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Personality disorders

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Personality specific character traits- temperament, ... typical for concrete person. formed by early adulthood, persist ... obj.anamnesis, observation ... – PowerPoint PPT presentation

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Title: Personality disorders


1
Personality disorders
  • MUDr. Martin Perna
  • Dept. of Psychiatry,
  • Masaryk University, Brno

2
Personality disorders
  • Personality specific character traits-
    temperament, emotional reactivity, fairness,
    interpersonal relations establishment, needs,
    expectations, stinginess, generosity, arrogance,
    independence and others...
  • typical for concrete person.
  • formed by early adulthood, persist throughout
    life

3
Personality disorders
  • Personality- is formed and exists in interaction
    between hereditary factors and large psychosocial
    contact
  • Hereditary factors seem to be basic to establish
    the type of personality
  • Various influences in ontogenetical expierience
    can modify it.

4
Personality disorders
  • Personality disorder- when personality traits are
    rigid and self-defeating, they may interfere with
    functioning and even lead to psychiatric symptoms
  • cause more or less suffering of patient or other
    persons or both and lead to social maladaptation
    (relations, family, work...)
  • such personality seems to be disbalanced,
    whithout harmonical coordination of behaviour

5
Dynamic of symptomatology
  • relative stacionary, lasting for a long time
    from early adulthood to senile age
  • during the life there can be the periods of
    better or worse functioning. Great role on the
    outcome state may play the situation factors as a
    family, social or work integration, state of
    health, economical status and another.
  • with ageing some symptoms can mitigate
    (impulsivity, agressivity, dissocial behaviour,
    psychastenic symptoms), the another can
    accentuate (depressive symptoms, touchieness).

6
General prevalence
  • widely diverge- (used method of study,
    diagnostical system...)
  • the most common estimations range of all P.D. is
    about 10-23.
  • Paranoid 0,5-2,5
  • Schizoid ?
  • Schizotypal 3(in category F2 in ICD-10)
  • Antisocial 3 (disocial in ICD-10)
  • Borderline 2
  • Histrionic 2-3
  • Narcissistic less than 1
  • Avoidant 0,5-1
  • Dependent 2,5-25

7
Psychiatric comorbidity
  • about one half of all psychiatric patients have
    personality disorder, frequently comorbid with
    other diagnosis
  • personality factors interfere with the response
    to treatment and increase personal
    incapacitation, morbidity, and mortality of these
    patients
  • personality disorders are also a predisposing
    factor for many other psychiatric diseases,
    including substance use disorders, suicide, mood
    disorders, impulse-control disorders, eating
    disorders, and anxiety disorders.

8
Somatic comorbidity
  • Proportion of patients in somatic medicine have
    personality disorders comorbid with their
    physical illnesses
  • Personality factors have been associated with
    increased risk for coronary artery disease,
    angina pectoris, psoriasis, m.Crohn, ulcerative
  • colitis, and other so-called psychosomatic
  • diseases.

9
Diagnostic process
  • -Complete psychiatric examination
  • -Objectivisation- obj.anamnesis, observation
  • -Exclusion of secondarity -somatic examination,
    brain imaging, EEG, laboratory (BCH, toxicology,
    infections, endokrinology)
  • -Psychological examination -personality tests

10
Classifications
  • ICD-10 (F60 Specific P.D.)- WHO
  • DSM-IV (Diagnostical and statistical manual)
    -American Psychiatric Association
  • both are similar with some differences
    (e.g.schizotypal disorder- in ICD in ch. F2)

11
General diagnostic criteria- ICD-10
  • G1. enduring patterns of inner experience and
    behavior as a whole deviate markedly from the
    culturally expected and accepted range. Deviation
    in more than one of the following areas (1)
    cognition, (2) affectivity , (3) control over
    impulses and gratification of needs
  • (4) manner of relating to others and of
    handling interpersonal situations.
  • G2. behavior is inflexible, maladaptive across a
    broad range of personal and social situations

12
General diagnostic criteria- ICD-10
  • G3. personal distress, or adverse impact on the
    social environment, or both
  • G4. the deviation is stable and of long duration,
    onset in late childhood or adolescence
  • G5. not as a manifestation or consequence of
    other adult mental disorders 
  • G6. organic cause must be excluded

13
Personality disorders
  • ICD-10
  • F 60 -Specific personality disorders
  • Paranoid P.D.
  • Schizoid P.D.
  • Dissocial P.D.
  • Emotionally unstable P.D.
  • Histrionic P.D.
  • Anancastic P.D.
  • Anxious (avoidant) P.D.
  • F 61 Mixed and Other P.D.

14
  • Paranoid personality disorder
  • (1) excessive sensitivity to setbacks and rebuffs
  • (2) tendency to bear grudges persistently
  • (3) suspiciousness, tendency to distort
    experience by misconstruing the neutral or
    friendly actions as hostile
  • (4) situation inadeqate sense of personal rights
  • (5) recurrent suspicions regarding sexual
    fidelity of sexual partner
  • (6) self-referential attitude, associated
    particularly with excessive self-importance
  • (7) "conspiratorial" explanations

15
  • Schizoid personality disorder
  • (1) few, if any, activities provide pleasure
  • (2) emotional coldness or flattened affectivity
  • (3) limited capacity to express feelings
  • (4) an appearance of indifference to valuation
  • (5) little sexual interest with another person
  • (6) consistent choice of solitary activities
  • (7) preoccupation with fantasy and introspection
  • (8) low or no need of any confiding relationships
  • (9) insensitivity to social norms and conventions

16
  • Dissocial personality disorder
  • (1) callous unconcern for the feelings of others
  • (2) attitude of irresponsibility and disregard
    for social norms, rules, obligations
  • (3) incapacity to maintain enduring
    relationships, no difficulty in establishing them
  • (4) very low tolerance to frustration and a low
    threshold for aggression
  • (5) incapacity to experience guilt or to profit
    from adverse experience
  • (6) proneness to blame others or to plausible
    rationalizations for the conflict behavior

17
  • Emotionally unstable personality disorder
  • Impulsive type
  • (1) tendency to act unexpectedly without
    consideration of the consequences
  • (2) marked tendency to quarrelsome behavior and
    to conflicts with others
  • (3) liability to outbursts of anger or violence,
    with inability to control the behavioral
    explosions
  • (4) difficulty in maintaining any course of
    action that offers no immediate reward
  • (5) unstable and capricious mood

18
  • Emotionally unstable personality disorder
  • Borderline type
  • At least three of the symptoms mentioned in
    criterion for impulsive type, and
  • (1) disturbances in and uncertainty about
    self-image, aims, and internal preferences
  • (2) liability to become involved in intense and
    unstable relationships, often leading to
    emotional crises
  • (3) excessive efforts to avoid abandonment
  • (4) recurrent threats or acts of self-harm
  • (5) chronic feelings of emptiness

19
  • Histrionic personality disorder
  • (1) self-dramatization, theatricality, or
    exaggerated expression of emotions
  • (2) suggestibility
  • (3) shallow and labile affectivity
  • (4) continual seeking for excitement and
    activities in which is the center of attention
  • (5) seductiveness in appearance or behavior
  • (6) overconcern with physical attractiveness
  • Egocentricity, continuous longing for
    appreciation, lack of consideration for others,
    and persistent manipulative behavior complete the
    clinical picture, but are not required for the
    diagnosis.

20
  • Anancastic personality disorder
  • (1) feelings of excessive doubt and caution
  • (2) preoccupation with details, rules, order,
    organization, or schedule
  • (3) perfectionism that interferes with completion
  • (4) conscientiousness and scrupulousness
  • (5) undue preoccupation with productivity to the
    exclusion of pleasure and relationships
  • (6) pedantry and adherence to conventions
  • (7) rigidity
  • (8) unreasonable insistence that others submit to
    exactly way of doing things, or unreasonable
    reluctance to way of doing of them

21
  • Anxious (avoidant) personality disorder
  • (1) persistent feelings of tension and
    apprehension
  • (2) belief that one is socially inept, personally
    unappealing, or inferior to others
  • (3) excessive preoccupation with being criticized
    or rejected in social situations
  • (4) unwillingness to become involved with people
    unless certain of being liked
  • (5) restrictions in lifestyle because of need for
    physical security
  • (6) avoidance of social or occupational
    activities that involve significant interpersonal
    contact, because of fear of criticism,
    disapproval, or rejection.

22
  • Dependent personality disorder
  • (1) encouraging or allowing others to make the
    most of one's important life decisions
  • (2) subordination of own needs to others on whom
    is dependent, and compliance with their wishes
  • (3) unwillingness to make reasonable demands on
    the people one depends on
  • (4) feeling uncomfortable or helpless when alone,
    because of exaggerated fears of inability to care
    for oneself
  • (5) preoccupation with fears of being left to
    care for oneself
  • (6) limited capacity to make everyday decisions
    without an advice and reassurance from others

23
  • Mixed and other personality disorders(F61)
  • Features of several of the specific
    personality disorders are present
  • but
  • not to the extent that the criteria for any
  • of the specified personality disorders in that
    category are met.

24
Personality disorders DSM-IV
  • schizotypal
  • schizoid
  • paranoid
  • narcissistic
  • borderline
  • antisocial
  • histrionic
  • obsessive-compulsive
  • dependent
  • avoidant
  • passive-aggressive
  • depressive

25
Personality disorders DSM-IV
  • Cluster A - odd, aloof, and eccentric features
  • (paranoid, schizoid, schizotypal)
  • Cluster B - dramatic, impulsive, and erratic
    features (borderline, antisocial, narcissistic,
    histrionic)
  • Cluster C - anxious and fearful features
  • (avoidant, dependent, and obsessive-compulsiv
    e)

26
Complications
  • -secondary mental illnesses (depression,
    medicament, drug or alcohole abuse or addiction,
    eating disorders, impulse-control disorders,
    anxiety disorders, short psychosis)
  • -suicidal behavior
  • -acts of self-harm
  • -violence and crime behaviour
  • -risk behaviour (sexualy transmitted infections,
    drug application...)

27
Treatment
  • Motivation to the therapy, compliance and
    efficiency is different from case to case.
  • - Psychoterapy - basis
  • - Pharmacotherapy -in some cases, symptomatic
  • - few controled studies of efficiency
  • - difficult but helpful

28
Psychoterapy
  • - the choise of the type of psychoterapy
    depends
  • on specific type of P.D. and other factors as
    motivation to therapy, intelectual state,
    ego-syntonicity or dystonicity, age and another.
  • - basic psychoterapeutic support
  • - psychoanalytic individual or group
  • - cognitive-behavioral therapy

29
Pharmacotherapy
  • - symptomatic, follows symptoms
  • target permanent symptoms (long-term) or actual
    state (acute anxiety, disquiet, suicidal beh.,
    agitation, emotional crises...)

30
Pharmacotherapy for symptoms
  • depression- SRI, IMAO, atyp.AP
  • acute anxiety and agitation- BZD, AP
  • anxiety- (S)SRI, buspiron, IMAO, low dose AP
  • em. instability- VAL, CBZ, Li, low dose AP
  • em. flateness- atyp.AP, SSRI, IMAO
  • dysforia- SSRI, low dose atyp.AP
  • aggression- Li, antikonv., AP
  • impulsivity- SSRI, anticonv., Li, low dose AP
  • psychotic- AP

31
References
  • Waldinger RJ. Psychiatry for medical students,
    Washington, DC American Psychaitric Press, 1997
  • Kaplan HI, Sadock BJ, Grebb JA. Kaplan and
    Sadocks synopsis of psychiatry, Baltimore
    Williams and Wilkins, 1997
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