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Personality Disorders Types of Personality Disorders Paranoid personality Schizoid personality Cluster A Schizotypal personality Antisocial personality Borderline personality Histrionic personality Cluster B Narcissistic personality Avoidant personality Dependent personality Cluster C Obsessive-compulsive personality Classification of P.D ICD-10: F 60 -Specific personality disorders: Paranoid P.D. Schizoid P.D. Dissocial P.D. Emotionally unstable P.D. Histrionic P.D. Anankastic P.D. Anxious (avoidant) P.D. Dependent P.D F 61 –Mixed and Other P.D. General characteristics of P.D - Inflexible, maladaptive patterns of personality - Begins early in adulthood - Results in social, occupational problems or distress Facts About Personality Disorders Onset usually late childhood, early adolescence Causes others distress Affects behavior in many situations Poor insight Little behavior change Coded on Axis II Etiology Hereditary factor : chromosomal abnormality or genetic predisposition Relation of personality disorder to mental disorder P.D and upbringing eg. Disturbed parent-child relationship Cont………….. Other causes maternal deprivation in antisocial P.D Physical & sexual abuse in childhood (borderline P.D) Excessive use of repression (histrionic P.D) Fixation in the oral stage of development (dependent P.D) Lack of parental affection & persistent rejection (paranoid P.D) General Diagnostic Criteria for PD’s Enduring pattern of inner experience or behavior that deviates from expectations of culture, manifested in two or more of the following: - cognition (perception of self, others) affectivity (intensity, range of emotions) interpersonal functioning impulse control Enduring pattern is inflexible, pervasive in many situations General Diagnostic Criteria for PD’s Enduring pattern leads to distress, impairment in important areas of functioning Pattern is stable and of long duration, can be traced back to childhood Pattern not better explained by another disorder Pattern not due to substance abuse or medical condition Cluster A Personality Disorders Paranoid, schizoid, and schizotypal personality disorders Marked by eccentricity, odd behavior, not psychosis Share a superficial similarity with schizophrenia (a milder version) Cluster B Personality Disorders Antisocial, borderline, histrionic, and narcissistic personality disorders Being self-absorbed, prone to exaggerate importance of events Having difficulty maintaining close relationships Cluster C Personality Disorders Avoidant, obsessive-compulsive, dependent disorders People are often anxious, fearful, and depressed Cluster A Personality Disorders Paranoid Personality Disorder Lack of trust in others Fear that friends may be disloyal, unfaithful Being hypersensitive, overly suspicious, perceived as hostile DSM-IV Criteria for Paranoid PD Pervasive distrust, suspicion of others, and four or more of the following: suspects, without basis, that others are exploiting, harming, deceiving is preoccupied with unjustified doubts of loyalty or trustworthiness of people is reluctant to confide in others persistently bears grudges perceives attacks on reputation has unjustified suspicions about fidelity of others Facts About Paranoid Personality Disorder Affects 0.5–2.5 percent of population Sometimes several individuals band together into groups that share paranoid beliefs More common in males Schizoid Personality Disorder Enduring pattern of thinking and behavior characterized by pervasive indifference to others diminished range of emotional experiences, expressions Socially isolated, lacking in social relationships DSM-IV Criteria for Schizoid PD Detachment from social relationships, restricted emotions, as indicated by four or more of the following: neither desires nor enjoys social relationships prefers solitary activities has little interest in sexual experiences gets pleasure from few activities lacks close friends appears indifferent to praise or criticism shows emotional coldness, detachment, flat affect Schizotypal Personality Disorder Enduring pattern of discomfort with others and odd, peculiar thinking and behavior Shares symptoms with both paranoid and schizoid personality disorders Most closely linked to schizophrenia DSM-IV Criteria for Schizotypal PD Acute discomfort with social relationships, eccentric behavior, and five or more of the following: ideas of reference odd beliefs unusual perceptual experiences odd speech suspiciousness inappropriate or constricted affect odd or eccentric appearance and behavior lack of close friends excessive social anxiety Cluster B Personality Disorders Antisocial, borderline, histrionic, and narcissistic personality disorders Being self-absorbed, prone to exaggerate importance of events Having difficulty maintaining close relationships Antisocial Personality Disorder Pervasive, persistent disregard for or violation of rights of other people DSM-IV Criteria for Antisocial PD Pattern of disregard for rights of others since age 15, as indicated by three or more of the following: failure to conform to social norms, respect lawful behavior deceitfulness, lying, conning others for profit or pleasure impulsivity, failure to plan ahead irritability, aggressiveness, repeated fights DSM-IV Criteria for Antisocial PD disregard for safety of others consistent irresponsibility, failure to honor obligations lack of remorse Facts About Antisocial PD Affects 2.5–3.5 percent of population More common in men Highest prevalence among men 25–44 yr old 40 percent of affected men and 24 percent of affected women were diagnosed with conduct disorder as children Causes of Antisocial PD Genetics Birth trauma Sensation-seeking Family dynamics Modeling and media Borderline Personality Disorder Enduring pattern of thinking, behavior that involves instability of mood, self-image, interpersonal relationships efforts to avoid real or imagined abandonment unrealistically positive or negative opinions about others (intense relationships or nonexistance) Facts About Borderline Personality Disorder Affects 2 percent of population More common in women Threats/actions of self-harm are common Attributed to parental loss or abuse in childhood Treatment mostly unsuccessful – often use behavior therapy DSM-IV Criteria for Borderline PD Instability in relationships, self-image, marked impulsivity, and five or more of the following: efforts to avoid real or imagined abandonment pattern of unstable, intense relationships identity disturbance impulsivity in two or more areas that are selfdamaging DSM-IV Criteria for Borderline PD recurrent suicidal behavior, gestures, threats affective instability chronic feelings of emptiness inappropriate intense anger transient, stress-related paranoid ideas Histrionic Personality Disorder Enduring pattern of thinking, behavior characterized by excessive emotionality and attentionseeking behavior Person is typically self-centered, demanding Appears in 2–3 percent of the population Mainly diagnosed in women Person dresses eccentrically, seductively DSM-IV Criteria for Histrionic PD Excessive emotionality, attention-seeking, and five or more of the following: being uncomfortable when not center of attention rapidly shifting moods uses physical appearance to draw attention interactions characterized by provocative exaggerates in dramatic manner is suggestible, easily influenced considers relationships more intimate than they are Narcissistic Personality Disorder Enduring pattern of thinking, behavior characterized by grandiosity, preoccupation with own achievements and abilities DSM-IV Criteria for Narcissistic PD Grandiosity in fantasy and behavior, need for admiration, lack of empathy, and five or more of the following: has grandiose sense of self-importance is preoccupied with fantasies of power, success, love believes he or she is special or unique DSM-IV Criteria for Narcissistic PD requires excessive admiration has sense of entitlement takes advantage of others to achieve own needs lacks empathy is often envious of others is arrogant Cluster C Personality Disorders Avoidant, obsessive-compulsive, dependent disorders People are often anxious, fearful, and depressed Avoidant Personality Disorder Enduring pattern of thinking, behavior characterized by pervasive social discomfort fear of negative evaluation social isolation being easily hurt fear of disapproval Shy and socially uncomfortable but desire social contact Avoid it because of fear of embarrassment or criticism Obsessive-Compulsive Personality Disorder Enduring pattern of thinking, behavior characterized by perfectionism, inflexibility Preoccupied with rules, excessively moralistic, judgmental Dependent Personality Disorder Enduring pattern of submissive, dependent behavior Exceedingly dependent on others for advice, reassurance Feelings of anxiety and helplessness when alone Treatment Motivation to the therapy, compliance and efficiency is different from case to case. - Psychoterapy - basis - Pharmacotherapy -in some cases, symptomatic - few controled studies of efficiency - difficult but helpful Psychotherapy - the choice of the type of psychoterapy depends on specific type of P.D. and other factors as motivation to therapy, intelectual state, age and another. - basic psychoterapeutic support - psychoanalytic: individual or group - cognitive-behavioral therapy Pharmacotherapy - symptomatic, follows symptoms - target: permanent symptoms (long-term) or actual state (acute anxiety, disquiet, suicidal beh., agitation, emotional crises...) Pharmacotherapy for symptoms depression- SRI, MAOI, atyp.AP acute anxiety and agitation- BZD, AP anxiety- (S)SRI, buspiron, MAOI, low dose AP em. instability- VAL, CBZ, Li, low dose AP em. flateness- atyp.AP, SSRI, IMAO aggression- Li, AP impulsivity- SSRI, anticonv., Li, low dose AP THANK YOU