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Psychopharmacology for patients with Personality Disorder

Personality develops in response to inherited dispositions (temperament) and environmental influences


(character), which are experiences unique to each person.
Personality disorders result when the combination of temperament and character development produces
maladaptive, inflexible ways of viewing self, coping with the world, and relating to others.
There are four categories gave by Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text
Revision (DSM-IV-TR; American Psychiatric Association [APA], 2000) and those are Cluster A (Odd and
Eccentric), Cluster B (Dramatic and Emotional), Cluster C (Anxious and Fearful) and Proposed personality
disorder categories: depressive and passive-aggressive personality disorders.
Temperament refers to the biologic processes of sensation, association, and motivation that underlie the
integration of skills and habits based on emotion. There are four types of temperament and those are harm
avoidance, novelty seeking, reward dependence, and persistence.
Pharmacologic treatment of clients with personality disorders focuses on the CLIENTS SYMPTOMS rather than
the particular subtype. The four symptom categories that underlie personality disorders are cognitive
perceptual distortions, including PSYCHOTIC SYMPTOMS; affective symptoms and MOOD DYSREGULATION;
AGGRESSION and behavioural dysfunction; and ANXIETY.

1. PSYCHOTIC SYMPTOMS
- Patients with Cognitive-Perceptual Disturbance, affective dysregulation and detachment with low reward
dependence.
- Under Cluster A classification.
- For Acute and Chronic Psychotic Symptoms
o Conventional / Typical Antipsychotics
Clopixol (Zuclopenthixol) given via IM (Z-track).
Haldol (Haloperidol) oral tablet and IM.
Phenergan (Promethazine) - given via IM.

2. MOOD DYSREGULATION
- Patients with emotional instability, emotional detachment, depression, and dysphoria with low reward
dependence.
- Under Cluster A classification.
- Emotional Lability - refers to rapid, often exaggerated changes in mood, where strong. emotions or feelings
(uncontrollable laughing. or crying, or heightened irritability or temper)
Tegretol (Carbamazepine)- oral tablet

- Atypical Depression / Dysphoria - a subtype of major depression or dysthymic disorder that involves
several specific symptoms, including increased appetite or weight gain, sleepiness or excessive sleep,
marked fatigue or weakness, moods that are strongly reactive to environmental circumstances, and feeling
extremely sensitive to rejection.
o Selective Serotonin Reuptake Inhibitor (SSRIs)
Entapro (Ecitalopram) - oral tablet
Citalogen (Citalopram) - oral tablet
Prozac (Fluoxetine) - oral tablet
Paroxat (Paroxetine) - oral tablet
Zoloft (Sertraline) - oral tablet

o Other Antidepressants
Cymbalta (Duloxetine) - oral capsule
Effexor (Venlaflaxine) - oral capsule
Amitriptyline - oral tablet
Mirzagen / Remeron(Mirtazapine) - oral tablet

- Emotional Detachment- refers to an inability to connect with others on an emotional level, as well as a
means of coping with anxiety by avoiding certain situations that trigger it; it is often described as
"emotional numbing" or dissociation.
o Atypical Antipsychotic
Risperdal, Risperdal Consta (Risperidone) - oral tablet and IM (Z-track).
Zyprexa (Olanzapine) - oral tablet
Seroquel / Atapina (Quetiapine)- oral tablet
Abilify (Aripiprazole) - oral tablet

3. AGGRESSION AND IMPULSIVENESS


- may occur in impulsive people (some with a normal electroencephalogram and some with an abnormal
one); people who exhibit predatory or cruel behaviour; or people with organic-like impulsivity, poor social
judgment, and emotional lability.
- With high novelty seeking and under Cluster B Classification

o Affective Aggression (Normal Electroencephalogram) refers to an emotional, hostile and over-


reactive type of a person to a certain stimuli resulting in impulsive violence.
Anticonvulsants
Depakene - (Valproic Acid)- oral tablet
Tegretol - (Carbamazepine) - oral tablet
Dilantin (Phenitoin) oral capsule
Keppra (Levitiracetam) - oral tablet
Lyrica - (Pregabalin) oral capsule
Conventional / Typical Antipsychotics

o Predatory (hostility / cruelty) - is a type of aggression that is committed in response to a perceived


threat or insult. It is unplanned, reactionary, impulsive, and fuelled by intense emotion as opposed
to desire to achieve a goal. It is also involves hostile revengefulness and taking pleasure of
victimizing others.
Conventional / Typical Antipsychotics
Atypical Antipsychotic

o Organic-like aggression often accompanied by poor social judgement


Cholinergic agonists (donepezil) (N.A.)
Imipramine (Tofranil) (N.A.)

o Ictal aggression (Abnormal Electroencephalogram) or Unprovoked Aggression occurs in patients


with cerebral instability regardless of any associated traits.
Tegretol - (Carbamazepine) - oral tablet
Dilantin (Phenitoin) oral capsule
Benzodiazepines - makes the neuron negatively charged and resistant to excitation.
Rivotril - (Clonazepam)
Xanax - (Alprazolam)
Valium - (Diazepam)
Ativan (Lorazepam)

4. Anxiety
- seen with personality disorders may be chronic cognitive anxiety, chronic somatic anxiety, or severe acute
anxiety.
- With High Alarm Avoidance and under Cluster C classification.
o Chronic cognitive anxiety related symptoms manifested by fear, confusion, repetitive negative
thoughts, difficulty on concentrating/ focusing and other mentally-related symptoms that last
more than six months.
SSRIs
MAOIs (N.A.)
Benzodiazepines

o Chronic somatic -anxiety related symptoms manifested by physical symptoms like stomach aches,
muscle tension, hyperventilation and/or nausea that last more than six months.
MAOIs
SSRIs

o Severe anxiety both symptoms are manifested


MAOIs
Low-dose antipsychotics