Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him/her Show
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/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 other partner View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323040884500180 Personality and Personality DisordersMark A. Blais PsyD, ... Rafael A. Rivas-Vazquez PsyD, in Massachusetts General Hospital Comprehensive Clinical Psychiatry, 2008 Paranoid Personality DisorderThe core feature of paranoid personality disorder is a pervasive distrust and suspiciousness of others. Afflicted individuals are reluctant to confide in others; they assume that most people will harm or exploit them in some manner. In new situations, they search for confirmation of these expectations and view even the smallest slight as significant. They unjustifiably question the loyalty of friends and significant others, and consequently, are often socially isolated and avoid intimacy. They pride themselves on being rational and objective, but they appear to others as unemotional, affectively restricted, and hypervigilant. These individuals bear grudges and collect injustices. When their beliefs are challenged or they are stressed in any significant way, these individuals can show profound anger, hostility, and referential thinking. The most common differential diagnoses for paranoid personality disorder include delusional disorder (paranoid type), schizophrenia (paranoid type), schizoid personality disorder, and avoidant personality disorder. With delusional disorder and schizophrenia, reality testing is lost; in paranoid personality disorder, formal reality testing is said to remain intact. However, reality testing is a continuum, and it may be difficult to distinguish the degree of reality testing of a person with mild schizophrenia from that of a person with a florid paranoid personality disorder, especially if in the latter cer-tain cultural factors or a potential gain from manipulating the examiner are present. With schizoid and avoidant personality disorder, the amount and degree of paranoia is significantly less, which distinguishes it from paranoid personality disorder. The prevalence of paranoid personality disorder in the general population is approximately 0.5% to 2.5%. There appears to be an increased incidence in families with schizophrenia and delusional disorder. The diagnosis is far more common in males than it is in females. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B978032304743250041X Personality disordersGwen Adshead, Caroline Jacob, in Core Psychiatry (Third Edition), 2012 Paranoid personality disorder (Cluster A)ICD-10 diagnostic criteria include: •Excessive sensitiveness to setbacks •A tendency to hold grudges •Suspiciousness and frequent distortion of experience so that ‘neutral’ events become hostile and persecutory. •Tenacious sense of personal rights, often out of keeping with the situation •Recurrent suspicions, e.g. of infidelity •Excessive self-importance •Preference for unsubstantiated conspiratorial explanations of event, for the person and the world. The prevalence of paranoid personality disorder in community samples has been reported at about 0.7–1.3% but increases to 10% in psychiatric outpatient samples (Torgerson 2005; Coid et al 2006; Bernstein & Useda 2007) However, another large study of the general population of the USA showed a prevalence of 4.4% (Grant et al 2004). Paranoid personality disorder is often found with a co-morbid diagnosis of antisocial or borderline personality disorder in forensic populations. Frequent complaints against others or services may be revealed during history-taking and may suggest the presence of paranoid personality traits, if not a full diagnosis. Differential diagnosisParanoid thinking can be thought of as existing on a spectrum from ‘normality’ to extreme maladaptive thinking. A certain amount of caution or suspiciousness may be environmentally adaptive and understandable within certain social contexts. Other personality diagnoses, especially borderline and antisocial, may present with paranoid thinking as a significant feature but this alone is not sufficient for an additional co-morbid diagnosis of paranoid personality disorder. Psychotic illness and organic brain disease may present with paranoid thinking. Delusional disorder may be difficult to differentiate from paranoid personality disorder; the distinction may be the degree of conviction with which the beliefs are held, the impact upon the general functioning of the individual and the presence or absence of reality testing including plausibility. There may be co-morbidity with social anxiety and depression. AetiologyCognitive bias and information processing deficitsHigh levels of externalizing, personal attributional bias, in other words a tendency to blame negative experiences on others, are found in those with high degrees of paranoid thinking. Information processing deficits may include impairments in the ability to understand the intentions and minds of others (theory of mind) which can lead to misinterpretation of social interactions. Those with paranoia tend to be hypervigilant and therefore more likely to recall and sense ‘threat’ scenarios (Carroll 2009). Social influenceSettings where high levels of self-consciousness and associated low self-esteem may predispose to paranoid thinking, e.g. feeling excluded from social groups, isolation, sensory impairment, exposure to unfamiliar environments (immigration). The general suspiciousness and self-isolation of those with paranoid personality disorder may perpetuate a cycle whereby others react cautiously towards them, which further enhances their hypervigilance and self-consciousness. ManagementRisk assessmentRisk assessment is essential in these cases. Individuals with paranoid personality disorder frequently feel threatened and persecuted and this may lead to altercations with others, including strangers. Their tendency to perceive situations as hostile or as challenges to their status or self-esteem may enhance their propensity to react violently in ‘self-defence’ or retaliation. Paranoid personality features have been associated with histories of violent and antisocial behaviours (Carroll 2009). Sometimes those with paranoid personality disorder resort to weapon carrying to help feel safer when in public, or may become very avoidant of social situations and public places. This avoidance means that they often do not come into direct contact with services and are not ‘help-seeking’. Social isolation or stress may lead to an increase in paranoid ideation, which can develop into a psychotic episode. The presence of a transient psychotic episode will further increase risk of harm to others and any co-morbid disorders should be assessed and managed. Use of illicit substances, especially cannabis, amphetamine and cocaine, may enhance paranoid thinking and misinterpretations. Drug and alcohol use also increase the risk of violence due to their disinhibiting effects. Individuals should be encouraged to seek help for any substance misuse and to reduce or abstain from use. InterventionsThere is a limited evidence base for the treatment of paranoid personality disorder. PharmacotherapyAnecdotally, low dose antipsychotic medication may reduce levels of arousal and help prevent decompensation into acute psychotic episodes but the use of pharmacotherapy is not evidence-based. Psychological interventionsIt is likely that longer-term individual rather than group therapy will initially be required as the process of engagement and establishing trust within a therapeutic relationship will be challenging and will take time. The concept of group therapy may just be too overwhelming for an individual with paranoid personality disorder to consider. The long-term treatment goals should include increasing self-esteem, identifying and accepting feelings of vulnerability, establishing trust in others and verbalizing distress and feelings. In order to maximize engagement, clinicians should be transparent in their information-seeking and communication and attempt to avoid generating suspicion or feeling defensive themselves. Cognitive therapy has been used in paranoid personality disorder (Beck et al 2004). The aim of therapy is to enhance self-esteem and social skills, followed by identification and challenge of the paranoid belief system and tendency to attribute blame, with development or more rational thinking styles. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B978070203397100015X Alcohol-related DisordersM. Soyka, in International Encyclopedia of the Social & Behavioral Sciences, 2001 7.4 Alcohol PsychosisChronic alcohol consumption can result in different alcohol psychoses. In some cases a more or less chronic state with suspiciousness or more pronounced paranoid delusions can develop. This disorder is referred to as alcoholic paranoia or alcohol-induced psychotic disorder. The prototype of this psychosis is a delusional jealousy syndrome nearly exclusively found in male alcoholics who believe their spouse to have an extramarital relationship. Sometimes without the slightest evidence the alcoholic is convinced about his spouse's infidelity. Predisposing factors for the development of this syndrome are impotence or other sexual dysfunction, cognitive impairment, and a low self-esteem. The delusions often persist into abstinence. Delusional jealousy is a dangerous disorder with the patient often attacking or even killing his spouse. The other more prevalent alcohol-induced psychosis is alcohol hallucinosis which is characterized by vivid predominantly acoustic, sometimes visual hallucinations, delusions of reference or persecution, and fear. Other psychotic symptoms may also be prevalent. Different from alcohol withdrawal delirium the sensorium is usually clear and there is no amnesic syndrome for the psychosis. The psychopathology of alcohol hallucinosis closely resembles paranoid schizophrenia but there is no evidence for a common genetic basis. Alcohol hallucinosis, like alcohol paranoia, can develop during heavy drinking or more frequently within a few days or weeks of the cessation of drinking. In abstinent patients the prognosis of alcohol hallucinosis is usually good, but in 10 to 20 percent a chronic, schizophrenia-like psychosis can develop. Psychopharmacological treatment in alcohol psychosis (neuroleptics, sedatives) is recommended. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B008043076703744X Neurobiology of Psychiatric DisordersDonovan Maust, ... Michael E. Thase, in Handbook of Clinical Neurology, 2012 Positive and Negative Syndrome Scale (PANSS)The PANSS is a medical scale used for measuring symptom severity of patients with schizophrenia and was published in 1987 (Kay et al., 1987). The scale is a 30-item, seven-point rating instrument adapted from the BPRS (Overall and Gorham, 1962) and Psychopathology Rating Scale (Singh and Kay, 1975). Of the 30 parameters assessed, seven were chosen to constitute a Positive Scale (score range 7–49), seven a Negative Scale (7–49), and the remaining 16 a General Psychopathology Scale (16–112). The General Psychopathology portion was included as a separate but parallel (to positive and negative symptoms) measure of severity in schizophrenic illness. The Positive Scale includes the following items: •delusions •conceptual disorganization •hallucinatory behavior •excitement •grandiosity •suspiciousness •hostility. The Negative Scale includes the following items: •blunted affect •emotional withdrawal •poor rapport •passive-apathetic social withdrawal •difficulty in abstract thinking •lack of spontaneity and flow of conversation •stereotyped thinking. The General Psychopathology Scale includes the following items: •somatic concern •anxiety •guilt feelings •tension •mannerisms and posturing •depression •motor retardation •uncooperativeness •unusual thought content •disorientation •poor attention •lack of judgment and insight •disturbance of volition •poor impulse control •preoccupation •active social avoidance. Initial work on the PANSS demonstrated that trained clinical raters could achieve good reliability and that the scale had acceptable validity. Scores are normally distributed and demonstrate improvement with treatment (i.e., positive symptoms respond to pharmacological treatment). Factor analysis provides evidence for the construct validity of distinct positive and negative dimensions, while others suggest an additional disorganized subtype (Peralta Martin and Cuesta Zorita, 1994). View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780444520029000139 ManganeseD.S. Ávila, ... M. Aschner, in Encyclopedia of the Neurological Sciences (Second Edition), 2014 Other Health ProblemsOther signs of Mn intoxication include personality change consisting of irritability, lack of sociability, uncontrollable laughter, tearfulness, mild euphoria, and suspiciousness. These symptoms commonly precede the clinical motor presentation. Patients become abusive or even assaultive during brief emotional explosions. If the exposure to Mn continues, mental languor and extreme lack of energy and muscular weakness may occur; patients frequently fall asleep immediately after sitting down, even while at work. Tingling sensations or paresthesias have been reported, but no other sensory disturbances occur. Chronic inhalation of Mn may result in slower visual reaction time, impaired eye coordination, and poor hand steadiness. Respiratory problems have been reported, such as increased incidence of cough, bronchitis, dyspnea during exercise, and increased susceptibility to infectious lung disease. Reproductive effects, such as impotence and loss of libido, have been noted in male workers afflicted with manganism attributed to occupational exposure to high levels of Mn by inhalation. No information is available on the developmental effects of Mn in humans. In addition, animal studies have reported degenerative changes in the seminiferous tubules leading to sterility from intratracheal instillation of high doses of Mn (experimentally delivering the Mn directly to the trachea). In young animals exposed to Mn orally, decreased testosterone production and retarded growth of the testes were reported. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780123851574002633 ACUTE TREATMENTJohn M. Kane, in Antipsychotic Drugs and their Side-Effects, 1993 11.2 IndicationsThe most clear-cut indication for antipsychotic drug treatment remains schizophrenia. Psychotic signs and symptoms such as delusions, hallucinations, thought disorder and suspiciousness can be seen in a variety of disorders and are not specific to schizophrenia. It is critical, therefore, to establish a differential diagnosis and rule out other causes of psychotic states which might require other treatments. Although numerous investigators over the past 25 years have attempted to identify useful predictors of acute antipsychotic drug response, these efforts have not succeeded to the point of identifying individuals with schizophrenia for whom an acute trial of medication would not be recommended unless there were some absolute medical contraindications. The overwhelming majority of patients with schizophrenia benefit to some extent from antipsychotic medication and most benefit considerably. Clinical issues which require consideration during an acute treatment trial include: choice of drug; dosage; duration; and what strategies should be employed if the patient is not responding adequately. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B978012079035750018X CentenariansT.T. Perls, in Encyclopedia of Gerontology (Second Edition), 2007 The Centenarian PhenotypePersonalityThe Georgia Centenarian Study examined and compared the personality traits of three age groups: centenarians, octogenarians, and sexagenarians. The centenarians scored higher in suspiciousness, radicalism, fatigue, and depression but lower in intelligence, sensitivity, and stress. Preliminary findings from the New England Centenarian Study suggest that female centenarians score low in the personality domain of neuroticism. The subsequent ability to not dwell on things that are stressful could be an important survival trait. Functional StatusIn the Swedish Centenarian Study, 25% lived in their own home, 37% in assisted living, and 38% in nursing homes. In the New England Centenarian Study, the proportions were not too different, with approximately 15% living independently in their own homes, 35% living with family or in assisted living, and 50% living in nursing homes. While the majority of centenarians appear to have functional disability, this disability appears to be compressed toward the end of life. In the New England Centenarian Study's population-based sample, 90% of centenarians were independently functioning at the mean age of 92 years. Most subjects experienced a decline in their cognitive function only in the last 3 to 5 years of their lives. Despite delaying disability, a large proportion of centenarians still incurs age-related illnesses for many years. In a study of age of onset of age-related illnesses among 424 centenarians (323 males and 101 females), the subjects fit into three morbidity profiles: survivors, delayers, and escapers. Forty-three percent of the centenarians were survivors, or individuals who were diagnosed with age-related illness prior to age 80 (24% of the male and 43% of the female centenarians). Forty-four percent were delayers, individuals who delayed the onset of age-related diseases until at least age 80 (44% of the male and 42% of the female centenarians). Escapers, individuals who attained the 100th year of life without the diagnosis of an age-related disease, accounted for 13% of the centenarians (32% of the male and 15% of the female centenarians). That most centenarians appear to be functionally independent through their early 90s suggests the possibility that survivors and delayers are better able to cope with illnesses and remain functionally independent compared to other individuals who more readily die from those diseases. Thus, in the case of centenarians, it may be more accurate to note a compression of disability rather than morbidity. This is not the case, as would be expected, with illnesses associated with high mortality risks. When examining only the most lethal diseases of the elderly such as heart disease, non-skin cancer, and stroke, 87% of males and 83% of females delayed or escaped these diseases (relatively few centenarians were survivors of such diseases). Cognitive FunctionThe population-based Heidelberg Centenarian Study recently reported that both early education and lifelong intellectual activities correlated with better cognitive performance at age 100 years and older. The study reported that about 50% of centenarians demonstrated moderate to severe cognitive impairment and about 25% were found to be cognitively intact. These proportions are approximately the same as the cognitive function studies reported by the Danish (Jeune et al.), Swedish (Hagberg et al.), Georgia (Poon et al.), and New England Centenarian Studies, which indicated that about 70% of centenarians were cognitively impaired and 30% were cognitively intact. Conservatively, with strict criteria for no evidence of cognitive impairment, about 12–15% of centenarians show no evidence of impairment. Several centenarian studies conduct neuropsychological testing followed by postmortem neuropathological studies, which have led to several interesting observations. A number of cases have been described of centenarians who were cognitively intact near the time of death, yet at autopsy they were found to have no evidence of neuropathology including neurofibrillary tangles and neuritic plaques. These plaques and tangles, which are the pathological hallmarks of AD, were once thought to be inevitable consequences of aging. These cases might be considered examples of disease-free aging, and they support the notion that for some people, neuropathology is not an inevitable consequence of aging, nor can aging be blamed as the sole reason for the presence of pathology. Some researchers have observed that the frequencies of various dementia types are different among people who were nonagenarians or older compared with younger cohorts. The Danish Centenarian Study reported that 50% of the dementia cases among centenarians were due to vascular disease. An autopsy series of 13 Japanese centenarians with at most mild cognitive impairment revealed vascular but not AD pathology. It is likely that rare causes of dementia become more common among centenarians because people who are prone to develop AD die at younger ages, leaving survivors to be prone to clinically express other neurodegenerative illnesses such as vascular dementia, Pick's disease, and Lewy body disease. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B0123708702000354 Unusual psychiatric syndromesSadgun Bhandari, in Core Psychiatry (Third Edition), 2012 Othello syndromeOthello syndrome is characterized by the delusion of infidelity of the sexual partner (Box 23.3). Jealousy does not always occur as a delusion and may also manifest as an overvalued idea, or an obsession. In the majority of patients, it is quite clear when malignant jealousy exists, but in borderline cases jealousy of apparently normal proportions merges imperceptibly into delusional jealousy. A related syndrome is that of retrospective ruminative jealousy in which the patient is preoccupied with the past sexual activity of the sexual partner but without delusions of infidelity. Clinical aspectsThe condition occurs in both sexes but is commoner in males. It most commonly presents in the 4th decade. Onset is sudden but a history of increasing suspiciousness is often present. Confirmatory behaviours include checking for signs of infidelity, such as examining undergarments, going through pockets, watching and spying on the partner, following and interrogating the partner for hours in an attempt obtain a confession. Sexual activity may increase as the person demands more sex and in the context of ongoing relationship problems, this may cause further difficulties. AetiologyPsychodynamic explanations include projection of feelings of unfaithfulness and latent homosexual feelings. Morbid jealousy is frequently associated with sexual disorders especially erectile dysfunction. Partners frequently report sexual difficulties but it is difficult to determine whether the sexual problems are primary or secondary. Feelings of inadequacy are central to the disorder and may arise due to the partner being more sexually attractive. Diagnostic significanceDelusional jealousy can occur as a monodelusional disorder and is then diagnosed as a delusional disorder. It can also occur as a symptom of other disorders most commonly schizophrenia, and affective disorders (especially depression, which may enhance feelings of inadequacy). Alcohol abuse is present in 6–20% with morbid jealousy. According to Soyka et al (1991), this association holds good for male alcoholics only. Morbid jealousy has also been described in a number of organic conditions including infections, endocrine disorders and dementia. Enoch and Trethowan (1991) also suggest that psychiatric disorders such as depression are often quite common in relatives of patients suffering from delusional jealousy. ManagementTreatment is primarily with antipsychotics. As with schizophrenia, currently atypical antipsychotics would be an important aspect of pharmacological management. If the delusions are part of another disorder then the underlying disorder should be treated. Compliance with medication may be poor due to the nature of the delusion and in such cases compulsory treatment may be necessary. Psychotherapy for morbid jealousy has included: •Behavioural psychotherapy employing treatments for obsessions •Cognitive behaviour therapy that focuses on addressing factors that precipitate and maintain the jealousy and factors in the individual's personality that predispose to jealousy Which personality disorders fall into suspicious?These are grouped into three categories. Suspicious: Paranoid personality disorder. Schizoid personality disorder.. Avoidant personality disorder.. Dependent personality disorder.. Obsessive compulsive personality disorder (OCPD). Which personality has mistrust and suspicion as the prominent feature?Paranoid personality disorder: The main feature of this condition is paranoia, which is a relentless mistrust and suspicion of others without adequate reason for suspicion. People with paranoid personality disorder often believe others are trying to demean, harm or threaten them.
Which of the following personality disorders presents when a person is suspicious of other people?Paranoid personality disorder. People with this disorder are often cold, distant, and unable to form close, interpersonal relationships. They are often overly suspicious of their surroundings without good reason. People with paranoid personality disorder generally can't see their role in conflict situations.
What personality disorder is distrustful suspicious and a fault finder?Paranoid personality disorder (PPD) is a challenging mental health condition defined by mistrust and suspicion so intense that it interferes with thought patterns, behavior, and daily functioning.
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