Personality Disorders
A Case Presentation
Kate Hooks
Aims
To discuss a complex case and review
psychiatric history taking.
Look at Personality Disorder.
Review the Mental health act and the
changes made in 2008
Patient K
Pc- Jan 2010
Admitted via the crisis team with depression
and suicidal ideation involving her
daughter.
HPCMiserable from the age of 11.
Failed exam for Skipton Girls
Eating disorder
1995 first referrall to CAMHS for eating
1999 Grandmother died- admitted after taking
an overdose
Around this time- mother diagnosed with
breast ca
Abuse from chef where she worked
Abuse from taxi driver- lifts to school
Older sister went to university.
Around this time started drinking at school
(age14)
2000 university
2001 father diagnosed with stomach ca.
2002 Raped by acquaintance ......pregnant.
2003 baby c born
Moves back with parents and suffers
Postnatal Depression.
2004 Nurse training in Bradford- vulnerable to
men.
2005 lives in own cottage drinking 2-3 bottles
of wine per day.
2007 Father dies.
2008 2 admissions with suicidal ideas
Medical HX
IBS
Alcoholic polyneuropathy 2009.
Medication
Pregabalin
Thiamine and Vit B
Buspirone
Quetiapine
Ranitidine
Lamotrigine
Citalopram
Previously.....
Paroxetine
Venlafaxine
Fluoxetine
Started antidepressants at age 14
Family Hx
56 Teacher
27
29 Teacher
33 solicitor
6
baby
Childhood
Normal development
Happy up to the age 11
Parents ‘loving’
Dad could loose his temper
Education
Settle Middle school
Settle High
Edge Hill- Bradford
Qualified nurse 2006
Employment
Started work 2006
Break for detox later that year
Periods of sick leave
Gave up in Jan 2009
Relationships
Finds sexual relationships difficult
2 brief heterosexual relationships
Forensic
Put in a police van when trying to jump on
railway.
Substances
Took ecstasy once
Previously smoked cannabis
Alcohol- 1-4 bottles of wine per day
Premorbid personality
Describes self as ‘happy’ to age 11. Then
only ever brief moments of happiness.
Mental state varies on a daily basis and
within the consultation.
?
Personality Disorder
• Cognition
• Affect
• Behaviour
Epidemiology
2-18% in the community
Aetiology
Genetics
Childhood development
Neurophysiology Cognitive-behavioural
Management
Medication- Antipsychotics
Anticonvulsants and lithium
Antidepressants
Therapeutic community
Cognitive behavioural therapy
ICD10 Types
Paranoid
Schizoid
Dissocial
Emotionally unstable- impulsive type
Emotionally unstable- Borderline type
Histrionic
Anxious (avoidant)
Anankastic (OC)
Dependent
The Mental Health Act 1983
Section 2
Admission for assessment
Up to 28 days
Must be a danger to themselves or to others
Application made by an AMHP or nearest
relative and supported by 2 doctors
One section 12 app. Other usually GP.
Section 3
Diagnosis already known
Admission for compulsory treatment
Up to 6 months
Can be extended to 12 months
Section 4
Emergency admission
If no second medical recommendation
For a patient who is not admitted
NR or AMHP and 1 registered medical
practitioner.
72 hrs
5(2)
Inpatient
Responsible clinician or nominated deputy
72hrs
• 5(4)- nurse holding power 6hrs
• 17- Leave
• 136- Police officer can detain to safety
New- Community Treatment Order
Patients detained on section 3
Must- have mental disorder
- be appropriate treatment available
May need to- Reside at specific address
-Available for treatment
- avoid specified activities
Re called if they become a danger to
themselves or others.