Psychiatry and Behavioral Health Rotation

Patient will present as → a 33-year-old female says that her coworkers are planning to have her fired and they often ridicule her when she is not there.  She is attempting to pursue legal action to get her coworkers reprimanded for this behavior as she knows that they have an intention to harm her in some way.

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Key Points:

• Paranoid personality disorder is characterized by persistent feelings of suspiciousness and mistrust of other people.

DSM-5 Diagnostic Criteria

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

B. 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.

Psychotherapy

• Cognitive, behavioral, psychoanalysis

Pharmacologic

• Anxiolytics