ersonalityDisordersandForensicPsychiatry：人格障碍和法医精神病学课件

1、Personality Disorders and Forensic PsychiatryDepartment of Psychiatry1st Faculty of MedicineCharles University, PragueHead: Prof. MUDr. Ji Raboch, DrSc.第1页，共28页。Disorders of Adult Personality and Behaviour (F60-F69)F60Specific personality disorders F61Mixed and other personality disorders F62Endurin

2、g personality changes, not attributable to brain damage and disease F63Habit and impulse disorders F64Gender identity disorders F65Disorders of sexual preference F66Psychological and behavioural disorders associated with sexual development and orientation F68Other disorders of adult personality and

3、behaviour F69Unspecified disorder of adult personality and behaviour 第2页，共28页。F60 Specific Personality DisordersF60Specific personality disorders F60.0Paranoid personality disorder F60.1Schizoid personality disorder F60.2Dissocial personality disorder F60.3Emotionally unstable personality disorder F

4、60.4Histrionic personality disorder F60.5Anankastic personality disorder F60.6Anxious (avoidant) personality disorder F60.7Dependent personality disorder F60.8Other specific personality disorders F60.9Personality disorder, unspecified 第3页，共28页。F60 Specific Personality DisordersSpecific personality d

5、isorderssevere disturbances in the personality and behavioural tendencies of the individualnot directly resulting from disease, damage, or other insult to the brain, or from another psychiatric disorderusually involving several areas of the personalitynearly always associated with considerable perso

6、nal distress and social disruptionusually manifest since childhood or adolescence and continuing throughout adulthood.第4页，共28页。F60 Specific Personality DisordersPersonality disorder is persistent and appears already within late childhood and adolescence being fully manifested in adulthood (diagnosin

7、g after the age of 16-17 years)The disorder is usually associated with significant problems in occupational and social performanceCauses of personality disorders are mostly genetic though the influence of upbringing, parent-child relationship and social environment play also their roles.第5页，共28页。F60

8、.0 Paranoid Personality DisorderParanoid personality disorder - characterized by excessive sensitiveness to setbacks, persistent refusal to forgive insults and slights, suspiciousness, tendencies to misconstrue the neutral or friendly actions of others as hostile or contemptuous, suspiciousness conc

9、erning fidelity of sexual partner, tendencies to experience excessive self-importance and preoccupation with unsubstantiated conspiratorial explanations of events.Personality (disorder): expansive paranoidfanaticquerulantparanoidsensitive paranoid 第6页，共28页。F60.1 Schizoid Personality DisorderSchizoid

10、 personality disorder - few activities provide pleasure, emotional coldness, limited capacity to express either warm or hostile feelings with indifference to either praise or criticism, little interest in having sexual experiences with another person, preference for solitary activities, excessive pr

11、eoccupation with fantasy and introspection, lack of close friends and marked insensitivity to prevailing social norms and conventions.第7页，共28页。F60.2 Dissocial Personality DisorderDissocial personality disorder:gross disparity between behaviour and the prevailing social normsa callous disregard for t

12、he feelings of others, incapacity to maintain enduring relationships, gross attitude of irresponsibilityvery low tolerance to frustration, a low threshold for discharge of aggression and violenceincapacity to experience guilt and to profit from experience including punishmenta tendency to blame othe

13、rs, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with societyPersonality (disorder): amoralantisocialasocialpsychopathicsociopathic 第8页，共28页。F60.3 Emotionally Unstable Personality DisorderEmotionally unstable personality disorder:characterized by a defi

14、nite tendency to act impulsively without consideration of the consequences, together with affective instabilityoutbursts of anger may lead to violence, particularly in response to criticism (impulsive type)Two types may be distinguished:impulsive type - characterized predominantly by emotional insta

15、bility and lack of impulse control,borderline type - characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gest

16、ures and attemptsPersonality (disorder): aggressiveborderlineexplosive 第9页，共28页。F60.4 Histrionic Personality DisorderHistrionic personality disorder:self-dramatization, pseudologia phantastica, exaggerated expression of emotions, enhanced suggestibility, shallow and labile affectivity, continual see

17、king for excitement, appreciation by others, and activities in which the patient is the centre of attention, over-concern with physical attractiveness together with inappropriate seductiveness, egocentricity, manipulative behaviourPersonality (disorder):hystericalpsychoinfantile 第10页，共28页。F60.5 Anan

18、kastic Personality DisorderAnankastic personality disorder:characterised by feelings of excessive doubts, preoccupation with details, perfectionism interfering with task completion, excessive conscientiousness and pedantry, rigidityintrusion of insistent and unwelcome thoughts or impulses that do no

19、t attain the severity of an obsessive-compulsive disorderPersonality (disorder):compulsiveobsessionalobsessive-compulsive 第11页，共28页。F60.6 Anxious (Avoidant) Personality DisorderAnxious (avoidant) personality disorder:characterized by persistent and pervasive feelings of tension and apprehension, pre

20、occupation with being criticized or rejected by others, avoidance of social or occupational activities because of fears of disapproval or rejection 第12页，共28页。F60.7 Dependent Personality DisorderDependent personality disorder:characterized by pervasive passive reliance on other people to make ones ma

21、jor and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily lifelack of vigour may show itself in the intellectual or emotional spheresthere is often a tendenc

22、y to transfer responsibility to others. Personality (disorder):asthenicinadequatepassiveself-defeating 第13页，共28页。F62 Enduring Personality Changes, not Attributable to Brain Damage and DiseaseF62Enduring personality changes, not attributable to brain damage and disease F62.0Enduring personality chang

23、e after catastrophic experience F62.1Enduring personality change after psychiatric illness F62.8Other enduring personality changes F62.9Enduring personality change, unspecified 第14页，共28页。F62.0 Enduring Personality Change after Catastrophic ExperienceEnduring personality change after catastrophic exp

24、erience:present for at least two years, following exposure to catastrophic stresscharacterized by a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of being on edge as if constantly threatened, and estrangement.enduring pe

25、rsonality change after psychiatric illness (mostly schizophrenia) may appear due to the traumatic experience of suffering from a severe psychiatric illnessPersonality change after: concentration camp experiencesdisastersprolonged:captivity with an imminent possibility of being killedexposure to life

26、-threatening situations such as being a victim of terrorismtorture 第15页，共28页。Treatment of Personality DisordersPsychotherapypeople who complain about lack of confidence and have difficulties in making relationships are usually motivated for psychotherapyin emotionally unstable and dissocial personal

27、ities disorders the patient should recognize the situations which provoke his/her pathological reactions and should manage to avoid thempsychotherapy of personality disorders is a very difficult task and to reach a partial effect requests patients thorough motivationPharmacotherapy helps in emotiona

28、l disordersanxiolytics and SSRI antidepressants suppress anxiety and depressive symptomslithium and other thymoprofylactics (carbamazepin, valproic acid) reduces mood fluctuation and aggressive tendencies第16页，共28页。F63 Habit and Impulse DisordersF63Habit and impulse disorders F63.0Pathological gambli

29、ng F63.1Pathological fire-setting (pyromania)F63.2Pathological stealing (kleptomania)F63.3Trichotillomania F63.8Other habit and impulse disorders F63.9Habit and impulse disorder, unspecified 第17页，共28页。F63.0 Pathological GamblingPathological gambling:consists of frequent, repeating episodes of gambli

30、ng which dominate patients life leading to social, occupational, material and family detrimentit means an intense urge to gamble and preoccupation with ideas of the act of gambling which finally leads to large debts, criminal acting, loss of job and familyPsychotherapy and regime therapy is alike th

31、e treatment of alcoholism (group psychotherapy Anonymous gamblers, 12-steps psychotherapy, family therapy, etc.).第18页，共28页。F63.1 Pathological Fire-Setting (Pyromania)Pyromania:characterized by attempts at, or acts of setting fire to property or objects without any apparent motiveconnected with an in

32、tense interest in watching fires burn and feelings of increasing tension before the act, and intense excitement immediately after it has been carried out第19页，共28页。F63.2 Pathological Stealing (Kleptomania)Kleptomania - pathological stealing:means that the patient suffers from intense impulses to stea

33、l objects that are not acquired for personal use or monetary gainthis disturbance may appear within the symptomatology of eating disorders第20页，共28页。F63.3 TrichotillomaniaTrichotillomania:characterized by noticeable hair loss due to a recurrent failure to resist impulses to pull out hairs第21页，共28页。F6

34、4 Gender Identity DisordersF64Gender identity disorders F64.0Transsexualism F64.1Dual-role transvestism F64.2Gender identity disorder of childhood F64.8Other gender identity disorders F64.9Gender identity disorder, unspecified For details see lecture Paraphilias.第22页，共28页。F65 Disorders of Sexual Pre

35、ferenceF65Disorders of sexual preference F65.0Fetishism F65.1Fetishistic transvestism F65.2Exhibitionism F65.3Voyeurism F65.4Paedophilia F65.5Sadomasochism F65.6Multiple disorders of sexual preference F65.8Other disorders of sexual preference F65.9Disorder of sexual preference, unspecified For detai

36、ls see lecture Paraphilias.第23页，共28页。F66Psychological and behavioural disorders associated with sexual development and orientation F66.0Sexual maturation disorder F66.1Egodystonic sexual orientation F66.2Sexual relationship disorder F66.8Other psychosexual development disorders F66.9Psychosexual dev

37、elopment disorder, unspecified F68Other disorders of adult personality and behaviour F68.0Elaboration of physical symptoms for psychological reasons F68.1Intentional production or feigning of symptoms or disabilities, either physical or psychological (factitious disorder)F68.8Other specified disorde

38、rs of adult personality and behaviour F69Unspecified disorder of adult personality and behaviour For details see lecture Paraphilias.第24页，共28页。The Law and Ordinary Psychiatric PracticeConsent to medical treatment and to hospitalization - the patient should be informed about the treatment procedures

39、and probable side-effects of them to be able to give informed consent”.Compulsory admission and treatment (“admission without consent”) is realized in emergency situations (suicidal attempts, aggressive behaviour due to mental disorder towards other people, disorders of behaviour endangering patient

40、s life). A compulsory admission should be reported to the local court within 24 hours; the court will decide within one weeks period whether the admission has been justified.第25页，共28页。Civil LawTestamentary capacity means that the individual is able to make a valid will. If there are some doubts about it, the validity of the testament can be challenged. The testator should be of sound disposing mind” at the time of making it.Four legal criteria:the testator understands what a will is and what its consequences arehe knows the nature and extent of his prop