LIRA UNIVERSITY

P.O. Box 1035

Lira, Uganda
Tel: +256 -0414-694716
Email: ahealth.faculty@lirauni.ac.ug
Web: www.lirauni.ac.ug

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

COURSE UNIT: COMMUNITY MENTAL HEALTH

COURSE CODE: PHL3105

NAME OF LECTURER: Ms. ARYEK-KWE JOSEPHINE

Name REG.NO. Signature

NABYESERO 19/U/0320/PHL/PS
CATHERINE

BINEPE LHWANZO 19/U/0054/PHL

BWAMBALE
NIMUSIIMA PRAISE 19/U/0069/PHL
MAGEZI DERRICK 19/U/0059/PHL

PERSONALITY DISORDERS

Personality is the combination of thoughts, emotions, and behaviors that makes an individual
unique. It is the totality of the person’s emotional and behavioral traits that characterize their
day-to-day living.

Traits are all the aspects of a person's behavior and attitudes that make a person unique from
others

Personality disorder is a type of a mental disorder in which an individual has a rigid and
unhealthy pattern of thinking, functioning and behaving. These disorders are deeply ingrained,
maladaptive patterns of behavior, generally recognizable by adolescence and continuing
throughout adult life (Patricia Casey, 1974).

In some cases people may not realize that they have personality disorders because there way of
thinking and behaving seems natural to them and often blame others for the challenges they face

A person with personality disorder has trouble perceiving and relating to situations and people.
This causes significant problems and limitations in relationships, social activities, work and
school.

Personality disorders usually begin in teenage years or early adulthood. There are many types of
personality disorders some types may become less obvious throughout middle age

TYPES OF PERSONALITY DISORDERS

The ICD-11 nomenclature for Personality Disorders focuses on the impairment of self and
interpersonal personality functioning, which is classified according to degree of severity

 Personality Difficulty,
  Mild Personality Disorder,
 Moderate Personality Disorder and
 Severe Personality Disorder

Furthermore, the diagnosis may also be specified with one or more prominent trait qualifiers
Negative Affectivity, Detachment, Dissociality, Disinhibition, and Anankastia which contribute
to the impairment in personality functioning.

DSM−IV recognizes three clusters of personality disorder based on similar characteristics and
symptoms. Many people with one personality disorder have signs and symptoms of at least one
additional personal disorder

 Cluster A or the eccentric group which incorporate the paranoid, schizoid and schizotypal
categories (Schizo2Para)
 Cluster B or the dramatic group which includes the histrionic, borderline, narcissistic and
antisocial (BANa-H
 Cluster C or the anxious group which includes the obsessive−compulsive, avoidant and
dependent groups. DAOc

CLUSTER A

These are characterized by odd, eccentric thinking or behavior

Paranoid personality disorders

 People with this disorder have a constant mistrust and suspicion of others even those
they can trust for example parents and spouses.
 Unjustified belief that other are trying to herm of deceive them
 Angry or hostile reaction to perceived slights or insults
 Tendency to hold grudges

Schizoid personality disorder

 People with this disorder are characterized by aloofness (are distant and unfriendly),
detachment and emotional coldness.
  Lack of interest in social or personal relationships, preferring to be alone

 Limited range of emotional expression

 Inability to take pleasure in most activities

 Inability to pick up normal social cues

 Appearance of being cold or indifferent to others

 Little or no interest in having sex with another person

Schizotypal personality disorders

 People with schizotypal personalities are aloof and isolated but do have a feeling of
involvement in the world and have the capacity to form relationships to some extent.
 Peculiar dress, thinking, beliefs, speech or behavior
 Odd perceptual experiences, such as hearing a voice whisper your name
 Flat emotions or inappropriate emotional responses
 Social anxiety and a lack of or discomfort with close relationships
 Indifferent, inappropriate or suspicious response to others
 They usually have odd beliefs not amounting to delusions, magical thinking and
suspiciousness (Bender, 2004).

CLUSTER B

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable

thinking or behavior

Antisocial personality disorder

These people are sometimes called sociopaths or psychopaths and have following features

 Disregard for others' needs or feelings

 Persistent lying, stealing, using aliases, conning others
 Recurring problems with the law
 Repeated violation of the rights of others
 Aggressive, often violent behavior
  Disregard for the safety of self or others

Borderline personality disorder

Borderline means standing on the border between neurosis and psychosis.

 People with this disorder are characterized by unstable moods, poor self-image, chaotic
relationships and impulsive behavior like sexual promiscuity, substance abuse, over
spending and reckless driving.
 They have impulsivity of behavior with repeated self-harm, often cutting to express
anger, seek attention or numb the emotional pain.
 They have high distress and anger levels so they may be easily offended.
 These patients often have feelings of boredom and emptiness
 Can’t tolerate being alone and therefore engage in a frantic search for company and
promiscuous behavior.

Histrionic personality disorder

 Patients are characterized by intense, unstable emotions and distorted self-images.

 Their self-esteem depends on approval by others and does not arise from a true feeling of
self-worth.
 They have overwhelming desire to be noticed and are therefore dramatic and childish.
 This disorder is more common in women than in men and usually evident by early
adulthood.

Narcissistic personality disorder

People with this disorder have a grandiose sense of self-importance. Patients are characterized by
an exaggerated sense of superiority and preoccupied by fantasies of success, power and brilliance
and they believe it is their right to receive special treatment.

 They are usually self-centered,

 Lack empathy and also require constant attention and admiration.
 Patients direct feelings of envy at those whom they perceive as being more successful.
  They exaggerate their personal worth and may show interpersonal exploitativeness for
example they enter relationships only if they believe it will profit them (Bateman, 2006).

CLUSTER C

Avoidant personality disorder

 People with this disorder tend to avoid social contacts due to excessive concern over
being embarrassed or harshly judged.
 They are characterized by extreme social inhibition, inadequacy and sensitivity to
negative criticism and rejection.
 This affects their ability to interact with others and maintain relationships in day to day
life.
 They are shy, tense and easily embarrassed as a result they are isolated and lonely yet
have an overwhelming need to be accepted, while also being unsure of their self-worth
(Alden, 2002).

Dependent personality disorders

 Patients are characterized by a feeling of helplessness, submissiveness, dependency and

inability to make decisions.
 They have an overwhelming need to have others take care of them and spend great effort
trying to please them.
 They believe they can’t take care of themselves and have trouble making every day
decisions such as what to wear, eat without other other’s reassurance.
 They display passive and clinging behaviors and have a fear for separation.

Obsessive compulsive (anankastic) personality disorder (OCPD)

OCPD is defined by strict orderliness, control and perfectionism. People with this disorder are
characterized by

 punctuality
 neatness
 Difficulty with uncertainty and a great need to be in control.
  Such individuals like routine and may have a timetable for each day, which is not
permitted to vary from week to week.
 They may be rigid in their views, lack spontaneity and in extreme cases insist on others
adhering to their views and their timetables, leading to disagreements. This affects their
relationship with others (Association, 1952).

CAUSES OF PERSONALITY DISORDERS

Personality disorders are thought to be caused by a combination of genetic and environmental

influences as explained below

Genetics, some studies show that some malfunctioning genes might cause certain personality
disorders. Others link anxiety, fear and aggression to genetics. It’s also believed that certain
personality traits are passed just inherited from parents.

Environment, this involves the surrounding one grows in, events that occurred and relationships
with family members and others. Children raised in hostile environment have suffered from
insensitive parenting and verbal abuse during childhood and are three times more likely to suffer
from narcissistic personality disorder

Social economic status, an individual’s economic background greatly influences their

personality throughout their entire life.

Faulty child upbringing

 Childhood trauma, many people who are diagnosed with borderline or schizotypal
personality disorder experienced sexual/bullying during childhood.
 Peers, strong bonds or relationships with family, relatives or friends might cause
dependent personality disorders

High reactivity, sensitivity to light, texture, noise and other stimuli might cause a very young
child to develop anxious personalities during their teenage years and into adulthood

RISK FACTORS

 Family history of personality disorders or other mental illness

  Being diagnosed with childhood conduct disorder
 Variations in brain chemistry and structure

DIAGNOSIS

Observation, observe antisocial personality disorders – rash, irresponsible and aggressive

Mental state examination, psychiatric evaluation; discuss about the thoughts, feelings and
behavior through use of questionnaires. Eg. Screening instrument, the Iowa Personality Disorder
Screen

MANAGEMENT

Personality disorders may not change throughout the individual’s entire life but management is
about challenging ones thinking and behavior.

Psychotherapy (talk therapy)

It’s provided in individual sessions, group therapy or sessions that include family and friends.
Here the therapist deals with the patient by encouraging them to talk about their condition,
feelings, thoughts, mood and behavior. There are different types of psychotherapy given for
management of personality disorders and they include;

 Cognitive behavioral therapy helps patients to recognize and alter their inaccurate
perception about themselves, other people and the world around them.
 Interpersonal therapy; this mainly focuses on how patients interact with family and
friends. It’s based on the idea that a person’s way of communicating with others affects
the person’s mood and feelings and also improves communication skills
 Family focused therapy; this therapy educates the patient’s family on their family
member’s condition and informs them the ways to effectively handle or live with
difficulties associated with the condition.

Medication;
Antidepressants; taken to control and suppress feelings of anger, hopelessness and impulsivity
induced by personality disorders. Examples include, selective serotonin reuptake inhibitors like
fluoxetine and tricyclic antidepressants like amitriptyline,

Mood stabilizers; these can reduce irritability, mood swings and impulsive behavior. They are
mainly used in managing borderline personality disorder. Examples include lithium carbonate

Antipsychotics; are usually prescribed for people with schizoid personality disorder. They are
prescribed if the patient is losing touch with reality and to prevent recurring self-harm

Anxiolytics; they promote a sense of wellbeing in patients with personality disorders. For
example Benzodiazepines

Lifestyle modifications

 Avoid drug abuse and alcohol

 Get routine medical care
 Do physical activity to manage symptoms like depression, stress and anxiety

Conclusion

Personality disorders are also inflexible and pervasive across many situations, largely due to the
fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego
integrity of the individual) and are therefore perceived to be appropriate by that individual. In
addition, people with personality disorders often lack insight into their condition and so refrain
from seeking treatment. This behavior can result in maladaptive coping skills and may lead to
personal problems that induce extreme anxiety, distress, or depression and result in impaired
psychosocial functioning.

EPILEPSY
Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes
abnormal, causing seizures or periods of unusual behavior, sensations and sometimes loss of
awareness. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.
People with epilepsy are more likely to suffer from other issues, including mental health
concerns. Nearly 30 percent of people with epilepsy also have psychiatric problems. Depression
and anxiety are common, and epileptics also face a higher risk of suicide.
General Symptoms
Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process
your brain coordinates. Seizure signs and symptoms may include:
 Temporary confusion
 A staring spell
 Stiff muscles
 Uncontrollable jerking movements of the arms and legs
 Loss of consciousness or awareness
 Psychological symptoms such as fear, anxiety or deja vu
Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend
to have the same type of seizure each time, so the symptoms will be similar from episode to
episode.
Types of epilepsy
Doctors generally classify seizures as either focal or generalized, based on how and where the
abnormal brain activity begins.
1. Focal seizures
When seizures appear to result from abnormal activity in just one area the brain, they're called
focal seizures. These seizures fall into two categories:
Focal seizures without loss of consciousness: Once called simple partial seizures, these seizures
don't cause a loss of consciousness. They may alter emotions or change the way things look,
smell, feel, taste or sound. Some people experience Deja vu. This type of seizure may also result
in involuntary jerking of one body part, such as an arm or leg, and spontaneous sensory
symptoms such as tingling, dizziness and flashing lights.
Focal seizures with impaired awareness. Once called complex partial seizures, these seizures
involve a change or loss of consciousness or awareness. This type of seizure may seem like
being in a dream. During a focal seizure with impaired awareness, one stares into space and not
respond normally to the environment or perform repetitive movements, such as hand rubbing,
chewing, swallowing or walking in circles.
Symptoms of focal seizures may be confused with other neurological disorders, such as
migraine, narcolepsy or mental illness. A thorough examination and testing are needed to
distinguish epilepsy from other disorders.

2. Generalized seizures
Seizures that involve all areas of the brain are called generalized seizures. Six types of
generalized seizures exist.
Absence seizures. Absence seizures, previously known as petit mal seizures, typically occur in
children. They're characterized by staring into space with or without subtle body movements
such as eye blinking or lip smacking and only last between 5-10 seconds. These seizures may
occur in clusters, happening as often as 100 times per day, and cause a brief loss of awareness.
Tonic seizures. Tonic seizures cause stiff muscles and may affect consciousness. These seizures
usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control.
Since this most often affects the legs, it often causes you to suddenly collapse or fall down.
Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle
movements. These seizures usually affect the neck, face and arms.
Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches and
usually affect the upper body, arms and legs.
Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the
most dramatic type of epileptic seizure. They can cause an abrupt loss of consciousness and body
stiffening, twitching and shaking. They sometimes cause loss of bladder control or biting your
tongue.
Causes
Epilepsy has no identifiable cause in about half the people with the condition. In the other half,
the condition may be traced to various factors, including:
Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you
experience or the part of the brain that is affected, run in families. In these cases, it's likely that
there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, but
for most people, genes are only part of the cause of epilepsy. Certain genes may make a person
more sensitive to environmental conditions that trigger seizures.
Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause
epilepsy.
Brain abnormalities. Abnormalities in the brain, including brain tumors or vascular
malformations such as arteriovenous malformations (AVMs) and cavernous malformations, can
cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.
Infections. Meningitis, HIV, viral encephalitis and some parasitic infections can cause epilepsy.
Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by
several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This
brain damage can result in epilepsy or cerebral palsy.
Developmental disorders. Epilepsy can sometimes be associated with developmental disorders,
such as autism.
Risk factors
Certain factors may increase your risk of epilepsy:
Age. The onset of epilepsy is most common in children and older adults, but the condition can
occur at any age.
Family history. If you have a family history of epilepsy, you may be at an increased risk of
developing a seizure disorder.
Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your
risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing,
riding a motorcycle or engaging in other activities with a high risk of head injury.
Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead
to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of
these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy
diet, and exercising regularly.
Dementia. Dementia can increase the risk of epilepsy in older adults.
Brain infections. Infections such as meningitis, which causes inflammation in your brain or
spinal cord, can increase your risk.
Seizures in childhood. High fevers in childhood can sometimes be associated with seizures.
Children who have seizures due to high fevers generally won't develop epilepsy. The risk of
epilepsy increases if a child has a long fever-associated seizure, another nervous system
condition or a family history of epilepsy.
Common challenges for people with epilepsy include:
 Physical constraints
 Low self-esteem
 Fewer educational options
 Fewer work options
 Social isolation
 Inability to drive
 Perceived or real stigma

Treatment can help most people with epilepsy have fewer seizures, or stop having seizures
completely.
Treatments include
Anti-epileptic drugs (AEDs)
AEDs are the most commonly used treatment for epilepsy. They help control seizures in around
7 out of 10 of people.
AEDs work by changing the levels of chemicals in the brain. They do not cure epilepsy, but can
stop seizures happening.
Types of AED
Common types include:
 sodium valproate
 carbamazepine
 lamotrigine
 levetiracetam
 topiramate
The best type depends on things like the type of seizures, age and pregnancy.
Antidepressants or other medication may be prescribed. Psychotropic drugs can offer relief from
some symptoms and help to stabilize mood.
Brain surgery
Surgery to remove part of your brain may be an option if tests show that the seizures are caused
by a problem in a small part of your brain that can be removed without causing serious effects
In these cases, there's a good chance that the seizures could stop completely after surgery.
Other procedures
If AEDs are not controlling your seizures and brain surgery is not suitable for you, there are
other procedures that could help.
Vagus nerve stimulation (VNS). Vagus nerve stimulation (VNS) is where a small electrical
device similar to a pacemaker is placed under the skin of the chest. The device is attached to a
wire that goes under the skin and connects to a nerve in the neck called the vagus nerve. Bursts
of electricity are sent along the wire to the nerve, this can help control seizures by changing the
electrical signals in the brain.
VNS does not usually stop seizures completely, but it can help make them less severe and less
frequent.
Deep brain stimulation (DBS)
Deep brain stimulation (DBS) is similar to VNS. But the device placed in the chest is connected
to wires that run directly into the brain.Bursts of electricity sent along these wires can help
prevent seizures by changing the electrical signals in the brain. DBS is a fairly new procedure
that's not used very often, so it's not yet clear how effective it is for epilepsy.
Ketogenic diet
A ketogenic diet is a diet high in fats, and low in carbohydrates and protein. In children, the diet
is thought to make seizures less likely by changing the levels of chemicals in the brain. The
ketogenic diet was one of the main treatments for epilepsy before AEDs were available. But it's
now not widely used in adults because a high-fat diet is linked to serious health conditions, such
as diabetes and cardiovascular disease.
NON-PHARMACOLOGICAL TREATMENT
Many people with epilepsy suffer from mood disorders, but symptoms may be different than in
the general population. It’s important for a careful psychiatric evaluation to be done. Annual
screening for depression should be a routine part of care. Regular screening can help detect and
treat mood disorders before they become serious or life-threatening.
Cognitive Behavioral Therapy;
Cognitive behavioral therapy is grounded in the belief that thoughts guide feelings and actions. It
has been shown to reduce depression, anxiety, or anger in some people with epilepsy So if one
wants to manage their feelings and change their actions, they must first focus on changing their
thinking patterns
Educational Intervention
Educating patients about epilepsy can help in many ways. One study showed that people who
were given education about their epilepsy showed more understanding and less fear of seizures.
They were less likely to follow harmful self-treatment practices like changing their medication
dosage on their own.
Another study showed that children with epilepsy who received education about it behaved
better, saw themselves as being more socially able, and participated in more normal activities
than children with epilepsy who were not educated about it. Parents of children with epilepsy felt
less anxious after receiving educational intervention on epilepsy.
Relaxation Therapy
It is well known that stress can be a major contributor to poor sleep habits, changes in hormone
levels, and seizures. The goal of relaxation therapy is to reduce response to stress in life. Among
the many types of relaxation therapies are:
 Massage
 Acupuncture
 Progressive muscle relaxation
 Meditation
 Deep breathing
Talk Therapy
Therapy can help people with epilepsy cope with some of the emotional strain. Talking with a
trained professional can help to reduce psychological stress and improve mood. People can learn
strategies to better cope with some of the unavoidable challenges.
Support Groups
Epilepsy support groups can also be a good resource, as people with epilepsy sometimes feel
isolated. These groups are available for children, teens or adults. Joining a group of people with
similar challenges can benefit overall wellbeing. Support groups can be an effective way for
people living with epilepsy to build meaningful community and form friendships
Tracking Health
The area of the brain where seizures occur can also develop other problems. Keeping a daily
record helps individuals notice any changes in:
 Learning, concentration or memory problems
 Problems at school
 Problems sleeping
 Changes in mood or behavior
 Unexplained injuries or falls

REFERENCES

Alden, L. E. (2002). Avoidant personality disorder. Journal of personlity disorders, 16.

Association, A. P. (1952). Diagnostic and stastical manual of mental disorders.

Bateman, A. F. (2006). Mentalization-based treatment for borderline personality disorder. Oxford

university press.

Bender, E. (2004). personality disorders prevalence surprises researches. Psychiatric news, 39.

Patricia Casey, B. K. (1974). Fish's clinical psychopathology.

Mayor clinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093