Return to Scenario ListShow Learning Points most relevant to Phase 1:

Personality disorder

Clinical Discipline(s)/Organ System(s)
Psychiatry/Health Psychology, General Practice, Emergency Medicine
Progress Test Topic(s)
Mental health
You are on your Emergency Medicine placement. You see a 36 year old single NZ European man who is a frequent attender at the Emergency Department. He has presented following multiple cuts to both wrists; a repeated presentation. He reports that his mood is low but this is not consistent with his affect. He appears irritable and sensitive at times. Poor relationships existed with his parents and three siblings; he states ‘they have given up on me’. He was inconsistent when asked about his personal safety, suggesting admission would be safest. He had a history of childhood sexual abuse by an uncle. He reported problematic alcohol use. Current medications include antidepressant, mood stabiliser and antipsychotic medications. Attendance at community clinics has been erratic with multiple non-attendances. With the patient's consent, you contact his parents who are relieved to have received the phone call. They had been worried about their inability to contact him; they report extensive involvement and support of their son.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Current biopsychosocial theories of the aetiology of personality disorders
   - Psychology of temperament and personality
   - DSM-IV classification of personality disorders
Clinical and Communication Skills 
   - Elicit a history from a patient with a personality disorder; assess for other mental health disorders
   - Perform a mental state examination of a patient with a personality disorder
   - Perform a risk assessment for harm to self or others; assess suicide and neglect risk
   - Differential diagnosis of personality disorder
   - Interpret relevant investigations: electrolytes, hormonal screening, toxicology screen, imaging
   - Criteria for referral to psychiatric services
   - Identification of common features in patients with borderline and anti-social personality disorders including barriers to engagement and the development of therapeutic relationshi
   - Management of personality disorder: pharmacological, psychological, and other non-biological methods
   - Managing co-existing disorders such as mental illness that may occur independently of drug and alcohol abuse
   - Prognosis of personality disorders
Personal and Professional Skills 
   - Coping with chronic disease
   - Non-judgmental approach to mental illness
   - Social impact of mental illness
   - Showing empathy
   - Managing challenging behaviour
   - Boundary and personal wellbeing maintenance
   - Awareness of your reactions towards people with personality disorders
   - De-escalation techniques and interviewing with safety in mind
Hauora Māori 
   - Consideration of access to cultural / spiritual support for patient and whānau
   - Risk factors for mental illness in Maori (racism, age, income, deprivation)
   - Ethnic differences in reasons for hospitalisation by diagnosis of mental illness
   - Understand reasons for low contact with mental health services for Māori
   - Ethnic differences in suicide and suicide mortality in New Zealand
Population Health 
   - Epidemiology of personality disorders
   - Risks associated with personality disorders
Conditions to be considered relating to this scenario
antisocial personality disorder, borderline personality disorder, histrionic personality disorder, avoidant personality disorder, obsessive-compulsive personality disorder, passive-aggressive (negativistic) personality disorder, depressive personality disorder, schizophrenia, alcohol abuse/dependence, hypochondriasis, social phobia, post-traumatic stress disorder, schizotypal personality disorder, anxiety disorder, depression, bipolar affective disorder, anorexia nervosa, bulimia nervosa, dissociative disorder, substance abuse and dependence, narcissistic personality disorder, paranoid personality disorder, schizoid personality disorder
Less common but 'important not to miss'
delirium, schizoaffective disorder, schizophreniform disorder
Ganser syndrome