major depressive disorder (single episode 

major depressive disorder  (recurrent): more common

5 or more of the following nearly every day for 2 weeks & at least one of the symptoms include depressed mood or anhedonia

SIGECAPS

Sleep changes: increase or decrease

Interest: loss of interest in activities (anhedonia)

Guilt (worthlessness)

energy (lack) : common presenting sx (fatigue) (anergia)

Concentration: reduced ability to focus

Appetite: weight loss or gain

Psychomotor: agitation (anxiety) or retardation (lethargic)

Suicide

• psychotherapy and pharmacotherapy
• mild-brief psychotherapy interventions
• for more severe - antidepressant + psychotherapy 
• Psychotherapy - supportive, cognitive-behavioral, brief interpersonal therapies 
• Pharmacotherapy - SSRIs (DOC), SNRI's, TCA's, MAO-I
• ECT is used in psychotic, severe, or treatment-refractory depressions or when meds are contraindicated

fluoxetine (prozac)

paroxetine (paxil)

fluvoxamine (luvox)

escitalopram (lexapro)

sertraline (zoloft)

citalopram (celexa)

• long half-life so decreased incidents of discontinuation syndrome, good for patients with non-compliance 
• OK in pregnancy

• short half life 
• anticholinergic
• cause more weight gain than other SSRI's 

• short half life 
• anticholinergic
• cause more weight gain than other SSRI's 

Effexor (velafaxine)

Pristiq (desvenlafaxine)

Cymbalta (Duloxetine)

• lethal in overdose and can cause prolonged QT interval.  
• VERY effective but potentially unacceptable.
• MOA: inhibits enzymes that break down NE

• slow onset of action
• various CNS effects
• cardiotoxic and potentially fatal in overdoses (CI in pt's w/ heart blocks)
• orthostatic hypotension

• you cannot eat tyramine based foods (cheese, wine, beer, smoked meats) bc would cause flood of NE & cause HTN crisis
• also cannot be combined with other antidepressants 
• MAOI + SSRI = serotonin syndrome
• MAOI + TCA = delirium, HTN

• Nausea
• decreased appetite or increased appetite
• weight loss or gain
• excessive sweating 
• insomnia
• jitteriness, dizziness 
• dry mouth
• sexual dysfunction 
• serotonin syndrome
• serotonin withdrawal syndrome 

• at high doses or combined with other drugs, an exaggerated response can occur d/t increased amounts of serotonin
• alters cognitive function, autonomic function, and neuromuscular function
• diaphoresis, tremor, hyperthermia, seizures, maybe coma/death
• potentially fatal

• with discontinuation of any SSRI onset of withdrawal symptoms occur within a few days and can persist 3-4 weeks
• symptoms: disequilibrium, GI problems, flu-like symptoms, sensory disturbances, sleep disturbances 

• inhibit re-uptake 
• but WITHOUT

1. antihistamine (sedation)
2. antiadrenergic (orthostatic hypotension)
3. anticholinergic (dry mouth, constipation, urinary retention)

buproprion 

mirtazapine 

trazodone 

• 300mg once daily is target dose 
• better option than SSRI if sexual SE are a concern (particularly young men)
• common "add on" to a partially effective SSRI
• also can be used as one of first line agents if pt has ADD/ADHD and a comorbid depression
• can be used for treatmet of nicotine dependane
• SE: agitation, insomnia, weight loss, constipation
• CI in seizure patients 

• promotes sleep
• also less risk of sexual side effects
• cons of increasing serum cholesterol and triglycerides and being very sedating at low doses

• good for management of insomnia
• non-habit forming 
• side effect of priapism 

• mood disturbance + 3 or 4 of the following for 1 week
• symptoms of mania (DIGFAST)

• Persons experiencing manic episode often have POOR INSIGHT and resist treatment. 
•  Pharmacologic interventions for acute mania include: Antipsychotics in conjunction with benzodiazepines (for rapid tranquilization) and initiation of mood stabilizer medications (lithium or depakote).  
•  Antipsychotics are FREQUENTLY used in mania with AND without psychotic features.
• LITHIUM is the most commonly used mood stabilizer, but valproic acid (depakote) is equally as effective and is MORE EFFECTIVE FOR THE RAPID-CYCLING (4 mood disturbances/ year must be present) variant of mania.
• Mood stabilizer maintenance therapy is essential in preventing the recurrence of mania and appears to decrease the recurrence of depression.  
•   Psychotherapy is used to encourage medication compliance, and to help patients come to terms with their illness, and to help repair some of the interpersonal damage done while ill (infidelity, hostility, squandering money).
• CARE must be taken when prescribing antidepressants for depression or dysthymia because of their role in prompting more SEVERE or more frequent manic episodes.

• good for ACUTE mania
• also augmentation in anti-depressant therapy
• for cyclic mood disorders 
• for aggressive behaviors d/t psychiatric disorder 
• effective in long term prophylaxis of both mania & depressive episodes
• narrow TI window. Serum levels should be checked regularly to prevent toxicity 

•  GI-N/V/D
• Neuromuscular: tremors, lethargy, muscle weakness
• Endocrine: Hypothyroidism, goiter
•  Hematological: increased WBC. Benign and reversible
•  CV: Minor EKG changes and not recommended post-MI
• Derm: rash and acne-like lesions
•  Weight gain
• ***RENAL***relies on the kidneys for elimination, not the liver. Therefore, is contraindicated in those with kidney disease, the elderly, and women who are pregnant. (Lithium inversely related to sodium). Therefore, severe lithium toxicity can cause oliguria and renal failure.
• Other ***can cause congenital abnormalities, especially of the heart***. 

• first line agent for mania
• slightly better tolerated than other anti-convulsants 
• potential liver damage (watch out for ETOH = pancreatitis)
• GI
• nervous system : fatigue, dizziness
• can interfere with blood clotting 
• increased neural tube defects d/t decreased folic acid

• anticonvulsant
• older, not as efficacious as first line agents 
• bad side effect of bone marrow suppression 
• rash is most common side effect

• anticonvulsant
• side effect of hyponatremia - from water retention dt vasopressin like effect

• newer anti-convulsant 
• can treat bipolar depression well, but not good at treating manis 
• risk of SJS, risk increases with concurrent depakote use 

olanzapine (Zyprexa/Zydis)

Quetiapine (seroquel)

Clozapine 

Risperdone (Risperdal)

Geodone 

•     For at least two years (1 yr for children/ adolescents) presence of numerous hypomanic episodes and numerous periods with depressed mood or loss of interest or pleasure that did not meet criterion A (5 symptoms) of Major Depression
•  During a 2 yr period (1 yr in children/teens) of disturbance, never without hypomanic or depressive symptoms for more than two months at a time

• pychotherapy 
• mood stabilizers
• anti-depressants 
• persons w/ cyclothymia may never seek medical attention for their mood symptoms 

• Chronic Mood Disorder (Diagnosed when a patient presents with chronic depression of at least 2 years that has not been severe enough to meet the criteria for MDD). This is a more mild form of Major Depressive Disorder.
• Must have 2 of the following 

1. increased/decreased appetite and/or increased/ decreased sleep
2. low energy and self-esteem, hopelessness 
3. poor concentration or decision making 

• treatment is similar to major depression (anti-depressants, SSRI's, ect)
• EXCEPT that psychotherapy may play a larger role and the course of treatment may b e more protracted (meaning longer than usual)

• Emotional and behavioral reaction that is GREATER than what would be expected for the stressor
• Adjustment disorders occur within 3 months of the identified stressor and resolve within 6 months, unless stressor becomes chronic.
• Symptoms in response to bereavement DO NOT meet diagnostic criteria

tearfulness

depressed mood

vandalism

reckless driving

truancy

fighting 

anxiety 

• supportive psychotherapy or group therapy
• short term pharmacotherapy for associated insomnia, anxiety, or depression may be used but NOT first line

delusions 

hallucinations

ideas of reference

disorders of thought 

• Schizophrenia - symptoms >= 6 months
• Schizophreniform - symptoms 1 month - 6 months
• schizoaffective: meets criteria for MDD, manic episode, or mixed episode dring which schizophrenia criterial ALSO met 

• Neural developmental illness
• Reduced regional brain volume (in limbic regions like amygdala, hippocampus, parahippocampal gyrus) with enlarged cerebral ventricles is hallmark
• Altered DOPAMINE function strongly implicated in positive and negative symptoms

family hx

difficulties in prenatal and perinatal- infx during pregnancy

cannabis use 

• group of characteristic positive and negative symptoms
• deterioration in social, occupational, or interpersonal relationships
• continuous signs of the disturbance for at least 6 mo

• 2 or more of the following:

o   Delusions
o   Hallucinations
o   Disorganized speech
o   Grossly disorganized or catatonic behavior
o   Negative symptoms

• AND Social/occupational dysfunction
• Duration of at least 6 months
• Not schizoaffective disorder or a mood disorder with psychotic features
• Not due to substance abuse or a general medical disorder
•  Psychosis (being out of touch with reality) is a prominent feature of schizophrenia

• hallucinations: auditory, visual, olfactory, tactile (perceived that they are being touched)
• unusual thought content (delusions)
• conceptional disorganizations: speech and behavior

1. Psychotically disorganized speech ("word-salad", loss of associations)
2. Words not linked together based on normal rules of language
3. Difficult or impossible to understand
4. Behaviors not goal directed or make sense in context (taking off clothes in public, laughing at inappropriate times (at changing traffic light), adopting strange postures or freezing are catatonic behaviors)
5. Odd clothing or appearance

1. paranoid (MC)
2. referential
3. grandiose
4. religious
5. control
6. somatic 

• Affect flatting 
• alogia (lack of words)
• avolition (inactivity or early loss of interest in activities)
• anhedonia (inability to derive pleasure)
• asociality 

1. Paranoid 
2. Disorganized 
3. Catatonic
4. Undifferentiated
5. Residual

delusions

hallucinations

NO thought disorder

NO disorganized behavior

NO affect flatting 

word salad

loss of associations

display of emotions flattened or inappropriate

ie (laughing at traffic light)

• anti-psychotic primarily used 
• psychosocial treatments 
• long-term remitting/relapsing d/o with impaired interepisode function

parkinsonian movements 

(rigidity, tremors, bradykinesia)

akathesia

dystonia 

prolactin release. so if dopamine inhibited, prolactine increases = galactorrhea 

(schizophrenia)

Typical anti-psychotics-  dopamine D2 antagonists 

• haloperidol (haldol)
• prolixin (Fluphenazine)
• chlorpromazine (thorazine)
• thioridazine (mallaril)
• thiothixene (avene)

• associated with typical anti-psychotics 
• combination of hyperthermia, rigidity, and autonomic dysregulation

1. Fever
2. muscular rigidity
3. altered mental state
4.  autonomic instability.

• Lab findings include increased creatine kinase and myoglobinuria. Acute renal failure may be present.
• A significant mortality rate exists.
• Rarely, neuroleptic malignant syndrome associated with clozapine and other atypical antipsychotic 

abilify (aripiprazole)

seroquel (quetiapine)

clozaril (clozapine)

geodone (ziprasidone)

risperdal (risperidone)

invega (papilidarone)

zyprexa & zyprexa zydis (olanzapine)

symbyax (zyprexa and prozac combo)

serotonin

still works on dopamine but also serotonin

LOWER propensity to cause extrapyramidal SE

parital D2 agonist 

low EPS

no QT prolongation

low sedation

•   ***Side effect of AGRANULOCYTOSIS (white cell depletion)***. Therefore should perform routine CBC
• Known as a reserve drug
• Discontinued/banned use for some time because of harsh side effects
• 30% response rate in severely ill, treatment-resistant patients
• Patients need weekly CBCs for 6 mo then twice per month for another 6 mo ..
• After one year of nl blood draws, pt has labs monthly.
• Dirty drug that works on a lot of receptors
•  Clozapine may cause many side effects. The following side effects are grouped by the body system affected:

1.  Cardiovascular: decreases BP - dizziness or fainting; rapid HR, changes in heart rhythm and EKG
2. Nervous system: sedation, increased seizure tendency.
3.  Digestive system: increased appetite (weight gain), excessive salivation,N, constipation, abnormal liver tests, elevated blood sugar.
4. Autonomic: blurred vision, exacerbation of glaucoma, dry mouth, nasal congestion, decreased sweating, urinary incontinence

QT prolongation

take w/ food (absorption increased up to 100% w/ food)

risperdal consta (injection form)

most likely to induce hyperprolactinemia - galactorrhea, gynecomastia (men), menstrual irregularities (amenorrhea), changes in libido, ED in men

invega sustenna (injection form)

active metabolite of risperidone

zyprexa relpreev (injection form)

available in rapid dissolver water for acute symptoms

• prolixin : fluphenazine decanoate
• haldol: haloperidol decanoate
• risperdal consta
• invega sustenna
• zyprexa relpreev

• metabolic syndrome - weight gain, cholesterol abnormalities, increased risk of DM
• impaired glucose levels stems from the hyperphagia induced by the meds
• metabolic syndrome higher incidence w/ clozapine & olanzapine

• Often psychosocial stressors appear to be etiologic, for example, following migration.
• In migration psychosis, the recently immigrated person develops persecutory delusions (person falsely convinced others are out to harm him).  
• Many patients with delusional disorder have a paranoid character pre-morbidly.    

• Disorder is characterized by well-systematized nonbizarre delusions about events that could happen in real life (such as being followed, poisoned, infected, loved at a distance, having a disease, or being deceived by one’s spouse).  
• The delusions MUST be present for at LEAST 1 month, not impaired.
• Other than the delusion, the patient’s social adjustment may be NORMAL.

• trials of anti-psychotics appropriate but often ineffective
• primary treatment is psychotherapy

1. erotomanic
2. grandiose
3. jealous
4. persecutory
5. somatic
6. mixed
7. unspecified 

depressive

bipolar 

• meds that target the psychosis and mood disorder
• combo of anti-psychotic & mood stabilizer (lithium or depakote)
• prognosis is BETTER than for schizophrenia BUT WORSE than for bipolar d/o or major depression

• essentially short course schizophrenia WITHOUT the requirement of social withdrawal. 
•  Patients with this disorder have what appears to be a “full blown” episode of schizophrenia, including delusions, hallucinations, disorganized speech, or negative symptoms BUT the duration of illness including prodromal, active, and residual phases is FROM 1-6 months.  
• The diagnosis changes to schizophrenia once the symptoms have extended past 6 months, even if only residual symptoms are left.    

self-limited

anti-psychotic w/ severe impairement 

• biologic etiology remains obscure, theorist believe GAD is caused by cognitive distortions in which the pt's misperceive situations as dangerout when they are not 

• increased chronotropy and ionotropy
• blood redirected (from skin, fingertips, toes) to larger muscle groups (thighs, bicepts). This is why you get tingling in the fingertips 
• respiratory: increased speed and depth of breathing 
• increased sweating 

•  Excessive anxiety/worry occurring, w/difficulty controlling worrying for at least 6 months about a number of events or activities
• 3 of 6 symptoms present for more days than not: CRIMES!!!

1. Concentration poor
2. Restlessness
3. Irritability
4. Muscle tension
5. Easy Fatigability
6. Sleep disturbance

abouve having a panic attack (panic d/o)

or

being embaarrassed in public (social phobia)

• buspirone (DOC) - stimulates serotonin rec. & blocks dopamine rec.
• benzo's - duration of tx is limited bc of risk of dependence & tolerance 
• SSRI
• Gabapentin 
• BB
• relaxation techniqes 
• SSRI's are first line for anxiety (long term tx)

•  Finding that Benzodiazepines provide relief from anxiety (ie. Valium)
• Benzodiazepine receptors ordinarily receive GABA
• GABA causes neurons to stop firing (calms things down). GABA taking neurons out of a state of excitability.

•  period of extreme anxiety peaking within 10 minutes
• Typically declines within 30 minutes
•  Rarely lasts longer than one hour
• May have a definable trigger or be unexpected
• Requires 4 of the following: Palpitations/tachycardia, sweating, trembling or shaking, sensation of SOB or smothering, sensation of choking, CP or discomfort, nausea or abdominal distress, dizzy/unsteady/lightheaded/faint, derealization (feelings of unreality) or depersonalization (being detached from one's self), fear of losing control or "going crazy", fear of dying, Paresthesias, chills or hot flushes. 

• One of the following for at least one month:

o   Persistent concern about having additional panic attacks

o   Worrying about implications of the attack (losing control, "going crazy") 

o   Significant change of behavior related to the attacks (restriction of activities)

• Diagnosis should specify panic d/o with or without agoraphobia ( extensive avoidance of settings in which panic attacks have occurred)

  o   Agoraphobia is characterized by an intense fear of places or situation in which escape may be difficult or embarrassing

  o   Patients with agoraphobia and panic disorder typically fear having a panic attack in a public place and being embarrassed or unable to escape

  o   Agoraphobia alone: they simply avoid public arenas but DO NOT have panic attacks.

• pharmacotherapy & cognitive behavioral therapy
• acute management  

1. short course of benzo's
2. alprazolam (xanax) - DOC panic attacks
3. diazepam (valium) DOC for panic disorder

•  Maintenance management

1. SSRIs should be started as benzos are tapered
2. Paroxetine, fluoxetine, sertraline
3. TCA's
4. MAO-I's
5. cognitive behavioral therapy
6. exposure therapy 

diagnosed if sxs have lasted less than 3 months, after 3 months PTSD is considered chronic 

if the sxs don't appear within 6 months of the stressor then its diagnosed as delayed PTSD

type of anxiety d/o

those who develop PTSD from a stressful situation have impairments in daily functioning

developmentally younger individuals more susceptible

• necessarily involves exposure to a traumatic stressor
• traumatic event is re-experiences (1 or more)

1. Distressing recurrent images or thoughts
2.  Distressing recurrent dreams of event
3. Feeling like trauma will happen again (reliving, illusions, flashbacks, hallucinations)
4. Intense distress upon exposure to cues reminding of event
5. physiological reactivity upon exposure to cures that remind one of the event

• avoidance & numbing to avoid recall, 3 or more of the following must be present for more than 1 month

1.  Inability to recall an important aspect of the event
2.  Avoidance of activities, places or people reminding person of the traumatic event
3.   Attempts of avoiding talking or recalling event
4. Feelings of detachment or estrangement from others
5. Markedly decreased interest (anhedonia)
6.   Restricted range of affect
7.    Belief that future has been foreshortened because of event

• combo of smyptom-directed physchopharmacologic agents and psychotherapy
• first line: SSRIs for at least 6 months
• MAOI's, TCA's
• propanolol and other BB prevent development of PTSD if given early after trauma
• psychotherapy is effective 

• Occur within one month of traumatic event
•  Symptoms last 2 days to 4 weeks
• CONTRAST THIS TIMING FROM PTSD

• SSRI's
• anxiolytics (benzos) 
• counseling services

• Obsession is the thought, compulsion the action. Therefore, obsession drives compulsion.
• Mean age onset 20y
• Obsessions= persistent and recurrent thoughts, images, or impulses that are intrusive and inappropriate which can cause anxiety. They recognize that the disturbing thoughts, impulses and images are coming from their own mind.
• Compulsions= ritualistic/repetitive behaviors or thoughts that patients feel compelled to engage into to relieve anxiety and distress caused by the obsessions

OCD 

OCDP is egosystonic 

• SSRIs: first line (serotonin has been implicated as a mediator in obsessive thinking and compulsive behaviors)
• TCA - clomipramine 
• CBT
• systemic desensitization and flooding
• response prevention 

animal

natural environment

blood-injection-injury

situational

other

• Fear:  Intense fear of particular objects or situations (snakes, heights)
• Anxiety:  Marked immediate anxiety upon exposure to feared stimulus
• Insight: Individual recognizes that fear is excessive/unreasonable
• Avoidance: The feared stimulus is avoided or endured with much anxiety/distress
• Impairment: The individual is significantly impaired by the by the anxiety/distress or avoidance
• Duration: at least 6 months in individuals younger than 18
• Not accounted for by another condition

• fear 
• anxiety
• insight
• avoidance 
• impairment 
• duration: @ least 6 months in individuals < 18
• context : actual med condition is present (ie psoriasis) and the fear/anxiety doesn't stem from the actual condition but rather voice cracking in a singing performance

• mild cases - treated w/ CBT (flooding & systemic desensitization)
• SSRI's appear to be most effective 
• BB especially for performance anxiety 
• MAOI's, alprazolam, and gabapentin have also proven effective
• supportive individual and group psychotherapy is helpful to restore self-esteem & to encourage venturing into feared situations

Hypoactive sexual desire disorder 

• Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person's life. 
•  The disturbance causes marked distress or interpersonal difficulty. 
•   The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. 
•    general  or
• situational  (lacks sexual desire for current partner)
•  acquired (HSDD started after a period of normal sexual functioning) or
•  lifelong 

1. exhibitionism
2. fetishism
3. frotteruism
4. pedophilia
5. sexual masochism
6. sexual sadism
7. transvestic fetishism
8. voyeurism 

• psychological - paraphilias, particularly those of superficial nature (ie voyeurism) and those of recent onset are responsive to this in some cases 
• behavioral-emotive imagery is occasionally helpful in lessening anxiety in fetish problems
• social: self help groups facilitate adjustment to a often hostile society.  Helping persons to accept their situation and alleviate their guilt about the role they think they had in creating the problem 
• Medical: medroxyprogesterone acetate a suppressor of libidinal drive is used to mute disruptive sexual behavior in men of all ages
• fluoxetine or other SSRI may reduce some of the compulsive sexual behaviors

SSRI

proposed to work by reducing sexual arousal, compulsivity, and depressive symptoms. 

anti-androgens 

• Similar to physical castration, they work by reducing androgen levels, and have thus been described as chemical castration.
• The antiandrogen cyproterone acetate has been shown to substantially reduce sexual fantasies and offending behaviors.
• Medroxyprogesterone acetate and gonadotropin-releasing hormone agonists (such as leuprolide acetate) have also been used to lower sex drive.
• Due to the side effects, the World Federation of Societies of Biological Psychiatry recommends that hormonal treatments only be used when there is a serious risk of sexual violence, or when other methods have failed

odd or eccentric

paranoid

schizoid

schizotypical

anticipate harm, betrayal, and deception

they require emotional distance

• psychotherapy: including group therapy of choice
• pharmacologic : short term low doses of antipsychotics if severe (haldol) or benzos for anxiety or agitation

• LONERs
• preferred to be left alone and has difficulty experiencing or expressing emotion
• does not seek relationships but maintain important bond w/ a family member

• psychotherapy: including group therapy
• pharmacologic : +/- short term low dose anti-psychotics, anti-depressants, psychostimulants

• psychotherapy: including group therapy of choice
• pharmacologic: +/- short term low doses antipsychotics, antidepressants, or benzos

dramatic/emotional

1. antisocial
2. histrionic 
3. narcissistic
4. borderline

• display either a flagrant or well-concealed disregard for the rules and laws of society
• exploitative, lie frequently, endanger others, impulsive and aggressive, and rarely feel remorse for the harm they cause others
• alcoholism is frequently associated and imprisonment

• psychotherapy: establishing limits
• pharmacologic: not helpful. conduct d/o's in children may lead to anti-social behavior in adulthood. Must be 18y.o to diagnose 

• theatrical behavior dominates w/ lively and dramatic clothing 
• exaggerated emotional responses to seemingly insignificant events
• inappropriate flirtatious & seductive behavior across a wide variety of circumstances
• difficulty w/ intimacy, frequently believing their relationships are more intimate than they actually are

• paradoxical combo of self-centeredness & worthlessness
• their sense of self-importance is generally extravagant, and they demand attention and admiration
• concern or empathy for others is ABSENT
• appear arrogant, exploitative, and entitled
• low self esteem and have intense envy of those whom they regard as more desirable or worthy

• relationships are infused w/ anger, fear of abandonment, and shifting idealization and devaluation
• self image is inchoate, fragmented, and unstable with consequent unpredictable changes in relationships, goals, and values (frequent suicidal & parassuicidal behavior)
• impulsiveness leads to risk taking behavior like drug abuse, promiscuity, gambling

• psychotherapy: including group therapy tx of choice
• pharmacologic : +/- short term low doses of anti-psychotics, antidepressants, or benzos

anxious and fearful

1. avoidant 
2. dependent
3. obsessive compulsive personality disorder

• experience intense feelings of inadequacy, extremely sensitive to criticism so they often avoid spending time w/ ppl

• psychotherapy: establishing limits
• pharm : +/- BB for anxiety or SSRI for depression

• yearn to be cared for
• live in great & continual fear of separation from someone they depend on
• hence their submissive & clinging behavior

obsessive compulsive personality d/o 

EGOSYNTONIC 

• attention to minutiae impairs ability to finish what they started or to maintain sight of their goals
• cold and rigid in relationships
• makes frequent moral judgements
• devotion to work often replaces intimacy
• very serious and plodding 
• even recreation becomes a sober task

• tx: only personality d/o patients frequently seek help
• pharm: +/- BB for anxiety or SSRI for depression

•  Paranoid PD – is a pattern of distrust and suspiciousness  such that others’ motives are interpreted as malevolent
•  Schizoid PD – is a pattern of detachment from social relationships and restricted range of emotional expression. Appears indifferent to praise or criticism. Emotional coldness, detachment or flattened affect.
• Schizotypal PD – is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. Magical thinking (clairvoyance and telepathy). Ideas of reference
• Cluster A can be associated with psychosis. More withdrawn and less attention seeking.
• Treatment: to increase social skills/ group therapy. Medication: short course anti-psychotic, anxiolytic or antidepressant

• Antisocial PD– is a pattern of disregard for, and violation of, the rights of others. Displays inability to conform to social norms and rules
• Borderline PD– is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. Can lead to self-ham. Attention seeking behaviors because patient avoids abandonment
• Histrionic PD– is a pattern of excessive emotionality and attention seeking. Overly emotional, dramatic, seductive
• Narcissistic PD– is a pattern of grandiosity, need for admiration, and lack of empathy. Inflated ego, self-absorbed
• Cluster B More attention seeking

• Avoidant PD: extreme sensitivity to rejection. Have inferiority complex. Social phobia (fear of rejection in a setting). See themselves as unappealing.
• Dependent PD: submissive, clingy behavior. Fear of separation/ dislike of being alone. Psychological need to be cared for by other people
• Obsessive Compulsive PD: pervasive pattern of orderliness and perfection. Rigid, insist others submit to their ways. EGOSYSTONIC

• Psychotherapy recommended for most PD
• Cognitive behavioral therapy
• Family therapy
• Group Therapy
• Dialectical behavioral therapy- for Borderline PD
• §  DBT theory suggests that some people’s arousal levels in such situations (emotional situations found in romantic, family and friend relationships) can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels
• Teaches skills that will help with the task of coping with sudden, intense surges of emotion
• a therapy designed to help people change patterns of behavior that are not helpful, such as self-harm, suicidal thinking, and substance abuse.^[1] This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions
•  Pharmacological

§  Mood stabilizers-for mood instability and impulsiveness
§  Benzos for anxiety
§  B-blockers
§  SSRI-for depression, obsessive compulsive symptoms, and eating disturbance

§  Low dose antipsychotics-psychotic or paranoid symptoms