Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
59 Cards in this Set
- Front
- Back
|
What is the DSM-IV criteria for delirium? |
A. Disturbance in attention and awareness B. The disturbance develops over a short period of time, represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day C. An additional disturbance in cognition (e.g.memory deficit, disorientation, language, visuospatial ability, or perception) D. The disturbances in Criteria A and C are not better explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma. E. There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies. |
|
|
Name 5 drugs that can cause delirium |
Anticholinergics e.g. antiparkinsonian (benztropine), TCAs Tranquillisers and hypnotics e.g. diazepam , lithium, chlorpromazine Anti-epileptics Antihistamines 1 and 2 Antihypertensives Corticosteroids Cardiac drugs e.g. digoxin, diuretics, beta-blockers Opioids Sympathomimetics |
|
|
What medication can you consider for the management of acute psychotic behaviour/ agression? |
Haloperidol 1-5 mg PO according to response OR Olanzapine 2.5-10mg PO daily in 1-2 doses Severe symptoms: Haloperidol 2.5-5mg IM as single dose OR Droperidol 5-10mg IM as single dose (more sedating *Cover with benztropine 2mg PO or IM |
|
|
What is the DSM 5 criteria for minor neurocognitive disorder (mild dementia)? |
There is evidence of modest cognitive decline from a previous level of performance in one or more of the domains listed below, based on the concerns of the individual, a knowledgeable informant or the clinician; and a decline in neurocognitive performance, typically involving test performance in the range of one and two standard deviations below appropriate norms (i.e. between the third and sixteenth percentiles) on formal testing or equivalent clinical evaluation. The cognitive deficits are insufficient to interfere with independence (for example instrumental activities of daily living such as complex tasks such as paying bills or managing medications, are preserved), but greater effort, compensatory strategies, or accommodation may be required to maintain independence. The cognitive deficits do not occur exclusively in the context of a delirium. The cognitive deficits are not primarily attributable to another mental disorder (for example major depressive disorder and schizophrenia). |
|
|
What is the DSM 5 criteria for major neurocognitive disorder (mild dementia)? |
There is evidence of substantial cognitive decline from a previous level of performance in one or more of the domains listed below, based on the concerns of the individual, a knowledgeable informant, or the clinician; and a decline in neurocognitive performance, typically involving test performance in the range of two or more standard deviations below appropriate norms (i.e. below the third percentile) on formal testing or equivalent clinical evaluation. The cognitive deficits are sufficient to interfere with independence (i.e. requiring minimal assistance with instrumental activities of daily living). The cognitive deficits do not occur exclusively in the context of a delirium. The cognitive deficits are not primarily attributable to another mental disorder (for example major depressive disorder and schizophrenia). |
|
|
What are the 6 domains of cognition that may be affected in minor or major neuro-cognitive disorder? |
Complex attention - involves sustained attention, divided attention, selective attention and information processing speed Executive ability - involves planning, decision making, working memory, responding to feedback, error correction, overriding habits and mental flexibility Learning and memory - involves immediate memory, recent memory (free recall, cued recall and recognition memory) and long term memory Language - involves expressive language (naming, fluency, grammar and syntax) and receptive language Perceptual - Motor - Visual perception, praxis- involves picking up the telephone, handwriting, using a fork/spoon Social cognition - involves recognition of emotions and behavioural regulation, social appropriateness in terms of dress, grooming and topics of conversation |
|
|
Onset in late 50s and early 60s Insidious onset Early loss of short-term memory Progressive decline in intellect Death in 5-10 years Down syndrome Most likely diagnosis? |
Alzheimer type dementia (presenile dementia) |
|
|
What differentials would you consider in the diagnosis of dementia? |
D - Delirium, drugs E - Emotional disorder = depression, endocrine = thyroid M - memory = benign forgetfulness E - Elective = anxiety disorders/ neuroses N - neurological = CVA, head trauma T - Toxic = drugs/ medication, metabolic disease I - Intellect = low or retarded A - Amnesic disorders - Korsakov syndrome S - Schizophrenia chronic |
|
|
What features in history of a patient might make you consider the diagnosis of schizophrenia as opposed to dementia? |
Schizophrenia: Young onset (peak at 15-25 and 40) Memory usually not affected Frequent delusions, hallucinations and thought broadcasting Dementia: Middle-aged or elderly onset Memory always impaired Delusions are rare Hallucinations are uncommon Thought broadcasting never occurs |
|
|
What features on history might make you suspicious that a patient is going through early psychosis or having prodromal symptoms? |
Social withdrawal Reduced attention and concentration Reduced drive and motivation Depressed mood Anxiety Irritability/ agitation Suspiciousness Sleep disturbance Deterioration in role functioning |
|
|
What is the DSM-V criteria for diagnosis of schizophrenia? |
A. Characteristics of Symptoms: TWO OR MORE of the following, each present for a significant portion of time during a one month period (or less if successfully treated): Delusions, Hallucinations, Disorganised speech (e.g. frequent derailment or incoherence), Grossly disorganised or catatonic behaviour, Negative symptoms, ie affective flattening, alogia or avolition, (Note: Only one "A" symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviour or thoughts, or two or more voices conversing with each other). B. Social/Occupational Dysfunction: for a significant portion of time since the onset of the disturbance, one or more major areas of functioning, such as work, interpersonal relations or self-care is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic or occupational achievement). C. Duration: continuous signs of the disturbance persist for at least six months. This six month period must include at least one month of symptoms that meet criterion A (ie active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of disturbance may be manifested by only negative symptoms or two or more symptoms listed in criterion A present in an attenuated form, e.g. odd beliefs, unusual perceptual experiences). Exclusion Criteria: the remainder of the criteria (D-F in the DSM-IV text) specify that the signs and symptoms above are not better accounted for by another disorder, either psychiatric (ie mood disorder, schizoaffective disorder or pervasive developmental disorder), substance abuse (e.g. amphetamine intoxication or withdrawal) or a general medical condition (e.g. hyperthyroidism). |
|
|
Name 4 positive and 5 negative symptoms of schitzophrenia |
Postive: Delusions Hallucinations Thought disorder Disorganised speech and behaviour Negative: Flat affect Poverty of though Lack of motivation Social withdrawal Reduced speech output |
|
|
Name 4 cognitive and 2 mood symptoms of schitzophrenia |
Cognitive: Distractibility Impaired working memory Impaired executive function e.g. planning Impaired insight Mood: Mania (elevation) Depression |
|
|
What treatment options are there in the acute phase of schitzophrenia? |
Acute hospitalisation Drug treatment Supportive psychotherapy Support for patient and family |
|
|
What drugs are better at treating the positive symptoms of schizophrenia? |
First-generation antipsychotics (typical or conventional) e.g. haloperidol and chlorpromazine |
|
|
Which drugs are better at treating the negative and other symptoms of schizophrenia? |
Second generation (atypical) antipsychotics e.g. Risperidone, olanzapine, quetiapine, clozapine, amisulpride and aripiprazole |
|
|
What medications might you consider as first-line treatment when oral medication is possible in schizophrenia? |
Risperidone 0.5 to 1 mg orally, at night initially, increasing to 2 mg at night. Maximum daily dose is 6 mg OR Olanzapine 5 mg orally, at night initially, increasing to 10 mg at night. Maximum daily dose is 30 mg Amisulpride, aripiprazle, paliperidone, quetiapine etc. also options |
|
|
If you have no response in first line treatments of anti-psychotics after 4-6 weeks what should you consider? |
1. An alternative second-generation antipsychotic as recommended above OR 2. chlorpromazine 200 mg orally, at night initially, increasing in stages up to a maximum of 800 mg at night OR 2. Haloperidol 1.5 mg orally, at night initially, increasing in stages up to a maximum of 10 mg at night. Higher doses are approved for use, but are not recommended because of the risk of extrapyramidal adverse effects |
|
|
If you are unable to give oral medication in an acutely psychotic patient what medications might you consider? |
Midazolam 5 to 10 mg IM OR (if benzo tolerant or failure of midaz) Droperidol 5 to 10 mg IM OR Olanzapine 10 mg IM OR droperidol 2.5 to 5 mg IV, repeated every 3 to 4 minutes, titrated to clinical response, up to a maximum of 20 mg (if IV possible) |
|
|
What should you administer if a dystonic reaction occurs after giving anti-psychotics? |
1. benztropine 1 to 2 mg orally, IV or IM OR 2. benzhexol 2 mg orally. |
|
|
Why is chlorpromazine not recommended for long term use in psychotic patients? |
Because of photosensitivity reactions |
|
|
If compliance is an issue what anti-psychotic medications could you consider? |
Depot preparations e.g flupenthixol decanoate 10 mg IM, initially, then dose titrated to between 20 and 40 mg and the frequency titrated to between 2- and 4-weekly OR haloperidol decanoate 50 mg IM, initially, then dose titrated to between 50 and 200 mg every 4 weeks |
|
|
What should you remember when starting depot preparations? |
May take 2-4 months to produce a stable response so may need oral supplements in interim Start with IM test doses then titrate to recommended controlling levels Not as effective as oral therapy Give as deep IM injection with 21 gauge needle in buttock Use lowest dose possible to avoid tardive dyskinesia Reassess every 3 months |
|
|
What should you watch for in patients on anti-psychotic medications? |
Acute dystonias - bizarre muscle spasms affecting face, neck, tongue and trunk, oculogyric cises, opisthotonos and larynegeal spasm Akathisia - subjective motor restlessness of feet and legs Parkinsonian - seen relatively early in rx Tardive dyskinesia - abnormal involuntary movements Neuroleptic (antipsychotic) malignant syndrome - high temps, muscle rigidity, altered consciousness Cardiac dysfunction - QT prolongation |
|
|
What treatment can you give for acute dystonias for a patient on anti-psychotic meds? |
Benztropine 1-2mg IV OR IM |
|
|
What treatment can you give for akathisia for a patient on anti-psychotic meds? |
Reduce dosage until akathisia less troublesome or substitute thioridazine Can use propranolol, diazepam or benztropine as a short term measure |
|
|
What treatment can you give for parkinsonian features for a patient on anti-psychotic meds? |
Lower dose or substitute a phenothiazine in low dosage Alternatively use benztropine or benzhexol |
|
|
What treatment can you give for tardive dyskinesia for a patient on anti-psychotic meds? |
Weigh up benefits and risks of continuing treatment Prevent by using the lowest possible dosage of antipsychotic medication |
|
|
Neuroleptic malignant syndrome develops over hours to days. What is the classic tetrad of clinical features? |
1. hyperthermia 2. extrapyramidal effects—‘lead-pipe’ rigidity, bradykinesia or akinesia, dystonias, abnormal movements and postures, dysphagia, tremor 3. autonomic effects—tachycardia, hypertension, labile blood pressure, diaphoresis, tachypnoea 4. central nervous system (CNS) effects—drowsiness, confusion, coma, mutism, incontinence. |
|
|
What treatment can you give for neuroleptic malignant syndrome for a patient on anti-psychotic meds? |
Emergency Discontinue rx Ensure adequate hydration with IV fluids Cooling with tepid sponging and ice packs (if temp >39) If life-threatening: - bromocriptine 2.5 mg orally or via nasogastric tube, 8-hourly; the dose can be gradually increased based on clinical response up to 5 mg, 4-hourly. |
|
|
What triad of clinical effects might make you consider seratonin syndrome which develops within hours of commencing the seratonergic agent? |
Neuromuscular excitation—hyperreflexia, clonus (inducible or spontaneous), ocular clonus, myoclonus, shivering, tremor, hypertonia or rigidity Autonomic effects—hyperthermia (mild: less than 38.5 °C; severe: greater than 38.5 °C or rapidly rising), diaphoresis, flushing, mydriasis, tachycardia Central nervous system (CNS) effects—agitation, anxiety, confusion |
|
|
What is the difference between bipolar I and bipolar II disorder? |
Bipolar 1 - at least 1 episode of mania Bipolar 2 - hypomanic and depressive episodes only *hypomania = symptoms of mania that are less severe and of shorter duration |
|
|
What clinical features might a patient with mania have? (DSM 5 criteria for mania) |
An episode of mania must involve a sustained abnormalmood plus three of the following features present (orfour features if the patient’s mood is irritable rather thanelevated) to meet DSM-V* criteria: Inflated self esteem or grandiosity Increased talkativeness Decreased need for sleep, e.g. is rested after threehours sleep Easily distracted by unimportant or externallyirrelevant stimuli Flight of ideas characterised by a nearly continuousflow of accelerated speech, which abruptly shiftsfrom one topic to another An increase in goal-directed activity, e.g. at work,socially or sexually, or restlessness, i.e. purposelessactivity such as pacing or holding multipleconversations at once Excessive involvement in high-risk activities, e.g.spending money recklessly, sexual indiscretion orimprudent investments |
|
|
What clinical features might a patient with major depression have? (DSM 5 criteria for major depressive disorder) |
A major depressive episode is defined by five or more ofthe following symptoms, present at the same time, for atleast a two-week period. At least one of the symptomsmust be either a depressed mood or a loss of interest orpleasure: Depressed mood for most of the day, nearly everyday Markedly reduced interest or pleasure in all, oralmost all, of the day’s activities, most of the day,nearly all dayInsomnia or hypersomnia, nearly every day Feelings of worthlessness or excessive orinappropriate guilt, nearly every day Significant weight loss when not dieting, or weightgain of more than 5% in a month, or a decrease orincrease in appetite nearly every day Psychomotor agitation or retardation nearly everyday A decreased ability to think or concentrate, orindecisiveness, nearly every day Recurrent thoughts of death or suicide, or a suicideattempt |
|
|
What treatment is required for management of acute mania? |
Immediate hospitalisation (usually involuntary) 1st line rx: olanzapine 5 mg orally, at night initially, increasing to 10 mg at night. max 30 mg risperidone 0.5 to 1 mg orally, at night initially, increasing to 2 mg at night. max 6 mg |
|
|
What medication is recommended for management of bipolar depression? |
An antidepressant PLUS a drug recommended for prophylaxis of bipolar disorder OR quetiapine 50 mg orally, twice daily on day 1, then 100 mg twice daily on day 2, then increasing to 150 to 300 mg, twice daily |
|
|
What medication is recommended for the prophylaxis of recurrent bipolar disorder? |
Lithium carbonate 125 to 500 mg orally, twice daily for 2 weeks. The dose should then be adjusted according to the serum concentration determined after 5 to 7 days of steady-dose treatment OR (if depression is predominant) lamotrigine 25 mg orally, at night for 2 weeks, then 50 mg at night for 2 weeks, then 100 mg at night for 1 week, then 200 mg at night. To reduce the risk of serious skin reactions in patients also taking sodium valproate, the dose of lamotrigine should be half of the above at each step, aiming for a final maximum dose of 100 mg at night *Carbamazepine and sodium valproate are second line |
|
|
What non-pharmaceutical treatments can be considered in patients with bipolar disorder? |
Psychotherapies e.g. CBT and psycho-education ECT |
|
|
What is the DSM 5 criteria of body dysmorphic disorder? |
Appearance preoccupations: The individual must be preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance. “Preoccupation” is usually operationalized as thinking about the perceived defects for at least an hour a day. Note that distressing or impairing preoccupation with obvious appearance flaws (for example, those that are easily noticeable/clearly visible at conversational distance) is not diagnosed as BDD; rather, such preoccupation is diagnosed as “Other Specified Obsessive-Compulsive and Related Disorder”). Repetitive behaviors: At some point, the individual must perform repetitive, compulsive behaviors in response to the appearance concerns. These compulsions can be behavioral and thus observed by others – for example, mirror checking, excessive grooming, skin picking, reassurance seeking, or clothes changing. Other BDD compulsions are mental acts – such as comparing one’s appearance with that of other people. Note that individuals who meet all diagnostic criteria for BDD except for this one are not diagnosed with BDD; rather, they are diagnosed with “Other Specified Obsessive-Compulsive and Related Disorder.” Clinical significance: The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. This criterion helps to differentiate the disorder BDD, which requires treatment, from more normal appearance concerns that typically do not need to be treated with medication or therapy. Differentiation from an eating disorder: If the appearance preoccupations focus on being too fat or weighing too much, the clinician must determine that these concerns are not better explained by an eating disorder. If the patient’s only appearance concern focuses on excessive fat or weight, and the patient’s symptoms meet diagnostic criteria for an eating disorder, then he or she should be diagnosed with an eating disorder, not BDD. However, if criteria for an eating disorder are not met, then BDD can be diagnosed, as concerns with fat or weight in a person of normal weight can be a symptom of BDD. It is not uncommon for patients to have both an eating disorder and BDD (the latter focusing on concerns other than weight or body fat). Specifiers: Once BDD is diagnosed, clinicians should assess the two BDD specifiers to identify meaningful subgroups of individuals with BDD: Muscle dysmorphia: The muscle dysmorphia form of BDD is diagnosed if the individual is preoccupied with concerns that that his or her body build is too small or insufficiently muscular. Many individuals with BDD are additionally preoccupied with other body areas; the muscle dysmorphia specifier should still be used in such cases. Individuals with the muscle dysmorphia form of BDD have been shown to have even higher rates of suicidality and substance use disorders, as well as poorer quality of life, than individuals with other forms of BDD. In addition, the treatment approach may require some modification. Insight specifier: This specifier indicates degree of insight regarding BDD beliefs (for example, “I look ugly” or “I look deformed”) – that is, how convinced the individual is that his/her belief about the appearance of the disliked body parts is true. Levels of insight are “with good or fair insight,” “with poor insight,” and “with absent insight/delusional beliefs.” Note that absent insight/delusional beliefs are diagnosed as BDD, not as a psychotic disorder. |
|
|
What treatment options should you consider for a patient with body dysmorphic disorder? |
Counselling and psychotherapy SSRIs help if the symptoms suggest an obsessive compulsive disorder An anti-psychotic agent may help where beliefs are delusional or in the context of a psychotic disorder |
|
|
A relentless pursuit of thinness, resulting in weight loss or failure to gain weight during growth A refusal to maintain a normal body weight An extreme fear of gaining weight or becoming fat Physiological effects of starvation, such as amenorrhoea (in women) and bone loss In some, binge eating and/or extreme weight control behaviours, such as self-induced vomiting or laxative abuse. Dx? |
Anorexia nervosa * People with anorexia nervosa may have electrocardiogram changes such as prolonged QTc intervals |
|
|
Regular episodes of uncontrolled overeating of large amounts of food, namely binge eating Extreme weight control methods to counteract the perceived and feared effects of overeating, such as self-induced vomiting, purging (laxative and/or diuretic abuse), driven exercise and/or fasting Weight in the normal or overweight/obese range. Dx? |
Bulimia nervosa |
|
|
Recurrent episodes of binge eating with associated distress The absence of regular use of inappropriate weight control or compensatory behaviours characteristic of bulimia nervosa Doesn't fall into bulimia or anorexia criteria Dx? |
‘eating disorder not otherwise specified’ (EDNOS) |
|
|
What are the general management principals for an eating disorder? |
The guiding principles of treatment are: First, the restoration to a normal weight range for height and age Second, the identification, and management, of any contributing family and personal problems. Checking for physical complications, such as hypokalaemia or dehydration, is mandatory and may be lifesaving. * Consider SSRIs in bulimia |
|
|
What are the symptoms of acute alcohol withdrawal? |
Anxiety, tremor, sweating, nausea and vomiting, agitation, headache and perceptual disturbances Seizures are occasionally observed Symptoms usually appear within 6 to 24 hours of the last consumption of alcohol and typically persist for up to 72 hours, but may last for several weeks. |
|
|
What treatment can you give to help manage the symptoms of alcohol withdrawal? |
diazepam 20 mg orally, every 2 hours until symptoms subside. A cumulative dose of 60 mg daily is usually adequate. * thiamine 300 mg IM or IV, daily for 3 to 5 days then thiamine 300 mg orally, daily for several weeks - for thiamine deficiency |
|
|
What are the features of delirium tremens? |
Usually commences 72 to 96 hours after cessation of drinking and is characterised by gross tremors and fluctuating levels of agitation, hallucinations (usually tactile), disorientation and impaired attention. Fever, tachycardia and dehydration may be present. -> Immediate hospitalisation required for fluids, diazepam, thiamine and electrolyte imbalance correction |
|
|
What treatment should be given for alcohol over dose? (Lethal blood alcohol concentration is about 0.45-0.5%) |
Supportive and symptomatic No stimulants should be given Monitor for hypogylcaemia and metabolic acidosis |
|
|
What medication can be offered to a highly motivated patient that wants to give up alcohol abuse? |
Disulfiram 100 mg orally, once daily initially for 1 to 2 weeks, increase as required and as tolerated up to 300 mg daily. *Acamprosate can be used to help with the symptoms of protracted alcohol withdrawal (not acute). It has been shown to increase the time to first drink, prolong abstinence, and reduce the number of drinking days Acamprosate (patient less than 60 kg) 666 mg orally, in the morning, 333 mg at midday and 333 mg at night OR Acamprosate (patient 60 kg or more) 666 mg orally, 3 times daily. |
|
|
What are the symptoms of opioid withdrawal? |
Opioid withdrawal symptoms include agitation, sweating, musculoskeletal pain, abdominal cramps, diarrhoea, nausea and vomiting, seizures and goose flesh. Following cessation of heroin use, these effects peak at around day 2 to day 3 and are largely resolved after 5 to 7 days. |
|
|
What medications can be used for the long term management of opioid dependence? |
Methadone OR Buprenorphine |
|
|
What are the symptoms of cannabis withdrawal? |
Cannabis intoxication is characterised by sedation, euphoria, increased appetite, elevated heart rate, reddening of the eyes, cognitive (including memory loss) and psychomotor impairment and altered time perception. Transient panic, anxiety and paranoia can occur, more often in naive users. * Consider CBT - may be helpful in getting off |
|
|
What symptoms of benzodiazepine withdrawal might be seen? |
Common symptoms include anxiety, insomnia, irritability, myoclonic jerks, palpitations, and sensory disturbances such as hyperacusis and photophobia. Abrupt discontinuation in patients taking high doses (eg greater than 50 mg diazepam daily or equivalent) may be accompanied by seizures. |
|
|
What symptoms might be seen in amphetamine or cocaine over dose? |
Overdose of amphetamine, cocaine and other stimulant drugs can produce a range of symptoms including anxiety, insomnia, confusion, paranoid psychosis, tremors, seizures, rapid respiration, hyperthermia, rhabdomyolysis, hypertension, tachycardia and cardiac arrhythmias. Strokes may result in ongoing disability, while death can result from cardiac arrest and hyperthermia. Scratching a perceived skin irritation can cause deep excoriation of the skin that may be difficult to heal. |
|
|
What symptoms might be seen in ecstasy overdose? |
While the signs and symptoms are similar to those described for amphetamine - hyperthermia and hyponatraemia are the most significant toxic effects. Core body temperature may exceed 42°C and, in such cases, secondary pathological events (eg rhabdomyolysis, disseminated intravascular coagulation, acute kidney failure and metabolic disturbances) are likely to be present. |
|
|
What is borderline personality disorder characterised by? |
An unstable sense of self and identity manifesting in chronic inner emptiness and boredom A severe disturbance of interpersonal function Developmental immaturity Mood instability Recurrent impulsive and maladaptive behaviours such as binge eating, stealing, drug use problems, and deliberate self-harm. |
|
|
What features might you expect in a patient with antisocial personality disorder? |
The key features of ASPD are that the person routinely disregards the rights of others as demonstrated by deceitfulness, impulsivity and lack of remorse as well as repeated criminal acts, disregard for the safety of others, failure to meet obligations and aggressive behaviour. A developmental history reveals that this is a longstanding pattern with conduct disorder (aggression to others, destruction of property, deceitfulness and serious violations of rules) also occurring before the age of 15. |
|
|
What features might you expect in a patient with paranoid personality disorder? |
A person with PPD is typified by pervasive distrust of others, interpreting their motives as being malevolent. They are excessively sensitive, quick to take offence, often feel slighted and then will counterattack as well as hold longstanding grudges. People with PPD can at least entertain the possibility that they have misinterpreted a situation or that they may be overreacting |
|
|
What is the first line treatment for personality disorders? |
Psychological therapy |
