Paranoid personality disorder

Background

• A pattern of distrust and suspiciousness such that oth­ers' 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:
  • 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 oth­ers 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

• Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, anti-psychotics and anti-anxiety medications

Disposition

• Discharge

See Also

• Personality disorders