Review of DSM5 Mental Disorders for NCMHCE Study

1. Antisocial Personality Disorder

2. Borderline Personality Disorder

3. Histrionic Personality Disorder

4. Narcissistic Personality Disorder

Cluster B disorders are known as dramatic

Pervasive patterns of thinking, moods and actions

Relative to self perception, distressing or exciting circumstances, personal impulses and urges, other people

Begun in youth, consistent and inflexible in many personal and social situations and stable over time

Causes problems

S2. Assess Testing Personality Disorders

Questionnaire- 4 MCMI3 (Millon) MMPI CATI (Coolidge ) Dimensional

Assessment of Personality Pathology—Basic Questionnaire

Structured Clinical Interview

International Personality Disorder Examination

NEO Five-Factor Inventory Thematic Apperception

Test Global Assessment of

Functioning scale Adult Attachment

Interview

S4. TreatmentTherapy Psychodynamic Therapy CBT CBT Schema Therapy DBT Mindfulness Therapy Mentalization Focused Therapy

Diagnosis IDisregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behavior From age 15 and now at least 18 years old Evidence of conduct disorder and HDAD before

age 15

Diagnosis IIRequires 3 or more of the following: Failure to conform to social norms

and laws, repeatedly arrested; Deception, repeatedly lying, or

conning others Impulsivity or failure to plan ahead Irritability and aggressiveness, with

repeated physical fights or assaults

Reckless disregard for safety of self or others;

Consistent irresponsibility, regarding work or financial obligations

Lack of remorse, rationalizing having mistreated

Diagnosis IIICo-occurring

1. Anxiety disorders2. Depressive disorder3. Impulse control disorders4. Substance-related disorders5. Somatization disorder6. Attention deficit hyperactivity

disorder7. Borderline personality disorder8. Histrionic personality disorder9. Narcissistic personality disorder

Contributing factors: Childhood ADHD Reading

problems Low IQ Brain injury

Rule out: Not only during

psychotic or manic episodes

S1. Find Out S2. Assess & Refer MCMI3 (Millon) MMPI Structured Clinical

Interview

S4. Treatments 1. Very challenging Clients deny having a

problem and see no costs of their actions

Usually brought to treatment by authorities

May simulate remorse to manipulate staff

Non-critical, non-judgmental stance

Focus on practical benefits of prosocial behavior

2. Therapy Schema therapy Multisystemic therapy Individual therapy, with

a structured and active approach

Reality Based Approach for Anger Management, substance use recovery, and Social Skills Training

Diagnosis I Marked impulsivity and instability of affects,

interpersonal relationships and self image Highly sensitive to rejection Present by early adulthood

Diagnosis IRequires at least 5 of following:1. Frantic efforts to avoid real or

imagined abandonment2. Unstable, intense

relationships with extreme idealization and devaluation

3. Identity disturbance: unstable self-image or sense of self

4. Impulsivity in at least 2 self-damaging ways (substances, eating, driving)

5. Recurrent suicidal or self-mutilating threats or behavior

6. Emotional instability and reactivity of mood

intense episodic dysphoria, irritability, or anxiety

Lasting hours or day34457. Chronic emptiness8. Inappropriate, intense anger9. Transient, stress-related

paranoid ideation or severe dissociative symptoms

Diagnosis IICo-occurring: Rule out:

Thyroid conditions Substance abuse Dissociative Identity

Disorder

S1. Find Out S2. Assess & Refer MCMI3 (Millon) MMPI Structured Clinical

Interview

4. Treatments Helpful for clients to understand their condition and direct their care plan Expect problems

in relation to therapist

Long term care is needed

Family support important

Psychotherapy Dialectical Behavior Therapy is best Mentalization-based treatment (MBT) Transference-focused psychotherapy Schema-focused CBT may help STEPP group therapy

Medications for symptoms Depakote for impulsivity Naltrexone for self-injury Antipsychotics for disorganized

thinking

S5. Monitoring Improved social functioning More consistency in

relations with therapist

S6. Termination Monitor medications (may

be many)

Diagnosis 1Onset in early adulthoodExaggerates interpersonal problems and blames othersRequires:1. Discomfort if one is not the center of attention2. Inappropriate flirtatious and provocative behavior3. Display of shallow and labile emotions4. Dressing in a manner to draw attention to themselves5. Speech is overly impressionistic and shallow6. Theatrical and excessively emotional personal presentation7. Suggestible by others and the situation, easily follows fads8. Overestimates the level of intimacy in a relationship

Diagnosis IICo-occurring: Borderline Personality

Disorder Substance abuse disorders Antisocial, Dependent, and

Narcissistic personality disorders

Depression Anxiety disorders Panic disorder Somatic disorders Anorexia nervosa Attachment disorders

Rule out: Bipolar, hypomanic

phase Borderline Personality

Disorder Narcissistic Personality

Disorder PTSD

S1. Find Out S2. Assess & Refer MCMI3 (Millon) MMPI Structured Clinical

Interview

S4. Treatments Very challenging since clients deny that they have a problem and blame others May act suicidal or depressed

to gain attention Non-critical, non-judgemental

stance is essential

Possible treatments:1. CBT 2. Long term

psychotherapy3. Group Therapy4. Functional Analytic

Therapy (behavioral therapy)

S5. Monitoring Social functioning

S6. Termination Monitor for suicide

Diagnosis IKey: Excessively preoccupied

with adequacy, power and prestige

Unable to see the destructive damage they are causing to themselves and to others in the process

Diagnosis IRequires at least 5: Grandiose sense of self-

importance Preoccupied with

fantasies of success, power, brilliance, or love

Belief that they are exceptional and can only be understood by others who are important

Needs admiration Sense of entitlement Exploitative and

oppressive behavior No empathy Envious and resentful of

others or believes others envy them

Egotistical

Diagnosis IIICo-occurring: Depression Anxiety Substance abuse

Rule out: Substance abuse Antisocial personality

disorder Borderline personality

disorder Histrionic personality

disorder

S1. Find Out S2. Assess & Refer MCMI3 (Millon) MMPI Structured Clinical

Interview

S4. Treatments Very challenging since clients

deny symptoms Usually seeks treatment when

illness or other crisis shatters illusions of perfection

Will demand high status clinician; derisive towards lesser staff

Initial approach of support followed by step-by-step confrontation of the patient’s vulnerabilities

Therapy CBT as Schema Therapy Psychoanalytic for anger,

envy, self-sufficiency Expressive, conflict-solving

psychotherapy Residential may be neededMedications Depression Anxiety

S5. Monitoring Improved social

functioning

S6. Termination Monitor for suicide