MEDizzy - . A 38-year-old man had always been a “loner.” He had few

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Combined Neurology XIII

. A 38-year-old man had always been a “loner.” He had few friends in childhood, and as a teenager and young adult, he had no interest in getting to know others. He stuck to a strict daily schedule, consisting mainly of meals, work, and sleep. He visited his parents once a week, for Sunday dinner. He rarely went to social events, and when he had to, he would spend most of his time staring at the floor and would appear annoyed if someone attempted to converse with him. He had no interest in romantic relationships or friendships. What is the most likely diagnosis in this man?

ExplanationThe personality disorders consist of 10 distinct entities that share in common a chronic and pervasive pattern of inner experiences, thoughts, and behaviors. They affect the domains of cognition, impulse control, affectivity, and interpersonal functioning. Features are present in adolescence or early adulthood and persist over time. They deviate from accepted societal culture and norms and lead to distress or impairment. The caveat to the diagnosis of personality disorders is that the features do not occur in the context of signs or symptoms that are part of a mood, anxiety, impulse control, or psychotic disorder, or any other psychiatric disorder as the primary underlying illness. Personality traits are patterns of behavior or thinking about oneself and the environment that are relatively consistent over time, but they do not lead to a diagnosis of personality disorder unless they are maladaptive or cause functional impairment or distress. The personality disorders are categorized into clusters A, B, and C. Different personality disorders may co-occur in the same individual. questions 41 to 43 depict people that would be classified under cluster A of the personality disorders. This cluster includes paranoid, schizoid, and schizotypal personality disorders. Paranoid personality disorder, depicted in question 41, is marked by pervasive distrust, paranoia, and suspiciousness of others. Persons with paranoid personality disorders have an increased risk of comorbid major depressive disorder (discussed in questions 1 and 2), substance abuse, and agoraphobia (discussed in questions 7–8). Paranoid personality disorder is more common in males and may be an antecedent to paranoid type of delusional disorder (discussed 1088 in question 31). Schizoid personality disorder, depicted in question 42, is marked by blunted range of affect and emotions. There is a lack of interest in or enjoyment of social relationships and intimacy. Individuals with this disorder exhibit little pleasure in social activities, with a preference for solitude, and lack close friends outside of the immediate family. Schizoid personality disorder is more common in males, and may appear as an antecedent to delusional disorder (discussed in question 31) or schizophrenia (discussed in questions 24 and 25). Schizotypal personality disorder, depicted in question 43, is marked by odd, peculiar, and eccentric ideas, beliefs, and/or behaviors including magical thinking (such as superstitiousness or belief in clairvoyance or telepathy), paranoid ideation, and constricted affect. Individuals with this personality disorder have social anxiety and are uncomfortable with close relationships; they typically lack close friends outside of immediate family members. Patients with schizotypal personality disorder have comorbid major depression in 30% to 50% of cases. Patients with personality disorders lack insight into their pathology, but may be asked to seek care from a psychiatrist by family members or others in the setting of dysfunction in relationships, occupation, or otherwise. Treatment includes a combination of psychotherapy combined with pharmacotherapy aimed at the most prominent psychiatric symptoms (such as anxiolytics if anxiety is the main symptom, or mood stabilizers or antipsychotics if lability, aggression, and impulsivity are the most prominent symptoms).