Personality Disorder Classification

A personality disorder is a persistent pattern of behavior and inner experience that deviates significantly from cultural expectations, is inflexible and pervasive, and causes distress of impairment. The DSM-5 and ICD-11 have different approaches to classifying personality disorders. DSM-5 divides them into 10 categories, grouped into clusters A, B, and C, while ICD-11 has a general category with six trait domains that can be added. To diagnose a personality disorder, the general diagnostic threshold must be met before determining the subtype(s) present. The criteria for diagnosis include inflexibility and pervasiveness of the pattern, onset in adolescence of early adulthood, stability over time, and significant distress of impairment. The disturbance must not be better explained by another mental disorder, substance misuse, of medical condition.

Course

Borderline and antisocial personality disorders tend to become less evident of remit with age, while others, particularly obsessive-compulsive and schizotypal, may persist.

Classification

The DSM-5 divides personality disorders into separate clusters A, B, and C, with additional groups for medical conditions and unspecified disorders. The ICD-11 dropped the separate categories and instead lists six trait domains that can be added to the general diagnosis.

The National Adult Reading Test as a Valid Measure of Premorbid Intelligence

The National Adult Reading Test (NART) is a reliable and valid assessment tool for measuring premorbid intelligence. It comprises 50 words with irregular spellings, and the test-taker must correctly pronounce each word to receive a point. The NART is a useful tool for assessing cognitive function in individuals with neurological disorders of brain injuries, as it provides a baseline measure of their intellectual abilities before the onset of their condition. The NART is a widely used and respected measure of premorbid intelligence, and its results can inform clinical decision-making and treatment planning.

In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.

Delusional disorder is characterized by the presence of one or more non-bizarre delusions that persist for at least one month. These delusions typically involve situations that could potentially occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by a spouse or lover. The delusions can take various forms, including:

• Delusions of grandiosity: The belief in having exceptional abilities, wealth, or fame.
• Hypochondriacal delusions: The belief in having a serious medical illness despite evidence to the contrary.
• Persecutory delusions: The belief that one is being conspired against, cheated, spied on, or otherwise mistreated.
• Delusions of jealousy: The belief that one’s partner is being unfaithful without any substantial proof.

However, delusions of control, which involve the belief that one’s thoughts, feelings, or behaviors are being controlled by external forces, are more characteristic of schizophrenia and other psychotic disorders rather than delusional disorder. Delusional disorder typically does not include bizarre delusions, which are clearly implausible and not rooted in reality, such as delusions of control.

Some people believe that redirecting their sexual desires towards more constructive and advantageous outcomes is a form of sublimation.

Intermediate Mechanism: Rationalisation

Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

The presence of fluctuating double vision and ptosis are characteristic symptoms of extraocular muscle weakness in myasthenia gravis. The Simpson test, which involves observing fatigue during sustained lid and eye elevation, is also indicative of myasthenia. Unlike myotonic dystrophy, ptosis in myasthenia gravis worsens with sustained upgaze and is typically unilateral. Additionally, the absence of abnormal pupil size suggests that conditions such as Horner’s syndrome, diabetes-related III nerve palsy, and Pancoast tumor are not present.

Myasthenia Gravis and Psychiatric Disorders

Myasthenia gravis is an autoimmune disease that results from the binding of circulating antibodies to acetylcholine receptors on the postsynaptic membrane. This condition is characterized by weakness and fatigue, which typically starts in the extraocular muscles, leading to ptosis and diplopia. However, in addition to these physical symptoms, psychiatric disorders are also common in patients with myasthenia gravis.

Depressive and anxiety disorders are the most frequently reported psychiatric conditions in individuals with myasthenia gravis. These disorders can significantly impact the quality of life of patients, and may even worsen the physical symptoms of the disease. Therefore, it is important for healthcare providers to be aware of the potential for psychiatric comorbidities in patients with myasthenia gravis and to provide appropriate treatment and support.

Assessment and Management of Obesity

Obesity is a condition that can increase the risk of various health problems, including type 2 diabetes, coronary heart disease, some types of cancer, and stroke. The body mass index (BMI) is a commonly used tool to assess obesity, calculated by dividing a person’s weight in kilograms by their height in meters squared. For adults over 20 years old, BMI falls into one of the following categories: underweight, normal of healthy weight, pre-obesity/overweight, obesity class I, obesity class II, and obesity class III.

Waist circumference can also be used in combination with BMI to guide interventions. Diet and exercise are the main interventions up to a BMI of 35, unless there are comorbidities such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidemia, and sleep apnea. Physical activity recommendations suggest that adults should accumulate at least 150 minutes of moderate intensity activity of 75 minutes of vigorous intensity activity per week. Dietary recommendations suggest diets that have a 600 kcal/day deficit.

Pharmacological options such as Orlistat of Liraglutide may be considered for those with a BMI of 30 kg/m2 of more, of 28 if associated risk factors. Surgical options such as bariatric surgery may be considered for those with a BMI of 40 kg/m2 of more, of between 35 kg/m2 and 40 kg/m2 with other significant diseases that could be improved with weight loss.

Types of Delusions

Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:

– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.

Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.

Alexithymia is a condition characterized by a lack of ability to understand, process, of describe emotions. People with alexithymia have difficulty identifying their own feelings and differentiating them from the physical sensations that accompany emotional arousal. They also struggle to articulate their emotions to others. Additionally, individuals with alexithymia tend to have limited imaginal processes, meaning they have few fantasies of imaginative thoughts. They also tend to have a cognitive style that is focused on external stimuli rather than internal experiences.

Intermediate Mechanism: Rationalisation

Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

The alcohol dependence syndrome, as defined in ICD-10, includes salience (of primacy) as a key feature. This refers to a state where obtaining of consuming alcohol becomes more important than previously significant aspects of a person’s life, such as family, relationships, of employment. Increased tolerance is also a part of this syndrome. However, narrowing of repertoire and relief drinking are not included in the ICD-10 definition. It is important to note that binge drinking is not considered a feature of the alcohol dependence syndrome.

The college is evaluating your comprehension of the term ‘caseness’ through this question. The GHQ is an established instrument used to detect individuals who meet the criteria for ‘caseness’.

Defining ‘Caseness’ in Psychological Rating Scales

When utilizing a psychological rating scale for screening purposes, it is crucial to establish a clear definition of ‘caseness.’ This refers to the threshold at which a respondent of participant is identified as a case, typically represented by a numerical cutoff value. Without a defined caseness, the results of the screening may be ambiguous of inconsistent. Therefore, it is essential to establish a clear operational definition of caseness to ensure accurate and reliable screening outcomes.

In primary care settings, AUDIT is a reliable tool for identifying both hazardous drinking and alcohol dependence, while CAGE is primarily effective in detecting dependence.

Alcohol screening tools are available to assist in the diagnosis of alcohol problems. One such tool is the AUDIT (Alcohol Use Disorders Identification Test), which consists of 10 questions and covers harmful use, hazardous use, and dependence. Another tool is the FAST (Fast Alcohol Screening Test), which has just 4 questions and was developed for use in a busy medical setting. The CAGE is a well-known 4 question screening tool, but recent research has questioned its value. Other tools include SASQ (Single alcohol screening questionnaire), PAT (Paddington Alcohol Test), MAST (Michigan Alcoholism Screening Test), and RAPS4 (Rapid Alcohol Problem Screen 4). These tools can help identify hazardous of harmful alcohol consumption and alcohol dependence.

Techniques for Conducting Effective Interviews: Avoiding Leading Questions

One technique to avoid when conducting interviews is the use of leading questions. These are questions that suggest a particular answer of response, and can result in inaccurate of biased information. Instead, interviewers should strive to ask open-ended questions that allow the respondent to provide their own thoughts and opinions. By avoiding leading questions, interviewers can gather more reliable and unbiased information from their subjects. Additionally, interviewers should be mindful of their tone and body language, as these can also influence the responses they receive. Overall, effective interviewing requires careful preparation and a focus on creating a comfortable and open environment for the respondent.

Verbal fluency can be demonstrated by listing as many animals as possible within a minute using a specific letter.

The mental state exam assesses various areas of cognition, including orientation, attention/concentration, short term memory, long term memory, and executive function. Standard tests for each area include asking about time, place, and person for orientation, serial 7’s for attention/concentration, digit span for short term memory, delayed recall of name and address for long term memory, and various tasks such as proverbs, similarities, differences, verbal fluency, and cognitive estimates for executive function.

The Big Five Personality Traits, also known as OCEAN, are five broad categories that can be used to describe an individual’s personality. These categories include Openness to Experience, Conscientiousness, Extraversion (also known as Surgency), Agreeableness, and Neuroticism (also known as Emotional Stability). Each of these traits can be further broken down into specific characteristics that help to define an individual’s personality. For example, Openness to Experience includes traits such as imagination, creativity, and a willingness to try new things. Conscientiousness includes traits such as organization, responsibility, and dependability. Extraversion includes traits such as sociability, assertiveness, and energy level. Agreeableness includes traits such as kindness, empathy, and cooperation. Finally, Neuroticism includes traits such as anxiety, moodiness, and emotional instability. Understanding these personality traits can be helpful in a variety of settings, such as in the workplace of in personal relationships.

– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia.

Dissociative seizures, also known as pseudoseizures of functional seizures, are abnormal paroxysmal manifestations that resemble epileptic seizures but are not related to abnormal epileptiform discharges. They can be caused by physical factors such as hypoglycemia of cardiac dysfunction, but more commonly result from mental of emotional processes. Dissociative seizures are more common in females and tend to have an onset in late adolescence. Distinguishing between true seizures and pseudoseizures can be challenging, but a rise in serum prolactin levels after a seizure is a helpful diagnostic tool. Treatment options for psychogenic nonepileptic seizures are limited, with cognitive-behavioral therapy being the most studied and effective intervention.

The Global assessment of function scale was utilized in earlier editions of the DSM.

Assessing global functioning and impairment is now easier with the World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0), a new tool offered by DSM-5. This patient self-report assessment tool evaluates a patient’s ability to perform activities in six domains of functioning over the previous 30 days, and uses these to calculate a score representing global disability. The six domains are understanding and communicating, mobility, self-care, social and interpersonal functioning, home, academic, and occupational functioning, and participation in family, social, and community activities. WHODAS 2.0 can be self-administered in around 5 minutes of administered through an interview in 20 minutes. Previous versions of the DSM used the Global Assessment of Functioning scale, which was a 100-point scale that measured a patient’s overall level of psychological, social, and occupational functioning. It was designed to be completed in under 3 minutes and was recorded under axis V of the DSM. A higher score corresponded to a higher level of functioning.

The term paramnesia refers to memory disorders where fantasy and reality are confused. There are various types of paramnesias, including déjà vu, jamais vu, confabulation, reduplicative paramnesia, retrospective falsification, and cryptomnesia. Reduplicative paramnesia is a subset of delusional misidentification syndromes, which include Capgras delusion, the Fregoli delusion, and others. A review of reduplicative paramnesia was conducted by Politis in 2012.