Mental Health Exam Prep: Personality Disorders, Mood Disorders, Treatments and Medications

Antisocial Personality Disorder (Sociopathy)

• Transcript highlights describe a pattern of emotional instability, impulsivity, deceit, aggression, and reckless behavior, with a strong sense of being above norms and a lack of guilt.
• Core features (as discussed and aligned with common DSM concepts):
  • Persistent disregard for the rights of others and social norms
  • Deceitfulness, lying, manipulating others for personal gain
  • Impulsivity and failure to plan ahead
  • Aggression and reckless disregard for self and others' safety
  • Lack of remorse or empathic concern
• Possible nuance mentioned in the transcript: a “strong fear of abandonment” in some individuals; this is more characteristic of other personality disorders (e.g., dependent or borderline) but the speaker notes it as part of some antisocial presentations.
• Also noted: sometimes described as sociopathy; may have superficial charm and can be manipulative in relationships or criminal contexts.
• Practical consequences mentioned: relationships are often unfair or exploitative; talk of criminal behavior in some cases.
• Related terms to know: antisocial personality disorder, sociopathy.

Dependent Personality Disorder

• Description from transcript and core features:
  • A pervasive and excessive need to be taken care of, leading to submissive and clinging behaviors
  • Tremendous fear of independence and of making decisions without reassurance
  • Difficulty disagreeing with others for fear of losing support or approval
  • Belief in own inadequacy and tendency to tolerate abuse to maintain relationships
  • May seek to initiate or tolerate work that others prefer, and rely heavily on others for self-definition
• Central motif: abandonment fears and a lack of self-confidence drive dependent behaviors
• Relationship dynamics: dependence on others, difficulty asserting boundaries

Avoidant Personality Disorder

• Core features described in transcript:
  • Hypersensitivity to rejection or criticism
  • Extreme shyness and social inhibition
  • Feelings of inferiority relative to others and a persistent sense of social inadequacy
  • Avoidance of work or social activities that involve significant interpersonal contact due to fear of embarrassment
• Distinguishing vibe: avoidance stems from fear of negative evaluation rather than lack of desire for social contact
• Overall impact: avoidance limits life opportunities and social functioning

Obsessive-Compulsive Personality Disorder (OCPD)

• Transcript notes emphasize it is not the same as obsessive-compulsive disorder (OCD):
  • Characterized by pervasive perfectionism, rigidity, and a need for control
  • Preoccupation with detail, rules, and orderliness
  • Excessive devotion to work and productivity at the expense of flexibility, openness, and relationships
  • Difficulty discarding worn-out or useless items (hinted in transcript) and reluctance to delegate due to fear that others won’t meet exact standards
• Distinction from OCD: OCPD is a personality style; OCD involves true obsessions/compulsions (unrelated to personality structure)

Mood Disorders and Psychosis (Overview from Transcript)

• Bipolar disorder discussion touches on manic phases that may include psychosis (delusions, hallucinations) during mood elevation
• Psychosis associations:
  • Can occur in bipolar mania, major depressive episodes with psychotic features, and other conditions
  • PTSD mention: psychosis can be discussed in broader mental-health contexts, though PTSD primarily involves intrusion symptoms, hyperarousal, and avoidance (the transcript touches on hallucinations as a broader link in the lecture context)
• Anhedonia and flat affect appear as broader mood symptoms (reduced pleasure, reduced emotional expression)
• Alzheimer’s disease reference: psychotic features can occur in neurodegenerative conditions; transcript briefly notes hallucinations in such contexts
• Postpartum psychosis mention: recognized as a distinct condition that can include psychotic symptoms
• General health context: mood disorders can co-occur with psychosis; treatment often requires an integrated approach (therapy, pharmacology, and supportive care)

Treatments and Complementary Approaches

• Therapeutic approaches mentioned:
  • Mindfulness, meditation, yoga, acupuncture
  • Therapy dog programs and other complementary therapies
• Medication- and symptom-focused discussion (introductory, context given in lecture):
  • Antipsychotics (typical and atypical) and their side effects (EPS, TD, NMS)
  • Antidepressants and related agents (SSRI, SNRI, MAOI, TCAs)
• Practical notes from the clinician:
  • When discussing medication charts, emphasize category, mechanism, common side effects, and monitoring parameters
  • Emphasize safety and abuse reminders (medications like elixirs/suspensions, and alcohol interactions)
  • Consideration of non-pharmacological supports as adjuncts to pharmacotherapy

Pharmacology and Movement Disorders

• Antipsychotics overview:
  • Typical (first-generation) and atypical (second-generation) agents both used for psychosis and mood-psychosis conditions
  • Mechanisms differ by drug class, but all can impact dopamine pathways with varying metabolic and movement side effects
• Movement disorders to know:
  • EPS (extrapyramidal symptoms): early-onset motor symptoms such as dystonia, akathisia, parkinsonism
  • TD (tardive dyskinesia): late-onset, often persistent involuntary movements (orofacial, limb movements); may be irreversible; risk rises with duration of treatment
• Comparison: TD vs EPS
  • TD is a type of dyskinesia affecting the face and other muscles; emerges after exposure and can persist after stopping the drug
  • EPS includes acute symptoms that may improve after dose adjustment or drug discontinuation

Neurochemical Foundations and Onset of Action

• Neurotransmitters of interest (in context of antidepressants and mood disorders):
  • Serotonin, norepinephrine, dopamine
  • See the set: ext{NTs} = igl{ ext{serotonin}, ext{norepinephrine}, ext{dopamine} igr}
• Pharmacologic implications:
  • SSRIs primarily increase serotonin availability; onset of clinical effect typically after several weeks
  • SNRIs increase serotonin and norepinephrine; onset similar to SSRIs but with broader mood and energy effects
  • MAO inhibitors increase all monoamines (serotonin, norepinephrine, dopamine) but require dietary restrictions to prevent hypertensive crises
• Onset timelines (general guidance):
  • ext{SSRI onset}
    ightarrow ext{approximately } 2-6 ext{ weeks}
  • ext{SNRI onset}
    ightarrow ext{approximately } 2-6 ext{ weeks}
  • Note: initial improvements may be mood or sleep-related before full symptom relief
• Dietary and safety cautions for certain meds:
  • MAO inhibitors require tyramine-restricted diet to avoid hypertensive crisis: avoid foods with aged cheese, cured meats, some wines, and other fermented or aged items
  • Avoid alcohol and certain other substances that interact with antidepressants and antipsychotics

Specific Clinical Details and Exam-Relevant Points

• Symptoms and clinical observations discussed: mood swings, emotional dysregulation, impulsivity, fear of abandonment, indecision, and attempts to control others' behavior in various personality presentations
• Eating/feeding considerations in mania or hyperactive states:
  • Patients with high energy or reduced need for sleep may forget to eat; recommend high-calorie, nutrient-dense foods to maintain energy and nutrition
• Detox and substance-use context (detox considerations):
  • For alcohol and other substances, withdrawal and overdose crises require careful assessment and monitoring; overlap with medical stabilization and safety planning
• Diagnostic and exam context described:
  • A two-hour exam format with 90 questions; emphasis on practical clinical knowledge and ability to apply concepts to case scenarios

Practical Case Reflections and Takeaways

• Case-based prompts mentioned (e.g., dinner party scenarios) illustrate social and interpersonal dynamics in personality disorders and mood-related presentations
• The importance of differentiating between OCD and OCPD in assessment and treatment planning
• The necessity of integrating psychotherapy with pharmacotherapy for mood and psychotic spectrum disorders, plus supportive and complementary therapies
• Key safety considerations: monitoring for suicide ideation, escalation of agitation or aggression, and monitoring for movement disorders and neuroleptic malignant syndrome (NMS)

Quick Reference Summary (Key Points)

• Antisocial vs. other personality disorders: disregard for rights vs. fear of abandonment, dependence, avoidance, or rigidity
• Dependent: needs others for decision-making, fear of abandonment, submissiveness
• Avoidant: hypersensitive to rejection, social inhibition, low self-esteem
• OCPD: perfectionism, rigidity, control; not OCD
• Mood/psychosis: bipolar with possible psychosis; PTSD and postpartum psychosis considerations
• Treatments: psychotherapy + pharmacotherapy; mindfulness and complementary therapies
• Medications: SSRIs/SNRIs, MAO inhibitors, TCAs; antipsychotics (typical vs atypical); monitor EPS, TD, NMS
• NMS triad: hyperthermia, lead-pipe rigidity, autonomic instability; altered mental status
• TD vs EPS: TD often persistent; EPS often reversible with dose change
• MAOI diet restrictions: avoid tyramine-rich foods (aged cheese, cured meats, fermented foods, alcohol)
• Onset times: SSRIs/SNRIs generally take weeks to show full effect; MAOIs require dietary management; TCAs have different profiles
• Nutrition in mania: provide high-calorie, high-nutrition foods due to activity and poor meal planning