Common Psychiatric Problems

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Common Psychiatric Problems in Family Practice
Personality Disorders
Saudi Diploma in Family Medicine Center of Post
Graduate Studies in Family Medicine
Dr. Zekeriya Aktürk zekeriya.akturk_at_gmail.com www.
aile.net
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DSM - IV

• 5-Axis model adopted in 1980
• Axis 1
• Clinical disorders (e.g., mood anxiety
  disorders)
• Axis 2
• Personality disorders (e.g., narcissism,
  antisocial) mental retardation
• Axis 3
• Medical (physical) conditions influencing Axis 1
  2 disorders
• Axis 4
• Psychosocial environmental stress influencing
  Axis 1 2 disorders
• Axis 5
• Global Assessment of Functioning score highest
  level of functioning patient has achieved in
  work, relationships, and activities

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Definitions

• Personality - Usual Emotional Behavioral
  Characteristics
• Personality Traits - Components of Personality
• Temperament - Affective Tone, Intensity,
  Reactivity
• Character - Moral Personality Traits

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DSM IV Personality Disorders

• Paranoid
• Schizoid
• Schizotypal
• Antisocial
• Borderline

• Histrionic
• Narcissistic
• Avoidant
• Dependent
• Obsessive-Compulsive

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Characteristics of PD

• Relation to Axis I
• 10 - 20 of General Population
• Gender ? ASPD, Schizoid ? Avoidant,
  Dependent
• Etiological Theories
• Dynamic
• Biological / Genetic

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Paranoid PD

• Pervasive Distrust Suspiciousness, Interpret
  Motives as Evil
• 4 of
• Suspicious
• Feels attacked
• Preoccupation with distrust
• Jealous
• Wont confide
• Grudges
• Misinterprets motives

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Schizoid PD

• Detached Few Emotions
• 4 of
• Eschew (avoids) closeness
• No close friends
• Solitary
• Indifferent
• No sex interest
• Cold
• Not enjoy activities

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Schizotipal PD

• Discomfort with Relationships, Cognitive
  Distortions Eccentric
• 5 of
• Ideas of reference
• Odd magical beliefs
• Perceptual disturbances
• Odd thoughts/speech
• Paranoia
• Inappropriate affect
• Odd behavior/appearance
• Loner
• Anxious socially

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Antisocial PD (ASPD)

• Disregard Rights of Others (and meet Conduct
  Disorder)
• 3 of
• Unlawful
• Reckless
• Deceitful
• Irresponsible
• Impulsive
• Lack remorse
• Aggressive

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Borderline PD

• Unstable Relationships, Affect, Self-Image Plus
  Impulsiveness
• 5 of
• Fears abandonment
• Mood shifts
• Unstable relationships
• Feels empty
• Changing self-Image
• Anger
• Impulsive sex, spending, etc
• Temporary paranoia
• Suicidal behavior

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Histrionic PD

• Excessive Emotionality, Attention Seeking
• 5 of
• Needs attention
• Preens
• Seductive
• Dramatic
• Mood shifts
• Suggestible
• Impressionistic, vague speech
• Exaggerates relationships

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Narcistic PD

• Grandiose, Needs Admiration, Without Empathy
• 5 of
• Self important
• Exploitative
• Fantasies of success
• Lacks empathy
• Feels special
• Envious
• Needs admiration
• Arrogant
• Entitled

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Avoidant PD

• Inhibited, Inadequate, Sensitive
• 4 of
• Avoids social activity
• Reluctant relationships
• Fears intimacy
• Fears criticism
• Avoids new activities
• Sees self inferior
• Fears embarrassment

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Dependent PD

• Needs to be Taken Care of, Fears Separation
• 5 of
• Indecisive
• Seeks nurturance
• Avoids responsibility
• Fears solitude
• Avoids disagreements
• Frantic for relationships
• Lacks initiative
• Fears abandonment

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Obsessive Compulsive PD

• Orderliness, Perfectionist, Inflexible
• 4 of
• Detail oriented
• Unable to discard
• Perfectionism
• Cant delegate
• Work oriented
• Miserly
• Over conscientious
• Rigid

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Passive Aggressive PD

• Negative Attitudes with Passive Resistance to
  Demands
• 4 of
• Passive
• Envious, resentful
• Misunderstood, unappreciated
• Exaggerated complaints
• Sullen, argumentative
• Defiant then contrite
• Scorns authority

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Clusters

• A. Odd or Eccentric
• Paranoid, Schizotypal, Schizoid
• B. Dramatic or Erratic
• Antisocial, Histrionic, Borderline, Narcistic
• C. Anxious
• Avoidant, Obsessive Compulsive, Dependent