Personality disorders อ.พญ.ส ก ญญา ร กษ ขจ ก ล ภาคว ชาจ ตเวชศาสตร คณะแพทยศาสตร มหาว ทยาล ยนเรศวร
112
0
0
Full text
(2)
(3) Personality. disorder. ◦ Behavior - deviate from cultural standards ◦ Rigidly ◦ Lead to unhappiness and impairment ◦ Ego –syntonic ◦ Alloplastic.
(4) Enduring subjective experiences Onset in adolescence or early adulthood Stable through time Refuse psychiatric help Deny their problems . . Personality trait.
(5) . PD is a common and chronic disorder. . Generally considered to have poor prognosis. ½ of all psychiatric pts have PD.
(6) Classification Cluster A. ◦ schizotypal, schizoid, and paranoid ◦ odd, aloof features Cluster B. ◦ narcissistic, borderline, antisocial, and histrionic ◦ dramatic, impulsive, unstable and erratic features.
(7) Cluster C. ◦ obsessive-compulsive, dependent, and avoidant ◦ anxious and fearful features . Many persons exhibit traits that are not limited to a single personality disorder “multiple personality”.
(8) Etiology.
(9) Genetic Factors Cluster A ◦ Associated with schizophrenia ◦ Schizotypal > paranoid or schizoid.
(10) Genetic Factors . Cluster B ◦ Antisocial PD - alcohol , suicide ◦ Borderline PD – depression , mood disorders ◦ Histrionic PD - somatization disorder (Briquet’s syndrome).
(11) Genetic Factors Cluster C ◦ Avoidant - often have high anxiety levels. ◦ OCPD - show some signs asso with depression Shortened REM latency abnormal dexamethasone-suppression test (DST).
(12) Biological Factors . Hormones ◦ impulsive traits high levels of testosterone, 17-estradiol, and estrone..
(13) . Platelet Monoamine Oxidase ◦ Social activity ◦ Low platelet MAO levels noted in some pts with schizotypal disorders..
(14) . Smooth Pursuit Eye Movements ◦ saccadic (i.e., jumpy) Introverted low self-esteem tend to withdraw schizotypal PD.
(15) . Electrophysiology ◦ Changes in EEG antisocial and borderline types slow-wave activity.
(16) . NTs หลายตัวมีผลต่ อพฤติกรรมและบุคลิกภาพ ◦ Endorphine สูงขึน้ เฉื่อยชา ◦ Dopamine , Serotonin mood. . 5-HIAA are low ◦ Attempt suicide ◦ Impulsive ◦ Aggressive.
(17) Psychoanalytic Factors Sigmund. Freud :. ◦ personality traits are related to a fixation at one psychosexual stage of development..
(18) . Oral character ◦ Passive ◦ Dependent. . Anal character ◦ Stubborn ◦ parsimonious ◦ highly conscientious.
(19) Defense mechanism . Master feelings ◦ ◦ ◦ ◦ ◦ ◦. Anxiety Depression Anger Shame Guilt Others.
(20) Social factors เด็กเกิดการเรียนรู้ บ่ มเพาะนิสัยใจคอ บุคลิกภาพ Environment Culture Social.
(21) Cluster A.
(22)
(23) Paranoid personality disorder.
(24) Epidemiology . 0.5 to 2.5 % ในประชากรทั่วไป. มักจะไม่ ยอมรั บการรั กษา . Men > women.
(25) During interview มีทท ี ่ าวางตัวเป็ นทางการ ไม่ ค่อยผ่ อนคลาย สายตาสอดส่ าย มองไปรอบๆ ไม่ แสดงอารมณ์ ขัน มีทท ี ่ าจริงจัง พูดตรงไปตรงมา และมีเหตุผล . Defense : projection. Disdain = ดูถกู.
(26) Diagnosis . Excessive suspiciousness. . Distrust of others expressed. . Interpret actions of others as deliberately demeaning, malevolent, threatening, exploiting, or deceiving..
(27) Diagnosis . Begins by early adulthood. . Often pathologically jealous. . Externalize their own emotions. Idea. of reference.
(28) . In social situations ◦ may appear business-like and efficient ◦ but they often generate fear or conflict in others..
(29) Course and Prognosis Some – lifelong Harbinger of schizophrenia Lifelong problems working and living with others Occupational and marital problems are common. .
(30) Differential Diagnosis Delusional disorder Schizophrenia Borderline PD Antisocial PD Schizoid PD .
(31) Treatment . Psychotherapy ◦ treatment of choice ◦ T. should be straightforward ◦ T. must remember that trust and toleration of intimacy are troubled areas for patients with this disorder..
(32) . Individual psychotherapy not overly warm style from therapists.. . Usually do not do well in group psychotherapy.
(33) Pharmacotherapy . Dealing with agitation and anxiety. . Antianxiety agent – diazepam. . Antipsychotic - haloperidol.
(34) Schizoid Personality Disorder.
(35) Epidemiology . Prevalence 7.5%. . Men > women.
(36) Clinical Features Cold and aloof Quiet , distant, seclusive, and unsociable. Solitary interests Success at noncompetitive lonely jobs .
(37) . Inability to express anger directly.. . Nonhuman interests ◦ mathematics ◦ astronomy, ◦ very attached to animals.. . Require no personal involvement.. . Have a normal capacity to recognize reality.
(38) . They are the last to be aware of changes in popular fashion.. . Men may not marry because they are unable to achieve intimacy. . Women may passively agree to marry an aggressive man who wants the marriage..
(39) Differential Diagnosis Schizotypal PD Schizophrenia Paranoid PD Obsessive –compulsive disorder Delusional disorder Avoidant PD .
(40) Course and Prognosis Onset - usually occurs in early childhood Disorder is long lasting, but not necessarily lifelong The proportion of patients who incur schizophrenia is unknown. .
(41) Treatment . Psychotherapy ◦ similar to paranoid personality disorder..
(42) Pharmacotherapy ◦ ◦ ◦ ◦. small dosages Antipsychotics - agitation SSRIs - less sensitive to rejection BZDs - diminish interpersonal anxiety.
(43) Schizotypal Personality Disorder.
(44) Epidemiology 3% of the population Sex ratio is unknown Biological relatives of patients with schizophrenia .
(45) Clinical Features Strikingly odd or strange Magical & disturbed thinking and communicating Peculiar notions Ideas of reference (not delusion) Body illusions Derealization .
(46) Frank thought disorder is absent Speech . ◦ distinctive or peculiar ◦ have meaning only to them ◦ often needs interpretation. . Believe that they have other special powers of thought and insight..
(47) . Poor interpersonal relationships and may act inappropriately, isolated and have few friends.. . Under stress decompensate and have psychotic symptoms (usually brief).
(48) Differential Diagnosis Schizophrenia Schizoid PD Avoidant PD Paranoid PD Borderline PD .
(49) Course and Prognosis . Long -term study 10 % committed suicide.. . May be prodromal of schizophrenia. . Some, maintain a stable schizotypal personality.
(50) Treatment . Psychotherapy ◦ No differ from schizoid ◦ T. must not be judgmental about their beliefs or activities..
(51) Pharmacotherapy ◦ Antipsychotic ◦ Antidepressants.
(52) Cluster B.
(53) Antisocial Personality Disorder.
(54) Epidemiology . Men > women. . Onset is before the age of 15. . In prison, prevalence may be 75%. . Familial pattern is present.
(55) Clinical Features . Often seem to be normal and even charming and ingratiating. . Impress opposite-sex clinicians with the colorful, seductive aspects of their personalities. . Same -sex clinicians may regard them as manipulative and demanding.
(56) . Their histories beginning in childhood ◦ ◦ ◦ ◦ ◦ ◦ ◦. Lying Truancy Running away from home Thefts Fights Substance abuse Illegal activities.
(57) . They are extremely manipulative. . Promiscuity, spousal abuse, child abuse, and drunk driving. . Lack of remorse for these actions. . Appear to lack a conscience..
(58) Diagnosis ปี ผู้ป่วยต้ องมีอายุอย่ างน้ อย 18 ปี . Onset เกิดก่ อนอายุ 15.
(59) Differential Diagnosis Schizophrenia Substance abuse Mental retardation Mania .
(60) Course and Prognosis Unremitting course Prognosis varies Some - symptoms decrease as persons grow older. .
(61) Treatment . Psychotherapy ◦ If pts are placed in hospital. . Pharmacotherapy ◦ Deal with anxiety, rage, and depression ◦ Control impulsive behavior.
(62) Borderline Personality Disorder.
(63) Epidemiology Present in about 1-2 % Women > men . . First -degree relatives - Increased prevalence of ◦ major depressive disorder ◦ alcohol use disorders ◦ substance abuse.
(64) Clinical Features Almost always appear to be in a state of crisis Unstable affect, mood, behavior Can have short-lived psychotic episodes Behavior - highly unpredictable Object relations All good – all bad .
(65) . Repetitive self-destructive acts ◦ เรียกร้ องความสนใจ ◦ ประชด ◦ แสดงความโกรธ.
(66) . Cannot tolerate being alone - accept a stranger as a friend or behave promiscuously. . Fear of abandonment. . Feelings of emptiness. . Identity diffusion.
(67) Differential Diagnosis Schizophrenia Schizotypal personality disorder Paranoid personality disorder .
(68) Course and Prognosis Fairly stable High incidence of MDD Occupational problems Marital problems .
(69) Treatment . Psychotherapy : treatment of choice ◦ Is difficult ◦ Because pts regress easily act out their impulses show labile or fixed negative or positive transferences alternately love and hate T..
(70) . Behavior therapy ◦ control patients' impulses and angry outbursts ◦ reduce their sensitivity to criticism and rejection ◦ Social skills training - improve interpersonal behavior..
(71) Pharmacotherapy ◦ Antipsychotics : anger, hostility, and brief psychotic episodes ◦ Antidepressants : depressed mood ◦ Benzodiazepines : anxiety and depression.
(72) Histrionic Personality Disorder.
(73) Epidemiology Prevalence : 2-3% Women > men Association with somatization disorder and alcohol use disorders. .
(74) Clinical Features . High degree of attention-seeking behavior Tend to exaggerate their thoughts and feelings Make everything sound more important than it really is. Seductive behavior Need for reassurance is endless.
(75)
(76) Differential diagnosis Borderline PD Somatization disorder Dissociative disorder .
(77) Course and Prognosis . Some - symptoms decrease as persons grow older.
(78) Treatment . Psychotherapy ◦ Probably treatment of choice ◦ Pt are often unaware of their own real feelings ◦ Clarification of their inner feelings is an important.
(79) Pharmacotherapy ◦ adjunctive when symptoms are targeted.
(80) Narcissistic Personality Disorder.
(81) Epidemiology . Prevalence- < 1 % in general population..
(82) Clinical Features Grandiose sense of self-importance Consider themselves special and expect special treatment They handle criticism poorly May become enraged when someone dares to criticize them .
(83) Relationships are fragile Interpersonal exploitiveness is commonplace cannot show empathy Feign sympathy only to achieve their own selfish ends Fragile self-esteem susceptible to depression. .
(84) Differential diagnosis Borderline PD Antisocial PD Histrionic PD .
(85) Course and Prognosis Chronic and difficult to treat Aging is handled poorly They may be more vulnerable, therefore, to midlife crises than are other groups. .
(86) Treatment . Psychotherapy ◦ Difficult ◦ May be group therapy. . Pharmacotherapy ◦ Lithium - mood swings ◦ Antidepressants - depression.
(87) Cluster C.
(88)
(89) Avoidant Personality Disorder.
(90) Epidemiology Common Prevalence 1 -10% .
(91) Clinical Features Hypersensitivity to rejection Hypervigilant about rejection Timidity Show a lack of self-confidence Low self esteem .
(92) . Misinterpret other persons' comments ◦ derogatory or ridiculing. . Refusal of any requests ◦ leads them to withdraw from others and to feel hurt.
(93) Course and Prognosis . Able to function in a protected env.. . Some marry, have children, and live their lives surrounded only by family members. . If support system fail depression, anxiety, and anger.
(94) Differential diagnosis Schizoid PD Histrionic , Borderline PD .
(95) Treatment . Psychotherapy ◦ T. Encourages pt to move out into the world ◦ Caution ; failure can reinforce a patient's already poor self-esteem. ◦ Group therapy ◦ Assertiveness training.
(96) . Pharmacotherapy ◦ Used to manage anxiety and depression ◦ Serotonergic : help rejection sensitivity..
(97) Dependent Personality Disorder.
(98) Epidemiology Women >men Persons with chronic physical illness in childhood may be most susceptible to the disorder. .
(99) Clinical Features pervasive pattern of dependent submissive behavior cannot make decisions without an excessive amount of advice and reassurance from others .
(100) avoid positions of responsibility become anxious if asked to assume a leadership role do not like to be alone, they seek out others on whom they can depend .
(101) Differential diagnosis Histrionic , Borderline PD Schizophrenia , Schizotypal PD Agoraphobia .
(102) Course and Prognosis . Occupational functioning tends to be impaired ◦ disorder cannot act independently and without close supervision. Social relationships are limited to those on whom they can depend Risk - major depressive disorder .
(103) Treatment . Psychotherapy ◦ Treatment often successful. ◦ Insight-oriented therapies ◦ Behavioral therapy.
(104) . Pharmacotherapy ◦ Used to deal with specific symptoms.
(105) Obsessive-Compulsive Personality Disorder.
(106) Epidemiology Men > women Diagnosed most often in oldest children. Often have backgrounds - harsh discipline . . Freud: ◦ difficulties in the anal stage.
(107) Clinical Features Preoccupied with rule Regulations Orderliness Neatness Details Perfection Lack of flexibility .
(108) They are formal and serious Often lack a sense of humor . . Defense mechanism ◦ rationalization, isolation, intellectualization, ◦ reaction formation , undoing.
(109) Course and Prognosis Variable and unpredictable. May develop OCD Depressive disorders, especially those of late onset, are common. .
(110) Treatment . Psychotherapy ◦ Unlike other PD – OCPD are often aware of their suffering, and they seek treatment on their own ◦ Group therapy ◦ Behavior therapy ◦ Individual psychotherapies.
(111) . Pharmacotherapy ◦ Clonazepam – severe ◦ Clomipramine ◦ Serotonergic agents.
(112) Thank you for your attention !.
(113)
Related documents
“ความสัมพันธ์ของพฤติกรรมการบริโภค ไอโอดีน ระดับไอโอดีนในปัสสาวะของ หญิงตังครรภ์ และระดับ
In this work, we will employee the swarming technique to improve the bandwidth utilization of the peers in video conferencing systems, specifically P2P-MCS system..
PUT: It is used to create files on the server; it necessitates write access on the particular virtual directory, where the file is to be created.. Microsoft Telnet>telnet
Save To
Thailand Flash Note... ก ก*+ก, CGR
bottom view (right) A) Trichoderma species T-GL3, B) Trichoderma species T-GL7 C) Trichoderma species T-GL15, D) Trichoderma specie T-GL17 and E) Trichoderma species T-GL23... Table
Equity capital raised Dividends paid Others Cash flow from financing Net change in cash.. Important
An object with mass 1 kg on a frictionless, horizontal surface is attached to the spring, pulled a distance 1m to the right to stretch the spring and released.. If wind energy is
