Paranoid personality disorder
Background
- A pattern of distrust and suspiciousness such that othÂers' motives are interpreted as malevolent
Clinical Features
- Four (or more) of the following criteria, beginning in early adulthood and present in a variety of contexts:[1]
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
- Reads hidden demeaning or threatening meanings into benign remarks or events.
- Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
- Perceives attacks on his or her character or reputation that are not apparent to othÂers and is quick to react angrily or to counterattack.
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
- Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition
Differential Diagnosis
- Other mental disorders with psychotic symptoms
- Personality change due to another medical condition
- Substance use disorders
- Paranoid traits associated with other physical handicaps
- Other personality disorders and personality traits
Evaluation
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- Ask for clarification of any unclear terminology, be genuinely curious, ask clearly about physical symptoms
- Know patient may underreport symptoms due to desire to end social interaction with you
- Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, anti-psychotics and anti-anxiety medications
Disposition
- Discharge
See Also
External Links
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
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