Disease class: Personality Disorders
Personality disorder cluster: C (anxious)
See also
Other cluster C personality disorders
- Avoidant Personality Disorder
- Obsessive-Compulsive Personality Disorder
Showing posts with label psychiatry. Show all posts
Showing posts with label psychiatry. Show all posts
Monday, 5 August 2019
Dependent Personality Disorder
Histrionic Personality Disorder
Disease class: Personality Disorders
Personality disorder cluster: B (dramatic)
Commonly known as:
- HPD
Aetiology / Risk factors
- Severe psychological trauma in childhood, particularly:
- Sexual abuse
- Physical abuse
- Emotional abuse
- Neglect
- Loss of a close friend or relative
- Severe physical illness
- Inheritance of high-risk genes from parents
Symptoms and signs
- Anxiety
- Depression
- Self-harm
- Suicidal ideation
- Attempted suicide
- Recreational drug use
- Hypersexuality
- Psychosis
- Medically unexplained physical symptoms
- Alexithymia (lack of insight into their own emotions)
- Impulsivity
- Hypersensitivity to criticism
- Irritability
- Attention seeking behaviour
- Co-dependence
- Fear of abandonment
- Lack of self identity (to quote many patients: "I feel like a blank piece of paper, which nobody ever wrote on.")
- Abnormally flirtatious or charismatic behaviour
- Reckless, high-risk behaviour
- Criminal activity
- Lack of concern for the feelings and rights of others
Age of onset
- Signs and symptoms of emerging PDs can be observed throughout childhood and adolescence, with a marked increase in severity between 14-18.
- Personality disorders are never officially diagnosed in children, as the personality usually changes dramatically during the course of normal development.
- In some children, a diagnosis of Conduct Disorder may be made. CD is often called a precursor to Antisocial Personality Disorder,
because of the similarities in the conditions. Most children with CD
become less antisocial with normal development, but 25-40% of CD cases
later meet the diagnostic criteria for ASPD in adulthood.
Common co-morbidities
- Eating disorder
- Substance misuse disorder
- Anxiety disorder
- Depressive disorder
Stigmatising factors
Patients with personality disorders (particularly "psychopaths" and "narcissists") are frequently vilified in the media. Stigma has increased as public awareness of "borderline PD" has increased. Many healthcare workers, including mental health specialists, describe strong feelings of fear or frustration when engaging with most PD patients. For these reasons, a diagnostic label of "personality disorder" may have a negative impact on a patient's self-esteem.
The following stigmatising features can be demonstrated in a significant proportion of the PD population:
- A
widespread belief that PDs are 'incurable' or that 'every personality
is fixed': Severe dysfunction often persists until the patient reaches
their 40s. Significant progress is only seen once the patient develops a
sincere and strong commitment to change themselves.
- An
adversarial affect: PD patients often display aggression, hostility,
unpredictability, irrationality, impulsivity, hypersensitivity, and
similar traits.
- Intentional use of deceptive psychological manipulation techniques. For example: crying loudly, threatening, lying.
- Symptoms
and signs which are self-inflicted (self-harm; suicide attempts; substance misuse; factitious disorder;
malingering) or medically unexplainable (somatic symptom disorder).
- Self-destructive behaviours: Gambling, unsafe sexual practices, criminal activities.
- Non-compliance with medication, therapies and other interventions.
- A
subconscious resistance to change and fears of 'getting better',
becoming 'normalised', or losing support from healthcare providers.
Management
PD patients often seek help for physical complaints (e.g. self-harm;
suicide attempts; substance misuse; malingering; factitious disorder;
somatic symptom disorder).
Medical doctors have a legal and ethical obligation to investigate them
each time they present to healthcare settings (within reason). After
excluding any harmful 'organic' diseases, competent doctors should
consider possible mental health disorders and document their objective
findings thoroughly.
Diagnosis and stigmatisation
Patients with likely PDs often lack an official diagnosis, even if their healthcare providers strongly suspect it. PDs must be diagnosed by specialists after weeks or even months of regular assessment. They can be notoriously to diagnose, for reasons including:
- The huge variety of clinical presentations:
- Many PD patients demonstrate a 'classic' set of signs, symptoms and risk factors. Experienced clinicians can recognise likely PD in some patients in a matter of minutes. However, many PD patients lack these common features or mimic other conditions.
- They often lack insight into their condition.
- They often complain of physical problems rather than psychological ones.
- Substance
misuse is common within this group, and it is impossible to make a fair
and accurate diagnosis until they are clean and sober.
- At first presentation, some patients with EUPD can
be indistinguishable from patients with bipolar disorder. This has been demonstrated in studies with experienced
psychiatrists.
- Frequently poor engagement with healthcare services: frequent incidents of hostility towards healthcare staff, premature self-discharge from hospital or missed appointments (DNA: Did Not Attend).
- Concealment of essential information:
signs, symptoms, risk factors, etc. May be intentional or involuntary
(e.g. fluctuating emotional states; dissociation; repression of
traumatic memories).
- Difficulties in defining 'disordered' personalities: There is a broad spectrum of healthy personalities in the population and there is a risk of 'over-medicalising' uncommon, but healthy variations.
Diagnostic labels can be difficult to remove, once mentioned to the patient or entered into medical records. Various euphemisms are often used to convey that a patient may have HPD. For example: in the National Health Service, many patients with undiagnosed HPD are described as "cluster 8" patients. This is because "Care cluster 8" refers to "Non-psychotic, chaotic and challenging disorders", most commonly, EUPD.
Risk management
- Patients should be assessed for risk of suicide or self-harm and monitored carefully.
Medication
Patients
with PDs are often prescribed antidepressants, anxiolytics,
anti-psychotics, painkillers, hypnotics, sedatives, and other
medications. These are often unnecessary, or even harmful.
As a general rule of thumb for non-specialists, PDs usually benefit more from therapy than medication, whereas bipolar disorder usually benefits from medication more than therapy.
Therapy
- DBT:
Dialectical Behavioural Therapy. This is the most well-known and
well-regarded class of therapy available for HPD patients.
- CBT: Cognitive-Behavioural Therapy. This is cheaper, faster, more cost-effective, and more available than DBT. Unfortunately, the nature of HPD makes CBT relatively ineffective in this group, especially if it is not delivered through a guided 1-on-1 course.
- Psychodynamic psychotherapy. This involves a long period of very deep guided introspection and analysis of subconscious processes. This option is relatively expensive, difficult to access and promotes a high degree of dependence on the therapist until completion.
- Counselling: Relatively cheap and accessible. This usually involves talking about concerns and traumatic events at a superficial level. Counsellors are often self-employed and they are subject to less regulation than other clinicians.
- There is a risk to the mental health of both the
patient and the therapist, if the therapist lacks the skill or knowledge
to safely manage PDs.
Prognosis
- Severe dysfunction often persists until the patient reaches their 40s. Significant progress is only seen once the patient develops a sincere and strong commitment to change themselves.
Compare with:
- Bipolar disorder
- Attention deficit hyperactivity disorder
- Other cluster B (dramatic) personality disorders:
- Antisocial Personality Disorder
- Emotionally Unstable Personality Disorder
- Narcissistic Personality Disorder
- Conduct disorder (a similar disorder of childhood)
Schizoid Personality Disorder
Disease class: Personality Disorders
Personality disorder cluster: A (Odd)
See also:
Other cluster A (Odd) personality disorders:
Schizotypal Personality Disorder
Disease class: Personality Disorders
DSM-V category: Schizophrenia spectrum and other psychotic disorders
Personality disorder cluster: A (Odd)
See also:
Other cluster A (Odd) personality disorders:
Antisocial Personality Disorder
Disease class: Personality Disorders
Personality disorder cluster: B (dramatic)
Commonly known as:
- ASPD
- Psychopathy
- Sociopathy
Aetiology / Risk factors
- Severe psychological trauma in childhood, particularly:
- Sexual abuse
- Physical abuse
- Emotional abuse
- Neglect
- Loss of a close friend or relative
- Severe physical illness
- Inheritance of high-risk genes from parents
Symptoms and signs
- Recreational drug use
- Hypersexuality
- Alexithymia (lack of insight into their own emotions)
- Impulsivity
- Hypersensitivity to criticism
- Irritability
- Attention seeking behaviour
- Abnormally flirtatious or charismatic behaviour
- Reckless, high-risk behaviour
- Criminal activity
- Lack of concern for the feelings and rights of others
Age of onset
- Signs and symptoms of emerging PDs can be observed throughout childhood and adolescence, with a marked increase in severity between 14-18.
- Personality disorders are never officially diagnosed in children, as the personality usually changes dramatically during the course of normal development.
- In some children, a diagnosis of Conduct Disorder may be made. CD is often called a precursor to Antisocial Personality Disorder,
because of the similarities in the conditions. Most children with CD
become less antisocial with normal development, but 25-40% of CD cases
later meet the diagnostic criteria for ASPD in adulthood.
Common co-morbidities
- Substance misuse disorder
- Anxiety disorder
- Depressive disorder
Stigmatising factors
Patients with personality disorders (particularly "psychopaths" and "narcissists") are frequently vilified in the media. Stigma has increased as public awareness of "borderline PD" has increased. Many healthcare workers, including mental health specialists, describe strong feelings of fear or frustration when engaging with most PD patients. For these reasons, a diagnostic label of "personality disorder" may have a negative impact on a patient's self-esteem.
The following stigmatising features can be demonstrated in a significant proportion of the PD population:
- A
widespread belief that PDs are 'incurable' or that 'every personality
is fixed': Severe dysfunction often persists until the patient reaches
their 40s. Significant progress is only seen once the patient develops a
sincere and strong commitment to change themselves.
- An
adversarial affect: PD patients often display aggression, hostility,
unpredictability, irrationality, impulsivity, hypersensitivity, and
similar traits.
- Intentional use of deceptive psychological manipulation techniques. For example: crying loudly, threatening, lying.
- Symptoms
and signs which are self-inflicted (self-harm; suicide attempts; substance misuse; factitious disorder;
malingering) or medically unexplainable (somatic symptom disorder).
- Self-destructive behaviours: Gambling, unsafe sexual practices, criminal activities.
- Non-compliance with medication, therapies and other interventions.
- A
subconscious resistance to change and fears of 'getting better',
becoming 'normalised', or losing support from healthcare providers.
Management
PD patients often seek help for physical complaints (e.g. self-harm;
suicide attempts; substance misuse; malingering; factitious disorder;
somatic symptom disorder).
Medical doctors have a legal and ethical obligation to investigate them
each time they present to healthcare settings (within reason). After
excluding any harmful 'organic' diseases, competent doctors should
consider possible mental health disorders and document their objective
findings thoroughly.
Diagnosis and stigmatisation
Patients with likely PDs often lack an official diagnosis, even if their healthcare providers strongly suspect it. PDs must be diagnosed by specialists after weeks or even months of regular assessment. They can be notoriously to diagnose, for reasons including:
- The huge variety of clinical presentations:
- Many PD patients demonstrate a 'classic' set of signs, symptoms and risk factors. Experienced clinicians can recognise likely PD in some patients in a matter of minutes. However, many PD patients lack these common features or mimic other conditions.
- They often lack insight into their condition.
- They often complain of physical problems rather than psychological ones.
- Substance
misuse is common within this group, and it is impossible to make a fair
and accurate diagnosis until they are clean and sober.
- Frequently poor engagement with healthcare services: frequent incidents of hostility towards healthcare staff, premature self-discharge from hospital or missed appointments (DNA: Did Not Attend).
- Concealment of essential information:
signs, symptoms, risk factors, etc. May be intentional or involuntary
(e.g. fluctuating emotional states; dissociation; repression of
traumatic memories).
- Difficulties in defining 'disordered' personalities: There is a broad spectrum of healthy personalities in the population and there is a risk of 'over-medicalising' uncommon, but healthy variations.
Diagnostic labels can be difficult to remove, once mentioned to the patient or entered into medical records. Various euphemisms are often used to convey that a patient may have ASPD. For example: in the National Health Service, many patients with undiagnosed ASPD are described as "cluster 8" patients. This is because "Care cluster 8" refers to "Non-psychotic, chaotic and challenging disorders", most commonly, EUPD.
Risk management
- Patients should be assessed for risk of suicide or self-harm and monitored carefully.
Medication
Patients
with PDs are often prescribed antidepressants, anxiolytics,
anti-psychotics, painkillers, hypnotics, sedatives, and other
medications. These are often unnecessary, or even harmful.
As a general rule of thumb for non-specialists, PDs usually benefit more from therapy than medication, whereas bipolar disorder usually benefits from medication more than therapy.
Therapy
- DBT:
Dialectical Behavioural Therapy. This is the most well-known and
well-regarded class of therapy available for ASPD patients.
- CBT: Cognitive-Behavioural Therapy. This is cheaper, faster, more cost-effective, and more available than DBT. Unfortunately, the nature of ASPD makes CBT relatively ineffective in this group, especially if it is not delivered through a guided 1-on-1 course.
- Psychodynamic psychotherapy. This involves a long period of very deep guided introspection and analysis of subconscious processes. This option is relatively expensive, difficult to access and promotes a high degree of dependence on the therapist until completion.
- Counselling: Relatively cheap and accessible. This usually involves talking about concerns and traumatic events at a superficial level. Counsellors are often self-employed and they are subject to less regulation than other clinicians.
- There is a risk to the mental health of both the
patient and the therapist, if the therapist lacks the skill or knowledge
to safely manage PDs.
Prognosis
- Significant progress is only seen once the patient develops a sincere and strong commitment to change themselves.
Compare with:
- Bipolar disorder
- Attention deficit hyperactivity disorder
- Other cluster B (dramatic) personality disorders:
- Emotionally Unstable Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
- Conduct disorder (a similar disorder of childhood)
Paranoid personality disorder
Disease class: Personality Disorders
Personality disorder cluster: A (Odd)
See also:
Other cluster A (Odd) personality disorders:
Sunday, 4 August 2019
Dissociative Identity Disorder
Disease class: Dissociative disorders
Also known as
- DID
- Multiple personality disorder (incorrect terminology)
Features
- Dissociation (blacking out). There is often apparent amnesia (memory loss).
- The appearance of at least one disparate identity during periods of dissociation. Each identity may present a unique set of behaviours, values and beliefs.
Controversy amongst psychiatrists
- Due to the high association with emotionally unstable personality disorder, it has been suggested that DID is a variant of this disorder but is not a distinct disorder itself.
- Many modern psychiatrists consider DID to be an iatrogenic illness. They suggest that psychiatrists who believe that DID is a true psychiatric illness create the disease through their interactions with patients. By asking certain questions they can accidentally influence vulnerable patients.
Public misconceptions
- In the media this disorder is often referred to (incorrectly) as schizophrenia.
- It is often depicted visually with two actors standing in the same room and speaking. In reality, there are no visual or auditory hallucinations. The internal perspective of the patient should be dissociation. From an external perspective, they can be seen to adopt a new identity and set of behaviours.
Friday, 2 August 2019
Sexual Dysfunctions
DSM-V category: Primary category
DSM-V
- 302.74 (F52.32) Delayed Ejaculation (424)
- 302.72 (F52.21) Erectile Disorder (426)
- 302.73 (F52.31) Female Orgasmic Disorder (429)
- Specify if: Never experienced an orgasm under any situation
- 302.72 (F52.22) Female Sexual Interest / Arousal Disorder (433)
- 302.76 (F52.6) Genito-Pelvic Pain / Penetration Disorder (437)
- 302.71 (F52.0) Male Hypoactive Sexual Desire Disorder (440)
- 302.75 (F52.4) Premature (Early) Ejaculation (443)
- Substance/Medication-Induced Sexual Dysfunction (446)
- Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-IO-CM coding.
- Specify if:
- With onset during intoxication.
- With onset during withdrawal.
- With onset after medication use.
- 302.79 (F52.8) Other Specified Sexual Dysfunction (450)
- 302.70 (F52.9) Unspecified Sexual Dysfunction (450)
Paraphilic Disorders
This is a group of diseases which feature both:
- A sexual fetish (paraphilia).
- Significant dysfunction. For example:
- Shame, anxiety, guilt, low self-esteem.
- Damage to interpersonal relationships.
- Preoccupation with the fetish in everyday life.
- Illegal or unethical behaviour.
- Risk of exploitation, injury, or death.
Examples
- Dangerous sadism (sexual arousal from causing pain and humilation)
- Dangerous masochism (sexual arousal from receiving pain and humilation)
- Voyeurism (sexual arousal from spying)
- Necrophilia (sexual arousal from dead bodies)
- Hybristophilia (sexual arousal from illegal or unethical behaviour)
- Asphyxiophilia (sexual arousal from asphyxiation)
- Biastophilia (sexual arousal from rape)
- Chremastistophilia (sexual arousal from being a victim of robbery, fraud, unfair trading etc.)
- Paedophilia (sexual arousal from sexually immature people, children or infants)
- Autassassinophilia (sexual arousal from the idea of being killed or at high-risk)
- Pyrophilia (sexual arousal from fires)
- Erotophonophilia / lust murder (sexual arousal from murder)
Saturday, 20 July 2019
Wednesday, 3 July 2019
Tuesday, 2 July 2019
Somatic nervous system
Organ system: Peripheral nervous system
Definition: The component of the peripheral nervous system which mediates transmission of information between the conscious mind and the body.
Functions
- Sensation of the external and internal enviroments and conscious perception of these sensations.
- Transmission of output from the central nervous system (e.g. voluntary motor commands) to the effector tissues (e.g. muscles)
Pathology
- Paralysis
- Mononeuropathy
- Polyneuropathy
- Radiculopathy
- Allodynia
- Chronic pain
- Somatoform disorders
[Psychiatry] Introduction
This field specialises in diseases of the human mind. It is concerned chiefly with psychosis, anxiety, mood instability, substance misuse, maladaptive behaviour, and cognitive dysfunction. It overlaps with neurology, due to the relationship between the central nervous system and the mind.
Ancient Greek λογία (logia) = study
Subspecialties
- Child psychiatry
- Liason psychiatry
- Forensic psychiatry
- Neuropsychiatry
- Medical psychotherapy
Etymology
Ancient Greek ψυχή (psukhḗ) = soulAncient Greek λογία (logia) = study
History taking
Mental state examination
Assessment of cognition and memory
Common problems:
- Psychosis
- Anxiety
- Depression
- Self-harm
- Self-mutilation
- Recreational drug use
- Unemployment
- Social isolation
- Educational deficits
- Hypersexuality
- Suicide
Relevant diseases:
- Emotionally unstable (borderline) personality disorder
- Major depressive disorder
- Adjustment disorder
- Post-traumatic stress disorder
- Bipolar disorder
- Schizophrenia
- Anxiety disorders
- Phobias
- Obsessive–compulsive disorder
- Delirium
- Dementia
- Learning disabilities
- Attention deficit hyperactivity disorder
- Autistic spectrum disorder
- Substance use disorders
- Eating disorders
- Sexual dysfunction
- Sleep disorders
- Insomnia
- Speech disorders
- Stuttering
- Schizoaffective disorder
- Postnatal psychiatric disorders
- Postpartum depression
- Postpartum psychosis
- Gender dysphoria
- Body dysmorphic disorder
- Dissociative disorders
- Psychogenic amnesia
- Depersonalization disorder
- Dissociative identity disorder
- Delusional disorder
- Anti-social personality disorder
- Other personality disorders
- Impulse control disorder
- Pica
- Folie à deux (shared psychosis)
- Intellectual disability
- Medically unexplained physical symptoms
Thursday, 13 June 2019
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