Organic personality disorder

Organic personality disorder (OPD) is not included in the wide variety of group of personality disorders. For this reason, the symptoms and diagnostic criteria of the organic personality disorder are different from those of the mental health disorders, which are included in this various group of personality disorders. According to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems ICD-10, it defines the organic personality disorder as the personality change, which can be caused by traumatic brain injury (TBI) that means there are specific brain areas of patients, which have been injured after a very strong accident. Moreover, according to the ICD-10, the organic personality disorder is associated with a "significant alteration of the habitual patterns of premorbid behaviour".[1] Furthermore, organic personality disorder is associated with "personality change due to general medical condition".[2] There are crucial influences on emotions, impulses and personal needs because of this disorder. Thus, all these definitions about the organic personality disorder support that this type of disorder is associated with changes in personality and behaviour.

Causes

The organic personality disorder is included in a wide group of personality and behavioural disorders. This mental health disorder can be caused by disease, brain damages or dysfunctions in specific brain areas in frontal lobe. The most common reason for this profound change in personality is the traumatic brain injury (TBI).[1] Children, whose brain areas have been injured or damaged, may present attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and organic personality disorder.[3] Moreover, this disorder is characterised as "frontal lobe syndrome". This characteristic name shows that the organic personality disorder can usually be caused by lesions in three brain areas of frontal lobe. Specifically, the symptoms of organic personality disorder can also be caused by traumatic brain injuries in orbitofrontal cortex, anterior cingulate cortex and dorsolateral prefrontal cortex. It is worth mention that organic personality disorder may also be caused by lesions in other circumscribed brain areas.[4]

Diagnosis and symptoms

The ICD-10 includes a diagnostic guideline for the wide group of personality and behavioural disorders. However, every disorder has its own diagnostic criteria. In case of the organic personality disorder, patient has to show at least three of the following diagnostic criteria over a six or more months period. Organic personality disorder is associated with a large variety of symptoms, such as deficits in cognitive function, dysfunctional behaviours, psychosis, neurosis, emotional changes, alterations in expression function and irritability.[5] Patients with organic personality disorder can present emotional lability that means their emotional expressions are unstable and fluctuating. In addition, patients show reduction in ability of perseverance with their goals and they express disinhibited behaviours, which are characterised by inappropriate sexual and antisocial actions. For instance, patients can show dissocial behaviours, like stealing. Moreover, according to diagnostic guideline of ICD-10, patients can suffer from cognitive disturbances and they present signs of suspiciousness and paranoid ideas. Additionally, patients may present alteration in process of language production that means there are changes in language rate and flow. Furthermore, patients may show changes in their sexual preference and hyposexuality symptoms.[6]

Another common feature of personality of patients with organic personality disorder is their dysfunctional and maladaptive behaviour that causes serious problems in these patients, because they face problems with pursuit and achievement of their goals. It is worth to be mentioned that patients with organic personality disorder express a feeling of unreasonable satisfaction and euphoria. Also, the patients show aggressive behaviours sometimes and these serious dysfunctions in their behaviour can have effects on their life and their relationships with other people.[7] Specifically patients show intense signs of anger and aggression because of their inability to handle their impulses. The type of this aggression is called "impulsive aggression".[1] Furthermore, it is worth to be mentioned that the pattern of organic personality disorder presents some similarities with pattern of temporal lobe epilepsy (TLE). Specifically patients who suffer from this chronic disorder type of epilepsy, express aggressive behaviours, likewise it happens to patients with organic personality disorder.[1] Another similar symptom between Temporal lobe epilepsy and organic personality disorder is the epileptic seizure. The symptom of epileptic seizure has influence on patients' personality that means it causes behavioural alterations".[8] The Temporal lobe epilepsy (TLE) is associated with the hyperexcitability of the medial temporal lobe (MTL) of patients.[1] Finally, patients with organic personality disorder may present similar symptoms with patients, who suffer from the Huntington's disease as well. The symptoms of apathy and irritability are common between these two groups of patients.[9]

Treatment

As it has already been mentioned, patients with organic personality disorder show a wide variety of sudden behavioural changes and dysfunctions. There are not a lot of information about the treatment of this mental health disorder. The pharmacological approach is the most common therapy among patients with organic personality disorder. However, the choice of drug therapy relies on the seriousness of patient's situation and what symptoms are shown. The choice and administration of specific drugs contribute to the reduction of symptoms of organic personality disorder. For this reason, it is crucial for patients' treatment to be assessed by clinical psychologists and psychiatrists before the administration of drugs.

Additionally, the dysfunctions in expression of behaviour of patients with organic personality disorder and the development of symptom of irritability, which are caused by aggressive and self-injurious behaviours, can be dealt with the administration of carbamazepine. Moreover, the symptoms of this disorder can be decreased by the administration of valproic acid. Also, emotional irritability and signs of depression can be dealt with the use of nortriptyline and low-dose thioridazine. Except from the symptom of irritability, patients express aggressive behaviours. At the onset of drug therapy for effective treatment of anger and aggression, the drug of carbamazepine, phenobarbital, benztropine and haloperidol can be administrated in order to reduce the symptoms of patients with organic personality disorder. In addition, the use of propranolol may decrease the frequent behaviours of rage attacks.[10]

Finally, it is important for patients to take part in psychotherapy during drug therapy. In this way, many of the adverse effects of the medications, both physiological and behavioural, can be lessened or avoided entirely. Furthermore, the clinicians can provide useful and helpful support to patients during these psychotherapy sessions. Thus, the combination of drug therapy with psychotherapy can lead to the reduction of symptoms of this disorder and the improvement of patients' situation.

References
  1. Linden, David (2011-11-23). The Biology of Psychological Disorders. Palgrave Macmillan. ISBN 9780230358089.
  2. Widiger, Thomas, A. The Oxford Handbook of Personality Disorders. Oxford Library of Psychology. p. 21.
  3. Barkley, Russell, A. (2015). Attention-Deficit Hyperactivity Disorder. A Handbook for Diagnosis and Treatment (4th ed.). The Guilford Press. p. 374. ISBN 9781462517855.
  4. World Health Organization. "The ICD-10 Classification of Mental and Behavioural Disorders" (PDF). World Health Organization Institutional Repository for Information Sharing. Geneva : World Health Organization.
  5. Franulic, Alexei; et al. (2009). "Organic personality disorder after traumatic brain injury: cognitive, anatomic and psychosocial factors. A 6 month follow-up". Brain Injury. 14 (5): 431–439. doi:10.1080/026990500120538.
  6. "The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research" (PDF). World Health Organization. Geneva: WHO.
  7. Dowson, Jonathan, H.; Grounds, Adrian, T. (1995). Personality Disorders: Recognition and Clinical Management. Cambridge University Press. p. 126. ISBN 9780521029032.
  8. Kaufman, David, Myland (2007). Clinical Neurology for Psychiatrists (6th ed.). SAUNDERS ELSEVIER.
  9. Stein, George; Wilkinson, Greg (April 2007). Seminars in General Adult Psychiatry (2nd ed.). Royal College of Psychiatrists. p. 491. ISBN 9781904671442.
  10. Stark, Jack, A.; Menolascino, Frank, J.; Albarelli, Michael, H.; Gray, Vincent, C. (1988). Mental Retardation and Mental Health: Classification, Diagnosis, Treatment, Services (1st ed.). Springer-Verlag New York Inc.
Classification
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