🛑 Personality disorder
🌷Definition of personality
- it describe characteristic behavior, emotional and cognitive attributes of an individual
🌷definition of personality disorder
- Any characteristic personality that lead to painful consequence on patient or surroundings
- duration = 2years
- diagnosis after 18 years old
📌 presentation = usually with more than one personality (e.g 50% paranoid disorder, 30% obsessive disorder … and these percentages also important in plan management )
- personality disorder can can predispose to psychiatric disorder
- Personality disorder can coexist with psychiatric disorder (as Comorbidity and indicate worse prognosis)
- personality deterioration may occur if associated with other psychiatric disorder
📌Key for diagnosis
- cause distress or dysfunction for individual or surrounding
- persist over across a range of situation
- pervasive, stable and recognized since late adolescence
📌Classification
See the pictures below 👇🏻👇🏻
- cluster A (eccentric)
*paranoid
*schizoid - cluster B (dramatic)
*dissocial (psychopath, antisocial)
*borderline (emotional unstable)
*Histrionic
*Narcissistic - cluster C (anxious)
*Anankastic (obsessional)
*Anxious (avoidant)
*dependent
📌Epidemiology
- 2-15%
- most common
*Obsessive
*avoidant
*schizoid
*borderline - frequently coexist with psychiatric disorders.
- higher in specific populations
*prisoners (over 50% of men and 30% of women, with most being antisocial) - Psychiatric patients: ( 50%)
- substance misuse or eating disorder (70%)
📌Etiology
— Upbringing and childhood experiences -> Adverse childhood events, including sexual and physical abuse
— Genetic
*especially anankastic and dissocial types.
*XYY = Jacob’s syndrome -> Aggressive behaviour
📌DDX
- from other psychiatric disorder
**may misdiagnosis like borderline personality disorder with bipolar)
📌 Treatment
-> some treatments are effective, particularly for cluster B personality disorders
-> Management can be difficult
-> There are no licensed medications for the treatment of personality disorder.
➖Cluster A
*first : distinguish is from other psychosis (specially chronic delusional disorder)
*decide if there is a significant risk of harm to the person or others.
- decide what, if any, treatment should be given for the personality disorder.
— Low-dose antipsychotics (compliance is likely to be poor)
— social intervention
— Psychotherapy is said to be ineffective (even harmful)
➖ Cluster B
— psychotherapy
➖Cluster C
- rarely presents clinically -> little information about how to manage it.
— try to enhance self-esteem
📌Prognosis
- bad
- improvement is often observed by middle age.
- associated with an increased mortality rate.
- worsens outcome of comorbid psychiatric disorder
- increases the risk of violence when comorbid with psychosis.
✅ Cluster A
📌paranoid personality disorder = is a risk factor for development of a psychosis.
✅ Cluster B
📌Dissocial
- psychopathic = serial killer (kill the people with no feel of guilty)
- antisocial = hate the social but not a killer
📌Borderline
**Can present with :
- overdose or self cutting
- with depressive
- with quasi-psychosis
- with suicidal ideation
- with demand for help (admission or medication)
**Brain imaging suggests frontal lobe dopaminergic and serotoninergic function may be important.
** past history (these association not strong)
-childhood sexual abuse
– PTSD
– bulimia nervosa
📌Narcissistic
- not present with mania
.
✅ cluster c
- Risk for both anxiety and depress disorder
📌Anakastic
- unlikely to be OCD later on.
