Updated: 11/13/2018

Personality Disorders

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Overview
  • Personality trait
    • enduring patterns of behavior exhibited in a wide range of personal contexts
  • Personality disorder
    • pervasive, inflexible, extreme, maladaptive personality trait causing impaired functioning or subjective distress
    • ego syntonic
      • patient has limited awareness of disorder
    • course is usually stable by early adulthood
    • not usually diagnosed in children
Cluster A Personality Disorders
  • Characterization
    • "weird"
    • odd or eccentric
    • no meaningful social relationships
    • no psychosis
    • genetic association with schizophrenia
  • Types
    • paranoid 
      • excessive distrust and suspiciousness
    • schizoid
      • voluntary social withdrawal
        • content with social isolation (vs. avoidant)
      • limited emotional expression
    • schizotypal  
      • eccentric appearance
      • odd beliefs or magical thinking
Cluster B Personality Disorders
  • Characterization
    • "wild"
    • dramatic, emotional, or erratic
    • genetic association with mood disorders and substance abuse
  • Types
    • antisocial
      • disregard for and violation of rights of others with lack of remorse
      • criminality
      • males > females
      • conduct disorder if < 18 years
      • commonly known as "psychopathy"
      • classic triad
        • set fires, torture animals, bed wetting
    • borderline
      • unstable interpersonal relationships
      • impulsivity
      • sense of emptiness
      • fear of abandonment
      • females > males
      • splitting is a major defense mechanism
        • relationships are either all good ("my boyfriend is a perfect angel") or all bad ("my boyfriend is evil and I hate him")
      • self-mutilation
    • histrionic
      • excessive emotionality and attention-seeking
      • sexually provocative
      • overly concerned with appearance
      • think "telenovelas"
    • narcissistic
      • grandiosity
      • need for admiration
      • sense of entitlement
        • demands "the best"
      • lacks empathy
      • reacts to criticism with rage
Cluster C Personality Disorders
  • Characterization
    • "worried"
    • anxious or fearful
    • genetic association with anxiety disorders
  • Types
    • avoidant
      • hypersensitive to rejection
      • socially inhibited
      • feelings of inadequacy
      • desires relationships with others (vs. schizoid)
    • obsessive-compulsive
      • preoccupation with order, perfectionism, and control
      • ego syntonic
        • vs. OCD which is ego dystonic
    • dependent 
      • submissive and clingy
      • excessive need to be taken care of
      • low self-confidence
 

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Questions (12)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M1.PY.11281401) A 30-year-old male biology graduate student was dismissed from his PhD program after 8 years because he was not able to produce a thesis, claiming that his data was never exactly how he wanted it. He would spend weeks planning out a simple experiment, since everything had to be just right. For many experiments, he would start over because he felt he went out of order in adding the reagents to his media for his cells. He has had similar problems in his undergraduate courses, often failing to complete his assignments on time because he had to revise them until they were perfect. Which of the following disorders does this patient potentially suffer from? Review Topic

QID: 107071
1

Schizoid personality disorder

0%

(0/68)

2

Narcissistic personality disorder

1%

(1/68)

3

Obsessive compulsive personality disorder

87%

(59/68)

4

Paranoid personality disorder

0%

(0/68)

5

Obsessive compulsive disorder

10%

(7/68)

M1

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PREFERRED RESPONSE 3

(M1.PY.11281404) A 35-year-old male has been arrested on suspicion of arson. He has a history of criminal activity, having been jailed several times for assault and robbery. When asked why he burned down his ex-girlfriend's apartment, he just smiled. Which of the following would the male most likely have exhibited during childhood? Review Topic

QID: 107074
1

Bed-wetting

55%

(11/20)

2

Odd beliefs

15%

(3/20)

3

Fear of abandonment

5%

(1/20)

4

Need for admiration

20%

(4/20)

5

Perfectionist

0%

(0/20)

M1

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PREFERRED RESPONSE 1
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