Personality DisordersA 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 KPc- Jan 2010

Admitted via the crisis team with depression and suicidal ideation involving her daughter.

HPC-

Miserable 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 Ranitidine

Thiamine and Vit B Lamotrigine

Buspirone Citalopram

Quetiapine

Previously.....

Paroxetine

Venlafaxine

Fluoxetine

Started antidepressants at age 14

Family Hx

56 Teacher

2729 Teacher

33 solicitor

baby6

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.