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I. Personality Disorders:
Concepts
Personality disorder is defined in the ICD 10 as: `Deeply ingrained and enduring behaviour
patterns manifesting themselves as inflexible responses to a broad range of personal and social
situations. They represent either extreme or significant deviations from the way an average
individual in a given culture…

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(Schizotypal ­ grouped with Schizotypal
psychotic disorders in ICD)
Cluster B
Dissocial Antisocial
Emotionally unstable (2 subtypes) Borderline
Impulsive
Borderline
Histrionic Histrionic
Narcissistic
Cluster C
Anankastic Obsessive compulsive
Anxious (avoidant) Avoidant
Dependent Dependent
Cluster A
These disorders have a familial relationship to the schizophrenia spectrum. Stress
decompensation into psychosis can…

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emptiness, paranoid ideation and dissociation.
· Aetiology ­ dynamic theory (the border between neuroses and psychoses, splitting,
projective identification and projection are seen in borderline personality disorder),
attachment disorder, childhood abuse in >75%, low serotonin model and impulsive
behaviour
· High comorbidity with affective, anxiety, somatisation, PTSD and substance misuse…

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· Some evidence for the use of low dose neuroleptics in cluster B and schizotypal disorders
6
· Carbamazepine may be of use in behavioural dyscontrol in borderline PD 7
· Lithium may be of benefit for aggressive behaviour (although the majority of patients
with borderline personality disorder do not…

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also seen. There is a high level of co morbidity between personality disorder and other
mental disorders. 15
Children of parents with personality disorder are more likely to have a mental disorder than
children of parents with schizophrenia.


Mental illness in pregnancy
The first trimester is associated with an increase…

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be relatively safe if taken during pregnancy and do not appear to be teratogenic. Tricyclic
antidepressants have lower known risks during pregnancy than other antidepressants.
Fluoxetine is the SSRI with the lowest known risk during pregnancy. Breastfeeding does not
appear to be a problem with TCAs and the more limited…

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· Extrapyramidal symptoms in the neonate especially with depot medication (these are usually selflimiting).
Actions to take
· Advise women taking antipsychotics who are planning a pregnancy that raised prolactin levels
reduce the chances of conception. If levels are raised, consider an alternative drug.
· If prescribing olanzapine to a…

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Benzodiazepines
Risks to consider
· Cleft palate and other fetal malformations.
· Floppy baby syndrome in the neonate.
Paper III: General Adult Psychiatry - III Diet II: 2008
11
Actions to take
· Do not routinely prescribe to pregnant women, except for the short term treatment of extreme
anxiety and…

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The efficacy of SSRIs in the treatment of both physical and psychological symptoms of
premenstrual syndrome has been confirmed and studies have shown that these drugs also
reduce functional impairment.19 The onset of improvement is more rapid than that in SSRI
treatment of depressive disorder. Treatment can be given throughout…

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