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Key Features

Essentials of Diagnosis

  • Long history dating back to childhood

  • Recurrent maladaptive behavior

  • Difficulties with interpersonal relationships or society

  • Depression with anxiety when maladaptive behavior fails

General Considerations

  • Personality results from the interaction of a genetic substrate with personal drives and outside influences

  • Classification of disorder subtypes depends on the predominant symptoms and their severity

  • The most severe disorders are those that bring the patient into greatest conflict with society and tend to be classified as antisocial or borderline

  • Types of personality disorders

    • Paranoid

    • Schizoid (introverted, withdrawn)

    • Obsessive-compulsive

    • Histrionic (dependent, immature, seductive, egocentric, emotionally labile)

    • Schizotypal (socially isolated, suspicious, eccentric behaviors)

    • Narcissistic

    • Avoidant (fear rejection, low self-esteem)

    • Dependent (passive, unable to make decisions, poor self-esteem)

    • Antisocial (selfish, callous, promiscuous, impulsive)

    • Borderline (impulsive, unstable and intense relationships, affective instability, suicidal)

Clinical Findings

Symptoms and Signs

Table 25–3.Personality disorders: Classification and clinical findings (listed in alphabetical order).

Differential Diagnosis

  • Anxiety disorder, eg, general anxiety disorder

  • Major depressive disorder

  • Psychotic disorder, eg, schizophrenia

  • Substance abuse

  • Bipolar disorder

  • Personality change due to medical illness, eg, CNS tumor, stroke

Diagnosis

Laboratory Tests

  • These are mainly clinical diagnoses

Imaging Studies

  • Consider head CT if there is an abrupt personality change

Treatment

Medications

  • Antipsychotic agents may be required for short periods when conditions have temporarily decompensated into transient psychoses. Options include

    • Olanzapine, 2.5–10.0 mg once daily orally

    • Risperidone, 0.5–2.0 mg once daily orally

    • Haloperidol, ...

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