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kaplan_personality

kaplan_personality

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PERSONALITY DISORDERS
Personalit y
\ue000observable behavior AND subj ective inner experience
(public & privat e aspect s)

\ue000passive/ aggressive
\ue000ambitious, religious, friendly
\ue000qualifications of a personality d/ o implies certain

predictions about how a person will behave under
cert ain circumst ances.
\ue000Px are more likely t o ref use help & deny problems
\ue000Sympt oms are
\ue001Alloplastic\ue001 able to adapt to & alter external
environment
\ue001Ego synt onic\ue001 accept able t o t he ego
\ue000Px do NOT feel anxiety about their maladaptive
behavior
\ue000DSM IV TR definit ion:
\ue000Enduring subjective experiences & behavior that
deviat e from cult ural st andards (of t he individual)
\ue0002 or more of :
\ue001Cognition\ue001 ways of percieving & interpreting
self, ot her people & event s
\ue001Affectivity\ue001 range, intensity, lability, &
appropriateness of emotional response
\ue001Interpersonal functioning
\ue001Impulse cont rol

\ue000Rigidly (inflexible) pervasive & maladapt ive
\ue000Adolescent / early adult hood onset
\ue000St able
\ue000Lead to unhappiness & impairment (produce fxnal

impairment or subj ective distress)
\ue000Not a direct cause of another mental d/ o or
subst ance (medicat ion/ drugs)
\ue000Clust er A\ue001 px percieve as odd & eccent ric

\ue000Paranoid
\ue000Schizoid
\ue000Schizot ypal

\ue000
Cluster B\ue001 dramatic, emotional & erratic

\ue000ant isocial
\ue000borderline
\ue000histrionic
\ue000narcissistic

\ue000Cluster C\ue001 anxious, fearful

\ue000Avoidant
\ue000Dependent
\ue000Obsessive compulsive
\ue000Not ot herwise specified

\ue001Passive aggressive
\ue001Depressive
Et iology
\ue000

Cluster A \u2013 occur more commonly in biological relatives of px w/ schizophrenia (esp schizotypal); there is less correlation between paranoid or schizoid personalit y d/ o t o schizophrenia

\ue000Cluster B \u2013 have more relatives with mood disorders;
have overlap sympt oms
\ue000Ant isocial \ue001al cohol
\ue000Borderline \ue001 depression (also have abn DST)
\ue000Histrionic \ue001somat i zat i on ( Br i q uet \u2019 s)
\ue000Cluster C \u2013
\ue000Avoidant \ue001anxiet y
\ue000OC \ue001 monozygotic; depresion (short REM & abn
dexamet hasone suppression t est s : DST )
Biological factors

\ue000Impulsive traits\ue001\ue001 testosterone, 17 estradiol, estrone
\ue000\ue002 MAO\ue001 schizot ypal & more social
\ue000smooth pursuit eye movements\ue001 saccadic (j umpy) in

px who are introverted,\ue002self esteem, withdrawn &
schizot ypal
\ue000endorphins\ue001 ~morphine, analgesia, suppresion of
arousal
\ue000\ue001endorphins\ue001 phlegmat ic persons
\ue000\ue0025HIAA (serotonin metabolite)\ue001 suicidal, impulsive,
aggr essi ve
\ue000\ue001 5HT (using Prozac)\ue001 \ue002 depression, impulsiveness,
ruminat ion & produce sense of well being
\ue000\ue001 dopamine (using psychost imulant s like amphet amine)
\ue001induces euphoria
\ue000EEG changes\ue001 ant isocial & borderline (slow wave)
Psychoanalyt ic fact ors
\ue000Freud
\ue000Fixat ion at one psychosexual st age of dvlpt
\ue000Or al
charact er
\ue001
passi ve
&
dependent
(dependence on ot hers for food)
\ue000Anal character \ue001subborn, parsimonious, & highly
conscientious (struggle over toilet training)
\ue000Reich
\ue000Character armor\ue001 person\u2019 s defensive style to protect
themselves from internal mpulses & interpersonal
anxiet y
\ue000Paranoid \ue001 uses p r oj ect i on
\ue000Schizoid \ue001associat ed wit h wit hdrawal
\ue000When the defenses work, the px master their

feelings therefore viewing their behavior as ego syntonic (creating no distress to them even if it adversely af f ect s ot hers)

\ue000Internal obj ect relations
\ue000Int roj ect ion \ue001children internalize a parent or

another significant person as an internal presence that continues to feel like an obj ect rather than a sel f

\ue001Child owns t he t rait s of t he ext ernal obj ect
\ue000Defense mechanisms\ue001 4 lodestars of inner life
(instinct (wish/need), reality, important persons,
conscience)
\ue000Fant asy \ue001px schizoid, labeled as eccent ric, lonely

or frightened, seek solace & satisfaction within t hemselves by creat ing imaginary lives/ friends; fear of intimacy

\ue000Dissociation / Denial \ue001polyanna like replacement
of unpleasant affects w/ pleasant ones
\ue000Isolat ion \ue001 orderly, controlled persons who are
oft en labeled OC
\ue000Proj ect ion
\ue001
px
attribute
t heir

own unacknowledged feelings to others; excessive faultfinding & sensitivity to criticism

\ue000Splitting\ue001 good and bad
\ue000Passive aggression \ue001 turn their anger against
t hemselves (masochism)
\ue000Acting out \ue001 tantrums, child abuse, pleasureless
promiscuit y
\ue000Proj ective identificaton \ue001@ borderline personality
pArAnOiD personality d/o
\ue000Long standing suspiciousness & mistrust of persons
\ue000Refuse responsibility for their own feelings and assign
responsibility to others
\ue000Hostile, irritable , angry
\ue000Bigots, injustice collectors, pathologically jealous
spouses
\ue0000.5 \u2013 2.5% @ general populat ion
\ue000can often pull themselves together & appear
undist ressed
\ue000M > F, NO familial pattern
\ue000DSM IV TR
\ue000Pervasive distrust & suspiciousness of thers such
that their motives are interpreted as malevolent
\ue000Early adult hood, w/ 4 or more
\ue001Suspect s (w/ o basis) t hat ot hers are exploit ing,
harming or decieving
\ue001Have unjustified doubts about the loyalty or
trustworthiness of friends or associates
\ue001Reluctant to confide in others because of
unwarranted fear that the information will be
used maliciously against him
\ue001Reads hidden demeaning or threatening
meanings int o benign remarks or event s
\ue001Bears grudges (unf orgiving)
\ue001Percieves attacks on his character/ reputation
& quick t o react angrily and count erat t ack
\ue001Recurrent suspicion regarding fidelity of
spouse/ sexual part ner
\ue000Formal manner, muscular tension, need to scan
environment for clues, humorless, serious
\ue000Arguments premises are false but goal directed &
logical
\ue000Ideas of reference, proj ection, prej udice
\ue000In ot hers, it is a harbinger of schizophrenia
\ue000TX
\ue000Psychot herapy \ue001 TX OF CHOICE
\ue000Pharmacot herapy
\ue001Diazepam (valium)\ue001 ant ianxiet y
\ue001Haloperidol (haldol)\ue001 antipsychotic, to
manage sever agitation or quasi-delusional
t hinking
\ue001Pimozide (orap(\ue001 antipsychotic,\ue002 paranoid
ideat ion
ScHiZOiD personality d/o
\ue000Lifelong pat t ern of social wit hdrawal
\ue000Discomfort with human interaction, introverted w/
bland const rict ed affect
\ue000Eccent ric, isolat ed or lonely
\ue000DSM IV TR
\ue000

Pervasive pat t ern of det achment from social relat ionships and a restricted range of expression of emotions in interpersonal set t i ngs

\ue000
Begins early adult hood, w/ 4 or more\u2026
\ue000
Neit her desires nor enj oys close relat ionships (inc f amily)
\ue000
Chooses solit ary act ivit ies
\ue000
Lit t le int erest in sexual experiences
\ue000
Takes pleasure in few act ivit ies
\ue000
Lacks close friends or confidant s (ot her t han first degree
relat ives)
\ue000
Indifferent t o praise or crit icism of ot hers
\ue000
Shows emotional coldness, detachment or flattened affect
\ue000
\ue0007.5 % general pop
\ue000\u201c sex rat io is unknown\u201d but some st udies say 2:1, M>F
\ue000Gravitate towards solitary j obs that involve little or no
contact w/ others (night work)
\ue000Can\u2019 t tolerate eye contact, eager for the interview to
end, fearful, give short answers, last to be aware of
changes in popular fashion.. et c.

\ue000Do not have schizophrenic relat ives
\ue000Have successful if isolat ed work hist ories
\ue000Onset early childhood??? \u2013p805
\ue000Long last ing, but not necessarily lifelong
\ue000TX

\ue000Psychot herapy
\ue001Px may become devot ed, if dist ant pxs
\ue000Pharmacot herapy
\ue001Ant ipsychot ics,
ant idepressant s
&
psychost imulant s
\ue001Serot onergic agent s --> make px less sensit ive
t o rej ect ion
\ue001Benzodiazepines --> help\ue002 interpersonal
anxiet y
ScHiZoTyPaL personality d/o
\ue000Odd, strange.. w/ magical thinking, peculiar notions,
ideas of reference, ilusions & derealization
\ue0003 % gen pop
\ue000sex rat io unknown
\ue000\ue001 association w/ schizophrenic relatives
\ue000\ue000DSM IV TR
\ue000Pervasive pattern of social & interpersonal deficits
marked by acut e discomfort w/ & reduced capacit y for
close relat ionships
\ue000Cognitive/ perceptual distortions & eccentricities of
behavior
\ue000Beginning by early adult hood w/ 5 or more \u2026
\ue000Ideas of reference (excluding delusions of
ref erence)
\ue000Odd beliefs or magical thinking w/ is inconsistent

w/ norms (superstition, clarivoyance, telepathy, sixth sense; in children, bizarre fantasies & preoccupat ions)

\ue000Suspiciousness or paranoid ideat ion
\ue000Inappropriat e or const rict d affect
\ue000Behavior or appearnce that is odd, eccentric or

peculiar
\ue000Lack of close friends or confidant s ot her t han first

degree relatives, excessive social anxiety that dsnt diminish with familiarity & tends to be associated w/ paranoid fears rather than negative j udgements about self.

\ue000Absence of psychosis (difference between schizotypal
& schizophrenia)
\ue000If psychosis is presnet, they are brief & fragmentary
\ue00010% event ually commit suicide
\ue000Tx
\ue000Psychot herapy
\ue000Pharmacot herapy
\ue001Antipsychotic --> ideas of reference, illusions
\ue001Ant idepressant s
AnTiSoCiaL personality d/o

\ue000Inabilit y t o conform t o t he social norms
\ue000NOT synonymous w/ criminality
\ue0003% M > 1% F
\ue000\ue000 poor urban areas & mobile resident s
\ue000boys from large families
\ue000onset before 15 (boys earlier)
\ue000in prison, 75%
\ue000familial pat t ern, 5% more comon in 1st degree relat ives

\ue000Mask of sanit y
\ue000Hervey Cleckley
\ue000Px may appear composed & credible, but beneath
the veneer there is tension, hostility, irritability &
r age
\ue000St ress int erview (confront at ion) may be necessary
\ue000DSM IV TR
\ue000Pervasive pat t ern of dsregard for and violat ion of right s
of ot hers occuring since age 15 years
\ue0003 or more of..
\ue000failure to conform to social norms w/ respect to
lawful behaviors (repeatedly performing acts that
are grounds for arrest)
\ue000deceitfulness, (repeated lying, use of aliases, or
conning others for personal profit or pleasure)
\ue000impulsivit y or failure t o plan ahead
\ue000irritability and aggressiveness, (repeated physical
fights or assaults)
\ue000reckless disregard for safet y of self or ot hers
\ue000consistent irresponsibility (repeated failure to
sustain consistent work behavior or honor financial
obligat ions)
\ue000lack of remorse (indifference to having hurt,
mist reat ed, or st olen from anot her)

\ue000at l east 18 y/ o
\ue000evidence of conduct d/ o w/ onset bef ore age 15 y/ o
\ue000not during schizophrenia or manic episode

\ue000unremitting course --> reaches peak at late
adol escence
\ue000have somatization disorders, depression, alcohol use,
subst ance abuse
\ue000Tx
\ue000Psychot herapy --> except immobilized px
\ue001When px are among peers, their lack of
mot ivat ion for change disappears
\ue000Pharmacot herapy
\ue001Psychost imul ant s
\ue003Met hylphenidat e
-->
at t ent ion
deficit / hyperact ivt y d/ o
\ue001Antiepileptic drugs --> control impulsive
behavior
\ue003Carbamazepine
\ue003Val proat e
\ue001\ue000 adrenergic ant agonist --> \ue002 aggr e si on
BoRdErLiNe personality d/o

\ue000on t he border bet ween neurosis & psychosis
\ue000ambulat ory schizophrenia
\ue000as-if personalit y d/ o (by Deut sch)
\ue000pseudoneurot ic schizophrenia (by Hoch & Polit an)
\ue000psychot ic charact er d/ o (by Frosch)
\ue000emot ionally unst able personalit y d/ o (ICD10)
\ue0001-2% gen pop
\ue000F (2x) > M
\ue000\ue001 prevalence of MDD, alcohol use, subst abuse

\ue000
\ue000
DSM IV TR
\ue000
Pervasive pattern of instability of interpersonal relationships,
self image, and affet s & marked impulsivit y
\ue000
Early adulthood
\ue000
5 or more of..
\ue000
frant ic effort s t o avoid real or imagined abandonment
\ue000
unst able
&
int ense
int erpersonal
relat ionships
characterized by alternating between extremes of
idealizat ion & devaluat ion
\ue000
identity disturbance: markedly & persistently unstable
self image or sense of self
\ue000
impulsivity in at least 2 areas that are potentially self
damaging
\ue001spending, sex, subst abuse, reckless driving, binge
eat ing
\ue000
recurrent suicidal behavior, gestures, or threats or self
mut ilat ing behavior
\ue000
affect ive inst abilit y due t o a marked react iviyt of mood
\ue001intense episodic dysphoria, irritability, anxiety
\ue001last ing few hrs only
\ue000
chronic f eelings of empt iness
\ue000
inappropriate int ense anger or difficult y cont rolling anger
\ue001frequent displays of temper, constant anger,
recurrent physical fights
\ue000
transient, stress related paranoid ideation or severe
dissociat ive sympt oms
\ue000shortened REM latency, sleep continuity disturbance,
abnormal DST, abn thyrotropin releasing hormone
results
\ue000also seen in depressive d/ o

\ue000appear in a st at e of crisis
\ue000mood swings common
\ue000short lived psychotic symptoms (micropsychotic

episodes) --> difference from schizophrenia

\ue000cannot t olerat e being alone
\ue000lack of consist ent sense of ident it y (ident it y diffusion)
\ue000proj ective identification

\ue000Ot t o Kernberg
\ue000Defense mechanism
\ue000Intolerable aspect of the self are projected onto

another; the other person is induced to play the
proj ect ed role & t he t wo persons act in unison
\ue000Rorschach test --> unstructured proj ective test which
shows the deviant processes
\ue000Distortion of relationships by considering a person as
eit her all good or all bad.
\ue000\ue000fairly stable
\ue000no progression t owards schizophrenia, but\ue001 incidence
of MDD
\ue000Dx before age 40 (when many life cycle choices are
made)
\ue000Tx
\ue000Psychot herapy
\ue001For best results add pharmacotherapy
\ue001Dialectical behavior therapy
\ue003Esp those w/ parasuicidal behavior (freq
cut t ing)
\ue000Pharmacot herapy
\ue001Antipsychotics \u2013 control anger, hostility, &
brief psychot ic episodes

\ue001Ant idepressant s \u2013
\ue001MAOI \u2013 modulat e impulsive behavior
\ue001Benzodiazepines \u2013

\ue003Alprazolam \u2013 help anxiety & depression
(caution: disinhibition)
\ue001Ant iconvul sant s
\ue003Carbamazepine \u2013 improve global fxning
\ue001SSRI

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