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Personality Disorders
Done by : Huda Almadhoun
Jordan University of Science and Technology
Psychiatry – 5th year medical student . |
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Personality Personality is one’s set of stable, predictable emotional and behavioral traits.
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Personality disorders Is an enduring pattern of inner experience and behavior .
Differs markedly from the expectations of the individual's culture. |
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Personality disorders Pervasive and inflexible.
Has an onset in adolescence or early adulthood.
Is stable over time, and leads to distress or impairment. |
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What is the Cause Biological, genetic, and psychosocial factors contribute to the development of personality disorders.
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Treatment Personality disorders are generally very difficult to treat, especially since few patients are aware that they need help. The disorders tend to be chronic and lifelong.
In general, pharmacologic treatment has limited usefulness except in treating coexisting symptoms of depression.
Psychotherapy and group therapy are usually the most helpful.
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Types of personality disorders : Cluster A
Cluster B
Cluster C
NOS |
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Cluster A : Paranoid
Schizoid
Schizotypal |
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Paranoid personality disorder |
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Case presentation A 30-year-old male says that his wife has been cheating on him because he does not have a good enough job to provide for her needs. He also claims that on his previous job, his boss laid him off because he did a better job than his boss. |
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PPD Patients with PPD have a pervasive distrust and suspiciousness of others and often interpret motives as malevolent. They tend to blame their own problems on others and seem angry and hostile.. |
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DIAGNOSIS AND DSM-IV CRITERIA Diagnosis requires a general distrust of others, beginning by early adulthood and present in a variety of contexts.
At least four of the following must also be present :
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DSM-IV CRITERIA 4+ 1. Suspicion (without evidence) that others are exploiting or deceiving him or her.
2. Preoccupation with doubts of loyalty or trustworthiness of acquaintances.
3. Reluctance to confide in others.
4. Interpretation of benign remarks as threatening or demeaning.
5. Persistence of grudges. ?
6. Perception of attacks on his or her character that are not apparent to others; quick to counterattack.
7. Recurrence of suspicions regarding fidelity of spouse or lover. |
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EPIDEMIOLOGY Prevalence: 0.5 to 2.5%
Men are more likely to have PPD than women.
Higher incidence in family members of schizophrenics. |
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DIFFERENTIAL DIAGNOSIS Paranoid schizophrenia: Unlike patients with schizophrenia, patients with paranoid personality disorder do not have any fixed delusions and are not frankly psychotic, although they may have transient psychosis under stressful situations.
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COURSE AND PROGNOSIS Some patients with PPD may eventually be diagnosed with schizophrenia.
The disorder usually has a chronic course, causing lifelong marital and job-related problems |
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TREATMENT Psychotherapy is the treatment of choice. Patients may also benefit from anti-anxiety .
medications or short course of antipsychotics for transient psychosis.
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Schizoid Personality Disorder |
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Case presentation A 45-year-old scientist works in the lab most of the day and has no friends, according to his coworkers. He expresses no desire to make friends and is content with his single life. He has no evidence of a thought disorder.
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Schizoid PD Patients with schizoid personality disorder have a lifelong pattern of social withdrawal. They are often perceived as eccentric and reclusive
They are quiet and unsociable and have a constricted affect. They have no desire for close relationships and prefer to be alone . |
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DIAGNOSIS AND DSM-IV CRITERIA A pattern of voluntary social withdrawal and restricted range of emotional expression, beginning by early adulthood and present in a variety of contexts.
Four or more of the following must also be present:
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DSM-IV CRITERIA 4+ Neither enjoying nor desiring close relationships (including family).
Generally choosing solitary activities.
Little (if any) interest in sexual activity with another person.
Taking pleasure in few activities (if any).
Few close friends or confidants (if any).
Indifference to praise or criticism.
Emotional coldness, detachment, or flattened affect.
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EPIDEMIOLOGY Prevalence: Approximately 7% .
Men are two times as likely to have schizoid personality disorder as women.
There is not an increased incidence of schizoid personality disorder in families with history of schizophrenia.
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DIFFERENTIAL DIAGNOSIS Paranoid schizophrenia: Unlike patients with schizophrenia, patients with schizoid personality disorder do not have any fixed delusions, although these may exist transiently in some patients . |
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Course Usually chronic course, but not always lifelong |
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TREATMENT Psychotherapy is the treatment of choice; group therapy is often beneficial.
Low-dose antipsychotics (short course) if transiently psychotic, or antidepressants if comorbid major depression is diagnosed . |
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Schizotypal personality disorder ! |
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Case presentation A 35-year-old man dresses in a space suit every Tuesday and Thursday. He has computers set up in his basement to “detect the precise time of alien invasion.” He has no evidence of auditory or visual hallucinations.
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Schizotypal PD Patients with schizotypal personality disorder have a pervasive pattern of eccentric behavior and peculiar thought patterns. They are often perceived as strange and eccentric |
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DIAGNOSIS AND DSM-IV CRITERIA . A pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, and discomfort with close relationships, beginning by early adulthood and present in a variety of contexts.
Five or more of the following must be present:
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DSM-IV criteria 5+ 1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking, inconsistent with cultural norms
3. Unusual perceptual experiences (such as bodily illusions)
4. Suspiciousness
5. Inappropriate or restricted affect
6. Odd or eccentric appearance or behavior
7. Few close friends or confidants
8. Odd thinking or speech (vague, stereotyped, etc.)
9. Excessive social anxiety
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EPIDEMIOLOGY Prevalence: 3.0%
More prevalent in monozygotic than dizygotic twins
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DIFFERENTIAL DIAGNOSIS Paranoid schizophrenia: Unlike patients with schizophrenia, patients with schizotypal personality disorder are not frankly psychotic (though they can become transiently so under stress).
Schizoid personality disorder: Patients with schizoid personality disorder do not have the same eccentric behavior seen in patients with schizotypal personality disorder.
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COURSE Course is chronic or patients may eventually develop schizophrenia.
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TREATMENT Psychotherapy is the treatment of choice
Short course of low-dose antipsychotics if necessary (for transient psychosis |
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