Personally disorders

🛑 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.

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