Personality Disorders A Case Presentation Kate Hooks.

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Presentation transcript:

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. 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 Raped by acquaintance......pregnant baby c born Moves back with parents and suffers Postnatal Depression Nurse training in Bradford- vulnerable to men lives in own cottage drinking 2-3 bottles of wine per day.

2007 Father dies admissions with suicidal ideas

Medical HX IBS Alcoholic polyneuropathy Medication Pregabalin Ranitidine Thiamine and Vit B Lamotrigine Buspirone Citalopram Quetiapine

Previously.....ParoxetineVenlafaxineFluoxetine Started antidepressants at age 14

Family Hx 56 Teacher Teacher 33 solicitor baby 6

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 ParanoidSchizoidDissocial Emotionally unstable- impulsive type Emotionally unstable- Borderline type Histrionic Anxious (avoidant) Anankastic (OC) Dependent

The Mental Health Act 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 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 5(4)- nurse holding power 6hrs 17- Leave 17- Leave 136- Police officer can detain to safety 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.