人格障礙和法醫(yī)精神病學(xué)

1、Personality Disorders and Forensic Psychiatry,Department of Psychiatry1st Faculty of MedicineCharles University, PragueHead: Prof. MUDr. Ji?í Raboch, DrSc.,,Disorders of Adult Personality and Behaviour (F60-F69),

2、F60Specific personality disorders F61Mixed and other personality disorders F62Enduring personality changes, not attributable to brain damage and disease F63Habit and impulse disorders F64Gender id

3、entity disorders F65Disorders of sexual preference F66Psychological and behavioural disorders associated with sexual development and orientation F68Other disorders of adult personality and behaviour F69Unspec

4、ified disorder of adult personality and behaviour,F60 Specific Personality Disorders,F60Specific personality disorders F60.0Paranoid personality disorder F60.1Schizoid personality disorder F60.2Dissocial person

5、ality disorder F60.3Emotionally unstable personality disorder F60.4Histrionic personality disorder F60.5Anankastic personality disorder F60.6Anxious (avoidant) personality disorder F60.7Dependent personali

6、ty disorder F60.8Other specific personality disorders F60.9Personality disorder, unspecified,F60 Specific Personality Disorders,Specific personality disorderssevere disturbances in the personality and behavioural

7、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 wit

8、h considerable personal distress and social disruptionusually manifest since childhood or adolescence and continuing throughout adulthood.,F60 Specific Personality Disorders,Personality disorder is persistent and appear

9、s already within late childhood and adolescence being fully manifested in adulthood (diagnosing after the age of 16-17 years)The disorder is usually associated with significant problems in occupational and social perfor

10、manceCauses of personality disorders are mostly genetic though the influence of upbringing, parent-child relationship and social environment play also their roles.,F60.0 Paranoid Personality Disorder,Paranoid personalit

11、y 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 cont

12、emptuous, suspiciousness concerning fidelity of sexual partner, tendencies to experience excessive self-importance and preoccupation with unsubstantiated conspiratorial explanations of events.Personality (disorder): e

13、xpansive paranoidfanaticquerulantparanoidsensitive paranoid,F60.1 Schizoid Personality Disorder,Schizoid personality disorder - few activities provide pleasure, emotional coldness, limited capacity to express either

14、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 preoccupation with fantasy and int

15、rospection, lack of close friends and marked insensitivity to prevailing social norms and conventions.,F60.2 Dissocial Personality Disorder,Dissocial personality disorder:gross disparity between behaviour and the prevai

16、ling social normsa callous disregard for the feelings of others, incapacity to maintain enduring relationships, gross attitude of irresponsibilityvery low tolerance to frustration, a low threshold for discharge of aggr

17、ession and violenceincapacity to experience guilt and to profit from experience including punishmenta tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflic

18、t with societyPersonality (disorder): amoralantisocialasocialpsychopathicsociopathic,F60.3 Emotionally Unstable Personality Disorder,Emotionally unstable personality disorder:characterized by a definite tendency

19、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 distingui

20、shed:impulsive type - characterized predominantly by emotional instability and lack of impulse control,borderline type - characterized in addition by disturbances in self-image, aims, and internal preferences, by chron

21、ic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attemptsPersonality (disorder): aggressiveborderlineexpl

22、osive,F60.4 Histrionic Personality Disorder,Histrionic personality disorder:self-dramatization, pseudologia phantastica, exaggerated expression of emotions, enhanced suggestibility, shallow and labile affectivity, conti

23、nual seeking 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, man

24、ipulative behaviourPersonality (disorder):hystericalpsychoinfantile,F60.5 Anankastic Personality Disorder,Anankastic personality disorder:characterised by feelings of excessive doubts, preoccupation with details, pe

25、rfectionism interfering with task completion, excessive conscientiousness and pedantry, rigidityintrusion of insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disord

26、erPersonality (disorder):compulsiveobsessionalobsessive-compulsive,F60.6 Anxious (Avoidant) Personality Disorder,Anxious (avoidant) personality disorder:characterized by persistent and pervasive feelings of tension

27、 and apprehension, preoccupation with being criticized or rejected by others, avoidance of social or occupational activities because of fears of disapproval or rejection,F60.7 Dependent Personality Disorder,Dependent per

28、sonality disorder:characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance wi

29、th 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 tendency to transfer responsibility to others.

30、 Personality (disorder):asthenicinadequatepassiveself-defeating,F62 Enduring Personality Changes, not Attributable to Brain Damage and Disease,F62Enduring personality changes, not attributable to brain damage and

31、disease F62.0Enduring personality change after catastrophic experience F62.1Enduring personality change after psychiatric illness F62.8Other enduring personality changes F62.9Enduring personality change, unsp

32、ecified,F62.0 Enduring Personality Change after Catastrophic Experience,Enduring personality change after catastrophic experience:present for at least two years, following exposure to catastrophic stresscharacterized b

33、y 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 perso

34、nality change after psychiatric illness (mostly schizophrenia) may appear due to the traumatic experience of suffering from a severe psychiatric illnessPersonality change after: concentration camp experiencesdisaster

35、sprolonged:captivity with an imminent possibility of being killedexposure to life-threatening situations such as being a victim of terrorismtorture,Treatment of Personality Disorders,Psychotherapypeople who complain

36、 about lack of confidence and have difficulties in making relationships are usually motivated for psychotherapyin emotionally unstable and dissocial personalities disorders the patient should recognize the situations wh

37、ich 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 patient’s thorough motivationPharmacother

38、apy helps in emotional disordersanxiolytics and SSRI antidepressants suppress anxiety and depressive symptomslithium and other thymoprofylactics (carbamazepin, valproic acid) reduces mood fluctuation and aggressive ten

39、dencies,F63 Habit and Impulse Disorders,F63Habit and impulse disorders F63.0Pathological gambling F63.1Pathological fire-setting (pyromania)F63.2Pathological stealing (kleptomania)F63.3Trichotillomania F63.8

40、Other habit and impulse disorders F63.9Habit and impulse disorder, unspecified,F63.0 Pathological Gambling,Pathological gambling:consists of frequent, repeating episodes of gambling which dominate patient’s life lea

41、ding 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 fami

42、lyPsychotherapy and regime therapy is alike the treatment of alcoholism (group psychotherapy — Anonymous gamblers, 12-steps psychotherapy, family therapy, etc.).,F63.1 Pathological Fire-Setting (Pyromania),Pyromania:ch

43、aracterized by attempts at, or acts of setting fire to property or objects without any apparent motiveconnected with an intense interest in watching fires burn and feelings of increasing tension before the act, and inte

44、nse excitement immediately after it has been carried out,F63.2 Pathological Stealing (Kleptomania),Kleptomania - pathological stealing:means that the patient suffers from intense impulses to steal objects that are not a

45、cquired for personal use or monetary gainthis disturbance may appear within the symptomatology of eating disorders,F63.3 Trichotillomania,Trichotillomania:characterized by noticeable hair loss due to a recurrent failur

46、e to resist impulses to pull out hairs,F64 Gender Identity Disorders,F64Gender identity disorders F64.0Transsexualism F64.1Dual-role transvestism F64.2Gender identity disorder of childhood F64.8Other gender

47、identity disorders F64.9Gender identity disorder, unspecified,For details see lecture Paraphilias.,F65 Disorders of Sexual Preference,F65Disorders of sexual preference F65.0Fetishism F65.1Fetishistic transvesti

48、sm 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, uns

49、pecified,For details see lecture Paraphilias.,F66Psychological and behavioural disorders associated with sexual development and orientation F66.0Sexual maturation disorder F66.1Egodystonic sexual orientation F66

50、.2Sexual relationship disorder F66.8Other psychosexual development disorders F66.9Psychosexual development disorder, unspecified F68Other disorders of adult personality and behaviour F68.0Elaboration of phys

51、ical symptoms for psychological reasons F68.1Intentional production or feigning of symptoms or disabilities, either physical or psychological (factitious disorder)F68.8Other specified disorders of adult personality

52、and behaviour F69Unspecified disorder of adult personality and behaviour,For details see lecture Paraphilias.,The Law and Ordinary Psychiatric Practice,Consent to medical treatment and to hospitalization - the patien

53、t should be informed about the treatment procedures and probable side-effects of them to be able to give ?informed consent”.Compulsory admission and treatment (“admission without consent”) is realized in emergency situ

54、ations (suicidal attempts, aggressive behaviour due to mental disorder towards other people, disorders of behaviour endangering patient’s life). A compulsory admission should be reported to the local court within 24 hour

55、s; the court will decide within one week’s period whether the admission has been justified.,Civil Law,Testamentary capacity means that the individual is able to make a valid will. If there are some doubts about it, the v

56、alidity 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 t

57、he nature and extent of his propertyhe knows the names of close relatives and can assess their claims to his propertyhe is free from an abnormal state of mind.Serious and persistent mental disorders cause incapacity o

58、f making decisions; the court appoints a guardian who is looking after patient’s affairs.,Criminal Law,A person who committed a crime in a state of mental disorder undergoes psychiatric examination:the expert gives a re

59、port on the mental state of the offender at the time of crime and on his/her present mental condition according to the report conclusions the court decides about diminished or missing responsibility of the offender and

60、about fitness to pleadif the offender is dangerous to other people on the ground of medical reasons the court can order compulsory treatment (psychiatric, antialcoholic, antitoxicomanic, sexuological),Psychiatric (Court

61、) Report,Psychiatric report is worked out at the request of police, prosecutor, counselor, court or any part of the action in court. It includesthe data of the examinationfamily and personal historythe account of the

62、crime given by the accused personpresent mental statemental state at the time of the crimefitness to pleadFinally the expert replies the questions put by the court.The court takes account of a report as of any other