Professional Documents
Culture Documents
PD: INTRODUCTION
Principles
Diagnosis
Classification
Management
Depends on the patient’s readiness to engage (c.f. dependent) and resources available.
Help person avoid situations that cause problems e.g. intoxication or confrontations
MHA now just need to state “appropriate treatment is available” to Section.
Help them find lifestyles that maximises strength, minimises personality difficulties
Be consistent w managing crisis pt. Admissions RARELY helpful and reinforce behaviour.
Consistent, community-based approach BETTER.
Inpatient – where?
o General psych wards (acute wards) – risk of dependence, risk of behaviour regression
o Therapeutic communities (Henderson and Cassel Hospitals)
o Specialist secure services
Careful DDx from mood disorders and psychosis. Bear in mind onset and course
Written care plan; ensure good communication w agencies to avoid “splitting” (disagreements
between staff induced by patient – people w these personality traits induce range of strong
feelings)
Respond to threats consistently and do not reinforce manipulative behaviours (e.g. splitting)
Transparency and clear boundaries agreed about unacceptable behaviour and nature of care
provided. Be clear of what you think, must use label/Dx, risk, Tx, admission etc. Important for
such patients who do not learn clear boundaries (e.g. sexually abused by parents – don’t know
right from wrong R/S)
Reliability = if you make an appointment, you must keep your word.
Personality disorders
Prognosis
SPECIFIC CONDITIONS
Aloof, suspicious, solitary they by nature tend to avoid services due to their suspiciousness
and persecutory belief.
Personality disorders
Key issues are (1) to distinguish them from psychosis esp. chronic delusional disorder; (2) to
decide if significant harm to themselves or others; (3) to decide if Tx should be given such as
low-dose antipsychotics (w consent and compliance may be poor) or social interventions (but
isolation rarely perceived by them as problem)
o Psychotherapy is C/I because harmful and ineffective…
Paranoid
o Suspicion and distrust of others w conspiracy
o Sensitivity of criticism + setbacks, defensive and combative, bear grudges
o Self-importance
o Paranoid PD is a RF for psychosis.
Schizoid
o Looks very similar to autism
o Emotionally cold and detached, introspective, social isolation (lack close friends)
o Lack joie de vivre (little enjoyment of activities, little interest in sex, prefer solitary
activities), preoccupation w fantasy, insensitive to norms and conventions
Schizotypal
o
This cluster rarely pt clinically (so very little knowledge on management). If it does, set realistic
goals, enhance self-esteem, and avoid escalating contact that simply fosters dependency.
Dx is made by someone who presents with DD or anxiety disorder. Cluster C is RF for both.
Anankastic (= obsessional)
o Excessive orderliness, preoccupation with detail, perfectionism
o Excess doubt and caution
o Obsessions here are egosyntonic (= not intrusive; e.g. cleanliness is Godliness, everyone
else is filthy)
V.s. OCD = egodystonic (= intrusive; I have to wash my hands 20X or I will die)
o Excessive productivity to the point that it affects social RS
o Inflexible, pedantic, dogmatic, stubborn, humourless
Anxious (= avoidant)
o Persistent tense and apprehensive feelings; believe they are socially inept or inferior
o Avoid personal contact, unwilling to get involve w people they like
o Restriction of lifestyle and social or occupational activities
o Excessive fear of criticism and rejection
Dependent
o Encourages others to make decisions, excessive need to be taken care of
o Subordinate one’s own needs to comply w others; unwilling to negotiate reasonably
o Feels uncomfortable or exaggerated anxiety if left alone; preoccupied w fears of being
left alone
o Limited capacity to make day-to-day decisions
o May overlap w BPD.
o S/E of admitting them = they become dependent on you and the institutin