PERSONALITY DISORDERS

PERSONALITY DISORDERS

Ancient antecedent that goes back to childhood. _
sans-serif; font size: 12 points; line-height: 115%; "> Recurrent behavior of maladjustment _ Low self-esteem and lack of confidence _ Minimum introspective capacity with tendency to blame others for all problems _ Significant difficulties with interpersonal relationships or society _ Depression with anxiety when behavior fails of maladjustment.

Generalities

The structure of an individual's personality, or his character, is an integral part of the personal image. It reflects genetics, interpersonal influences and recurrent patterns of behavior adopted to cope with the environment. The classification of subtypes of personality disorders depends on the predominant symptoms and their severity. The most serious disorders, those that lead the patient and a greater conflict with society, are also classified as antisocial (psychopathic) or borderline. Personality disorders can be a matrix for some of the most serious psychiatric problems (eg, schizoid, related to schizophrenia, and evasive types, related to some anxiety disorders)
Differential diagnosis Patients with personality disorders that are related to anxiety and depression when the pathological mechanisms to face situations and symptoms are failed. Sometimes, the most serious cases are decompensated towards psychosis under stress and simulate other psychotic disorders. _
Treatment

A. Social
Social and therapeutic environments, such as day hospitals, intermediate houses and self-help communities use peer pressure to modify self-destructive behavior. Often, the patient with a personality disorder does not benefit from the experience; The learning experience Relationships with people who have the same problem and repetition are possible in a structured setting of a useful community increase opportunities for behavioral treatment and increase learning. When problems are detected in a timely manner, both school and home can serve as pockets of intense social pressure to modify behavior, especially with the use of behavioral techniques.

B. Behavioral
The behavioral techniques employed are above all operant and aversion conditioning. The first only highlights the importance of identifying acceptable behavior and reinforcing it with praise and other tangible rewards. Aversive responses almost always involve punishment, although this may range from a mild reprimand to some specific punitive responses such as deprivation of privileges. The extinction is useful, since it is tried not to respond to inappropriate behavior and the lack of response in the end makes the person abandon that type of behavior. For example, anger and tantrums diminish rapidly when they do not induce a reaction. Dialectical behavioral therapy is a program of individual and group therapy designed specifically for patients with chronic suicidal tendencies and borderline personality disorder. It combines attention and a cognitive-behavioral model to correct self-awareness, interpersonal functioning, affective instability and reactions to stress.

C. Psychological
Psychological intervention is best conducted in groups. Group therapy is useful when it is necessary to improve specific interpersonal behavior. This mode of treatment also applies to patients known as expressives, who often act impulsively and inappropriately. The pressure of those who share the same problem in the group tends to limit rough behavior. The group also quickly identifies the types of patient behavior and helps improve the validity of the patient's self-assessment, so that the history of unacceptable behaviors can be effectively managed and their frequency decreased. Initial individual therapy should be supportive; that is, help the patient to stabilize again and mobilize their coping mechanisms. If the individual has the ability to observe their own behavior, a longer and more introspective therapy is indicated. The therapist must be able to handle countertransference feelings (which are often negative), maintain adequate boundaries in the relationship (no physical contacts, no matter how well intentioned) and refrain from making confrontations and premature interpretations.

D. Physician
Hospitalization is indicated in patients with high risk of suicide or homicide. In most cases, the treatment can be offered at community or day hospital centers. Antipsychotics may be required for short periods in the event of decompensation leading to transient psychosis (eg, olanzapine [2.5 to 10 mg / day orally], risperidone [0.5 to 2 mg / dose] oral day], or haloperidol [0.5 to 2 mg / day divided orally in two doses]). In some cases, these drugs are only required for a few days and can be discontinued when the individual recovers the adaptation level established earlier; They can also provide ongoing support. Carbamazepine, 400 to 800 mg orally a day divided into several doses, decreases the severity of behavioral dysregulation. In some borderline patients, antidepressants improve anxiety, depression and sensitivity to rejection. SSRIs may be of some use in decreasing aggressive behavior in impulsive patients. _

Prognosis Antisocial and borderline categories almost always have a reserved prognosis. Individuals with a history of abuse by parents and family history of mood disorders tend to present the greatest therapeutic challenges