Paranoid personality disorder
There is no accurate data on the prevalence of paranoid personality disorder. Patients rarely ask for help themselves and, when talking to a doctor, deny manifestations of personality disorder if they are sent by their relatives. Among the relatives of patients with schizophrenia, more cases of disorder than in the population. In men, it is more common than in women; individuals at high risk are those who have been formed in situations of various kinds of communicative restrictions (members of national minorities, residents of states with a ollitarian regime, emigrants, deaf people).
Clinic. Paranoid personality disorder is characterized by constant suspicion and distrust of people in general, a tendency to shift responsibility from themselves to others. This is an easily recognizable from fiction collective image of a collector of petty offenses and injustices, hypocrites, jealous husband, litigies . AT all kinds of situations they feel used in the interests of others, betrayed or offended. They are full of prejudices and often ascribe to others those thoughts and promptings that refuse to recognize in themselves. Transit ideas of a relationship are common, the wrong premises of which are purposefully and logically justified. At the same time, patients are convinced of their own objectivity and rationality. Their affective repertoire is limited, they lack humor, spiritual warmth, they often seem to be unemotional. The manifestations of power and authority are highly valued, all that is weakly and impairedly causes their contempt.
- Gannushkin considered the main feature of this type to be the tendency to form overvalued ideas, the most important of which “is the thought of the special meaning of … self.”In business, they can make an impression of energetic and active people, but others, as a rule, evoke negative feelings.
The conversation draws attention to muscular tension, inability to relax, and extreme suspicion of the doctor’s interpretations that may be unfavorable to them. Sometimes the disorder is a precursor to schizophrenia. In most cases, it lasts a lifetime, accompanied by problematic situations at work and in the patient’s family. As maturity is achieved and with low life stress, a psychological defense mechanism can act – the formation of reactions when patients become stressed by altruists.
In order to diagnose a paranoid personality disorder, a condition other than personality disorders (F60) must correspond to at least four of the following qualities or behavioral stereotypes: 1) excessive sensitivity to failures and failures; 2) constant dissatisfaction with other people, a tendency not to forgive insults, neglect, damage caused; 3) suspicion and a persistent tendency to distort the experience, when the neutral or friendly attitude of others is wrongly interpreted as hostile or dismissive; 4) laxity, selfishness, quarreliness and persistent, inadequate defense of one’s own rights;5) frequent unjustified suspicions of infidelity of marital or sexual partners; 6) increased self-esteem with a tendency to take what is happening to your account; 7) frequent unsubstantiated thoughts of conspiracies that subjectively explain events in a close or broad social environment.
Differential diagnosis. In the case of paranoid personality disorder, delineated delusional structures characteristic of delusional psychosis, as well as hallucinations and formal thinking disorders inherent in paranoid schizophrenia, are absent. Patients with a borderline type of emotionally unstable personality disorder are distinguished from this type by their ability to establish, albeit saturated with suspicion and heightened vulnerability, but extremely emotional relationships with others. Paranoid psychopaths are distinguished from antisocial lack of a chain of antisocial behavior in the anamnesis. With schizoid psychopaths, they are brought together by limited emotionality, but they are distinguished by their characteristic trait of intense suspicion and distrust. The most difficult to distinguish between paranoid and schizotypal disorder (F21), for which suspicion is also a feature.
In contrast to schizotypical , patients of this type do not have such a bizarre complex of behavioral, sensory and mental disorders, they are characterized not so much by the absence of distortions of communication skills, but by their characteristic orientation (eccentricity, eccentricity).
Treatment. The best approach is supportive individual psychotherapy. These patients do not tolerate group therapy, and behavioral seems to them too compulsory. Cognitive -behavioral programs aimed at reducing the background level of anxiety and improving the skills of problem-solving behavior achieve greater success . The physician should strive to be as open as possible, consistent and authentic, honest recognition of something here is always preferable to defensive reasoning. The doctor’s statements should be clear, unambiguous, the style of treatment should be professional, respectful and somewhat distant , given that trust and closeness of relationships are the problem areas of these patients.
One should not be overly zealous with the interpretation of dependency and the lowered self-esteem of patients, hiding behind the protective facade of mistrust and hostility. The basic setting of an unbiased and benevolent assistant helps the patient to adopt alternative explanations for what is happening. It is more productive not to rush into correcting such defense mechanisms as the negation of reality and the projection of guilt on others. It is better to just attentively listen to the accusations and complaints of the patient, avoiding standing on someone’s side.
These patients take drug therapy with an excessive amount of suspicion and the effect of it is usually not noted. Although the direct effect is indeed problematic, nonetheless, during episodes of alarming agitation, short-term administration of benzodiazepines is possible ; Delusionalinterpretations are an indication for prescribing small doses of Sonapax or Haloperidol .
Disorders of personality and behavior due to illness, damage or dysfunction of the brain
A common cause is a variety of structural brain damage, among which the most common trauma to the skull . The most etiologically significant are damage to the temporal and frontal areas.
Clinic. The syndrome is characterized by sharpening (strengthening) premorbid personality traits or the appearance of pathological personality traits. Control of impulses and expressions of emotions decreases, the latter become labile and superficial with a predominance of euphoria or apathy.Euphoria is devoid of true fun, which can be recognized by the patient. On the euphoric background, especially when the frontal lobes are damaged, there is a characteristic tendency to flat jokes.
The frontal syndrome as a whole is characterized by indifference, apathy, lack of involvement in what is happening in the immediate environment. There are frequent outbursts of rage on minor occasions, especially during alcoholism, accompanied by aggressive behavior. The generally accepted norms of behavior are not observed, sexual disinhibition and law conflicts are frequent. Typical is the inability of patients to anticipate the consequences of their actions, to understand the problems that they create to others. Blaming others is the most frequently used technique for solving their problems.
In cases of temporal epilepsy, there is often a loss of a sense of humor, viscosity (a tendency to pseudo-philosophizing , entrapped stuck on serious topics, ignoring the lack of interest in the interlocutor) and pronounced aggressiveness beyond convulsive manifestations. For such patients, characterized by a triad: the hypergraph (the endless diary writing, texts), increased religiosity (or preoccupation with a sublime idea) and hy about – or hypersexuality. Possible slight cognitive impairment (reduction of short-term memory) does not reach the degree of intellectual decline.
In the presence of structural morphological changes, the syndrome is persistent. The growth of an organic lesion (brain tumor, Huntington’s disease ) can transform the syndrome into dementia. In some cases, with the successful treatment of a primary disorder or cessation of intoxication, the syndrome may be reversed.
Diagnosis. The ICD-10 formulates the following diagnostic criteria common to the group of disorders F07: 1) objective data on the presence of organic cerebral disease, brain damage; 2) the absence of impaired consciousness or pronounced memory impairment; 3) the lack of convincing data on the presence of a different cause of personal and behavioral disorders characteristic of group F07.
Differential diagnosis. With dementia, personality disorders are only one aspect of global intellectual decline. The presence of an organic etiological factor distinguishes this syndrome from other mental illnesses accompanied by personality changes.
Treatment. The main is the impact (if possible) on the primary organic violation. Symptomatic treatment with various (depending on the target of therapy) drugs is variously effective: antipsychotics, anxiolytics , lithium, hormones, beta-blockers, non-tricyclic anti-depressant trazodone , anticonvulsants. In the presence of aggressive behavior in cases of temporal epilepsy, carbamazepine therapy is indicated . Should strive to avoid alcoholism. The participation of social workers contributes to the improvement of social accommodation of patients. Family counseling should provide emotional support for the patient’s family members and specific advice to help minimize unwanted patient behavior. Antisocial inclinations often make it necessary to keep these patients in specialized closed medical institutions.