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Personality Disorders A Case Presentation Kate Hooks.

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Presentation on theme: "Personality Disorders A Case Presentation Kate Hooks."— Presentation transcript:

1 Personality Disorders A Case Presentation Kate Hooks

2 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

3 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

4 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)

5 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.

6 2007 Father dies. 2008 2 admissions with suicidal ideas

7 Medical HX IBS Alcoholic polyneuropathy 2009. Medication Pregabalin Ranitidine Thiamine and Vit B Lamotrigine Buspirone Citalopram Quetiapine

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

9 Family Hx 56 Teacher 27 29 Teacher 33 solicitor baby 6

10 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

11 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

12 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.

13 ? Mental state varies on a daily basis and within the consultation.

14 Personality Disorder Cognition Affect Behaviour Epidemiology 2-18% in the community Aetiology Genetics Childhood development Neurophysiology Cognitive-behavioural

15 Management Medication- Antipsychotics Anticonvulsants and lithium Antidepressants Therapeutic community Cognitive behavioural therapy

16 ICD10 Types ParanoidSchizoidDissocial Emotionally unstable- impulsive type Emotionally unstable- Borderline type Histrionic Anxious (avoidant) Anankastic (OC) Dependent

17 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.

18 Section 3 Diagnosis already known Admission for compulsory treatment Up to 6 months Can be extended to 12 months

19 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

20 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

21 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.

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