOREDOM, EMPTINESS
      • FEELINGS OF ALONENESS
      • IMPULSIVENESS
      • SUICIDE ATTEMPTS
      • BRIEF PERIOD OF LOSS OF CONTACT WITH REALITY (MINI – PSYCHOTIC EPISODES)
      • OFTEN COMORBID WITH MOOD DISORDER
    • DEFENSE MECHANISM:
      • DENIAL
      • DISPLACEMENT
      • SPLITTING
      • POOR EGO FUNCTIONING
    • TYPICAL PATIENT PRESENTATION
    • A 39 – YEAR – OLD FEMALE PATIENT TELLS YOU ON HER SECOND VISIT THAT SHE IS IN LOVE WITH YOU. WHEN YOU REFER HER TO ANOTHER PRACTITIONER, SHE ATTEMPTS SUICIDE
  • AVOIDANT PERSONALITY DISORDER
    • THESE PATIENTS ARE:
      • SHY
      • SENITIVE TO REJECTION
      • SOCIALLY WITHDRAWN
      • HAS INFERIORITY COMPLEX
    • DEFENSE MECHANISM:
      • AVOIDANCE
      • REGRESSION
    • DDX:
      • SOCIAL PHOBIA
      • DEPENDENT PD
      • SCHIZOID PD
    • TYPICAL PATIENT PRESENTATION
    • A 40 YEAR – OLD WOMAN WHO LIVES ALONE SEEMS TENSE AND FEARFUL. SHE TELLS YOU THAT SHE WOULD LIKE TO HAVE FRIENDS BUT IS AFRAID THAT PEOPLE WILL NOT LIKE HER.
  • OBSESSIVE – COMPULSIVE PERSONALITY DISORDER
    • THESE PATIENTS ARE:
      • PERFECTIONISTIC
      • ORDERLY
      • STUBBORN
      • INDECISIVE
    • DEFENSE MECHANISM
      • ISOLATION OF AFFECT
      • RATIONALIZATION
      • INTELLECTUALIZATION
      • UNDOING
    • DDX:
      • OBSESSIVE – COMPULSIVE DISORDER
    • TYPICAL PATIENT PRESENTATION
    • A 32 YEAR – OLD MALE PATIENT TELLS YOU THAT HIS FOURTH ROOMMATE HAS JUST MOVED OUT BECAUSE THE PATIENT MAKES UNREASONABLE RULES AND SCHEDULE CONCERNING THE CARE OF THE APARTMENT
  • DEPENDENT PERSONALITY DISORDER
    • THESE PATIENTS ARE:
      • LACKS SELF – CONFIDENCE
      • LETS OTHERS ASSUME THEIR RESPONSIBILITIES
    • DEFENSE MECHANISM
      • REGRESSION
      • AVOIDANCE
    • DDX:
      • DEPRESSION
      • TYPICAL PATIENT PRESENTATION
      • A 30 YEAR – OLD FEMALE PATIENT CALLS YOUR OFFICE FREQUENTLY TO ASK YOUR ADVICE ABOUT OBVIOUS, MINOR MEDICAL PROBLEMS
  • PASSIVE – AGGRESSIVE PERSONALITY DISORDER
    • THESE PATIENTS ARE:
      • STUBBORN
      • INEFFICIENT
      • PROCASTINATES
      • SEEMS COMPIANT BUT ARE DEFIANT
      • NO LONGER A DSM IV DIAGNOSIS
    • TYPICAL PATIENT PRESENTATION
    • TWO WEEKS AFTER YOUR 40 YEAR – OLD MALE PATIENT AGREES THAT HE NEEDS TO LOSE 10 POUNDS AND YOU SPEND TIME DESCRIBING AN APPROPRIATE DIET, HE HAS GAINED 2 POUNDS AND TELLS YOU THAT HE DID NOT YET “GET A CHANCE” TO BUY THE NECESSARY DIET.