Showing posts with label Disorders. Show all posts
Showing posts with label Disorders. Show all posts

Thursday, 24 May 2018

Schizophrenia :Risk Factors, Treatment, and Antipsychotics

May 24, 2018

Schizophrenia: Risk Factors and Treatment



Schizophrenia :Treatment


Potential Psychosocial risk factors for Schizophrenia  include: 

  • Childhood diversity:
    • Emotional abuse
    • Physical abuse
    • Sexual abuse
    • Ignorance
    • Death of parents.

  • Migration, especially becoming a member of a lower socio-economic ethnic minority in an affluent nation.

  • Being born in the urban area.

  • Any life event full of stress 

  • Illicit Substance Use- Drugs which increase Dopamine activity (Cocaine, Amphetamine, Cannabis)  can cause psychotic symptoms similar to Schizophrenia. 

However, a greater proportion of patients with Schizophrenia use illicit drugs compared to the general population. While these drugs can cause psychotic symptoms,  it is unlikely that they actually cause Schizophrenia, but, in vulnerable individuals, they can-

    • Increase the frequency of relapse in a patient with Schizophrenia.

    • Bring forward the age of onset of Schizophrenia.

    • Can also interfere with the effectiveness of antipsychotics.



Treatment of Schizophrenia- General Principles


Antipsychotics (Neuroleptics) are the mainstay of treatment for Schizophrenia. If available, Cognitive Behaviour Therapy (CBT) may be used in addition to antipsychotic for treatment-resistant psychotic symptoms.



In severe, chronic Schizophrenia, the patient would need psychosocial rehabilitation.


Rationale for Anti-Psychotics

Dopamine Hypothesis of Schizophrenia: This states that Schizophrenia is due to an excess of Dopamine in the brain, so by decreasing the activity of Dopamine, Schizophrenia can be treated. 



Classification of Anti-Psychotics is as follows:

 1) Older / First Generation /Typical:
    
       a)    Chlorpromazine

       b)    Haloperidol

2) Newer / Second Generation / Atypical:

         a) Risperidone

         b) Olanzapine

         c) Quetiapine

         d) Clozapine



Clozapine: Clozapine is superior to antipsychotics as compared to other antipsychotics in managing 'Treatment Resistant'. Schizophrenia. ('Treatment Resistant' Schizophrenia: Schizophrenia that has not responded to at least 2 different antipsychotics given at an adequate dosage for an adequate period of time i.e at least 4-6weeks each.).




 About 20% - 30% of patients with Schizophrenia are Treatment Resistant. The most important thing to keep in mind is Clozapine has also an antisuicidal effect.



General Principles Of Using Antipsychotics:

   "Start Low, Go Slow"
  • Start at a low dose 

  • If needed, increase the dose gradually

  • Review mental state regularly

  • Monitor for side-effects

  • Avoid antipsychotics 'polypharmacy'(using more than one at the same time).

General Principles When Using Antipsychotics:


  • It usually takes at least 2 to 3 weeks for the antipsychotic effect to manifest, and a further 2 to 3 weeks for it to maximize.

  • If the patient improves, do continue medication for several months after recovery.

  •  If the patient does not improve, change to another antipsychotic.

Long-Term Maintenance Treatment for Schizophrenia:


Maintenance treatment is given to:
  • Maintenance control over symptoms.

  • Reduce the risk of relapse.

  • Improve the quality of life/functioning.

How long it needs to be given depends on:

  • A number of episodes.

  • The severity of the episodes.

  • Impact of episodes on functioning.


Other treatment options for Schizophrenia:
  • Psychoeducation

  • Cognitive Behaviour Therapy (CBT)

  • Family Therapy 

  • Art Therapy

  • Cognitive Remediation Therapy

  • Social Skills Training.






Friday, 18 May 2018

Schizophrenia -Subtypes, Symptoms and Epidemiology

May 18, 2018

Schizophrenia Definition



The term Schizophrenia is derived from Greek which literally means 'split mind' (Schizo means to 'split' and phren means 'mind'). 


The term Schizophrenia was coined by the Swiss Psychiatrist Eugen Bleuler in 1908. Schizophrenia is different from Multiple Personality Disorder which is a Dissociative disorder. 

Previously the term 'Dementia praecox' is used for this illness.


schizophrenia causes


Clinical features of Schizophrenia 
  •  Schizophrenia is a 'Psychotic' disorder.

  • Psychosis is a condition in which the patient has experiences that do not have any basis in reality.

  • The two main psychotic phenomena are Hallucinations and Delusions.

Hallucinations
  • A hallucination is a sensory perception in the absence of sensory stimulus.

  • It can occur in any of the five sensory modalities: auditory, visual, somatic, olfactory and gustatory.

  • Most common type of Psychosis is an Auditory hallucination.

  • For example: 
    • Hearing voices from outside one's head (even when the patient is alone).

Delusions

A delusion is a false, fixed belief held by the patient with absolute conviction, despite evidence to the contrary and not shared by others from the patient's family or cultural group.

 In Schizophrenia, delusions usually have a persecutory theme for example:
    • 'My neighbor or someone trying to poison me.'

    • 'My movements are being monitored by the cameras, wherever I go.'

Sometimes they have a grandiose theme for example:

    • I am immortal.

    • I am the richest person in the world.



Positive and Negative Symptoms of Schizophrenia 

Positive Symptoms:

  •  Includes Hallucinations, Delusions and Thought Disorder.

  • Seen in the acute phase of the illness.

  • Tend to respond well to an antipsychotic treatment.

Negative Symptoms:

  • Include lack of motivation, lack of speech, poor self-care, etc.

  • Seen in the chronic phase of the illness.

  • Tend to respond well to treatment.

Main subtypes of Schizophrenia 



Paranoid Schizophrenia 

Hebephrenic Schizophrenia 

Catatonic Schizophrenia 

Simple Schizophrenia 

Clinical features of Paranoid Schizophrenia 

 Paranoid Schizophrenia is the main subtype of Schizophrenia that the doctors encounter in clinical practices.

 Duration for a diagnosis of Paranoid  Schizophrenia is one month. Some of the main clinical features are mention below:
  • Delusions, hallucinations and thought disorder are prominent.

  • Examples of delusional themes: persecution, jealousy, and grandiosity.

  • Examples of hallucinatory themes: commenting/discussing, threatening, bodily sensations.

  • Thought disorder manifest as incoherent and irrelevant speech.

Clinical features of Hebephrenic Schizophrenia 


  •   Incoherent, disjointed, rambling speech.

  • Aimless behavior rather than goal-directed.

  • Delusions and hallucinations are either absent or not prominent.

( Duration for a diagnosis of Hebephrenic Schizophrenia is one month.)


Clinical features of Catatonic Schizophrenia

Catatonic stupor is one if the most dramatic presentation, in a stupor the patient is mute or immobile.

 Duration for a diagnosis of catatonic schizophrenia is 2 weeks. Other catatonic signs include:
  • Posturing

  • Waxy flexibility

  • Negativism

  • Command automatism

  • Excitement

Clinical features of Simple Schizophrenia

The predominance of negativism symptoms are as follows:
  • Social withdrawal

  • Loss of motivation

  • Aimlessness

  • Apathy

  • Flattering of effect
A marked decline in social functioning and absence of positive symptoms.


Duration for a diagnosis of simple schizophrenia is 1 year.


Epidemiology of Schizophrenia
  •  Lifetime prevalence is about 1%.

  • Annual incidence is about 0.02 per 1000.

  • Lifetime risk may be about 40 percent higher in males.

  • The peak age of onset: 15 to 24 in males; about 5 to 10 years later in females.

Etiology of Schizophrenia

The exact cause of Schizophrenia is unknown. The general consensus from research is that there is a combination of different factors which include:
    • Genetic factors

    • Other biological factors

    • Psychological factors

    • Social (environmental) factors.


Other helpful resources-

Schizophrenia Treatment

NIMH


Wednesday, 9 May 2018

Eating Disorders: Co-morbidity, Assessment, Management And Treatment

May 09, 2018
Eating Disorder: Assessment, Treatment, and Management


A considerable proportion of patients with Eating Disorders have other psychiatric disorders. Most common co-morbid illness is Depression, followed by Anxiety Disorders and Personality Disorders.


However, Psychosis, OCD, and PTSD are more common in Anorexia Nervosa as compared than in other eating disorders.
Secondly, Alcohol and substance misuse are the more common in Bulimia Nervosa than in other Eating Disorder.

comorbidity, treatment, management of AN,BN and BED


 Assessment For Eating Disorder - General Points

According to a medical report the majority of patients with Eating Disorder especially BN and BED do not receive proper treatment (either patient do not seek treatment or the diagnosis is overlooked). 

Here are the few points that could help for the assessment of Eating Disorder.


  • Take a comprehensive Medical History.

  • Measure the BMI (Body Mass Index).

  • Do a general physical examination, looking for the signs and symptoms of Anorexia Nervosa and Bulimia Nervosa.

  • Do routine blood tests before initiating the treatment.

  • Do a baseline ECG.

Management of Eating Disorders - Overview

  • There are a wide variety of treatments used for Eating disorders.

  • Normalization of nutrition and eating habits is a central goal in the treatment of patients.

  • As eating disorders tend to run  a chronic course, it is important to monitor and address, on an ongoing basis:

    • Psychiatric co-morbidities.

    • Physical health complications.

    • Changes in Social circumstances.

Management of Anorexia Nervosa-
  
Depending on the availability or need patient can be treated in a :

    • Routine Psychiatry Outpatients (Adult or Child and Adolescent Services) clinic.

    • General Psychiatry Inpatient Unit.

    • General Medical Inpatient Unit.

    • Specialist Eating Disorders Inpatients/Outpatients Unit.


Pharmacotherapy for AN

Based on the research, Atypical antipsychotics (Olanzapine) and Zinc supplementation could be beneficial.

 Moreover, it is important to identify and treat any co-morbid depression and anxiety accordingly, with antidepressants.



A rationale for using Atypical Antipsychotics in AN-
  • In order to help promote weight gain(Olanzapine could be beneficial).

  • To reduce hyperactivity (used by patients as a weight losing tactic).

  • According to some evidence from neuroendocrine studies that dopamine neurotransmission is increased in AN.

So, that means Antipsychotics that have dopamine antagonist effect might be helpful.

A rationale for using Zinc in AN-

 There is a zinc deficiency in AN and zinc plays an extreme role in neurotransmitter function, it has an appetite stimulant effect also.
 According to one study, it has been found effective and beneficial that a 14 mg of elemental zinc given daily for two months(as a suggested dose).



Treatment of Bulimia Nervosa-


  • Patients are generally treated as Outpatients.

  • CBT is the treatment of choice- either Individual CBT or Group CBT

  • Other CBT Options: web-based / Telemedicine CBT, Guided Self-help, Bibliotherapy(Self-help books).

  • Interpersonal Therapy may be another helpful option.

  • Education about Healthy dieting can be helpful.


Pharmacotherapy for BN-

 SRRIs (particularly high-dose of Fluoxetine) can be helpful in reducing bingeing urges and other obsessional preoccupation with weight.


 Antiepileptic Topiramate may be helpful as it has an appetite reducing the effect.



Management of Binge Eating Disorder

Studies show that it has a high placebo response. Similar treatment approaches as for BN.

  • Psychotherapy options:

    • CBT: Individual / Group/ Online/ Self- Guided Help/ Bibliotherapy.

    • Other psychotherapies: IPT (Inter-Personal Therapy)

  • Medications:

    • SRRIs (esp. Sertraline/ Esciatalopram / Citalopram), Imipramine, Topiramate, (Sibutramine is no longer approved due to risk of MI and stroke).

  • Weight loss treatment programmes / Individual coaching, etc can be helpful with obesity.



Other helpful Treatment Options for Eating Disorders


Exercise programmes (Light resistance training) this might be helpful in changing the patient's attitudes towards exercise and also may increase bone and joint strength.

  • Mindfulness training

  • DBT (Dialectical Behaviour Therapy)

  • EMDR

  • Yoga

  • Body Awareness Therapy

  • Estrogen Supplementation

  • Bright Light Therapy

  • Parenting skills training (parents need to create awareness among their children to reduce the risk of an eating disorder behaviors from an early age.)

Also, read 

          



Tuesday, 1 May 2018

Bipolar And Unipolar Disorder: Co-morbidity, Prognosis, Factors And Treatment

May 01, 2018
The Co-morbidity is common for both Polar and Unipolar disorders. Some common co-morbid psychiatric disorders include Anxiety disorder, alcohol/substance misuse, personality disorders, eating disorders, ADHD. 

Whereas, Physical co-morbidities include: Thyroid dysfunction, migraine, metabolic syndrome (induced by antipsychotics).
Bipolar and unipolar depression :Signs and Symptoms and treatment


Prognosis Of Mood Disorders- Poor Prognostic Factors

  •  Earlier age of onset(childhood-onset Bipolar).

  • Longer duration/increased severity of episodes.

  • Poor initial response to treatment.

  • Suicidal behavior.

  • Alcohol and substance misuse.

  • Low level of social support/ social integration.

Additionally increased frequency of episodes, Psychotic symptoms, mixed episodes, family factors such as high expressed emotions, and the first episode of depression rather than Mania are some poor prognostic factors for the Bipolar disorder.



Treatment of Depression (Bipolar And Unipolar Disorder)-



There are two main treatment approaches for depression, which is  used either on their own or in combination:
  1. Anti-depressants

  1. Psychotherapy (usually CBT-Cognitive Behaviour Therapy)

Rationale For Anti- Depressants-

Monoamine Hypothesis of Depression: This states that depression is due to a deficiency of Monoamines(Serotonin or Noradrenaline) in the brain so, by increasing the levels of one or both of these monoamines, depression can be treated.


Newer Antidepressant :

1) Agomelatine:
  • Agonist at MT1/MT2 melatonin receptors.
  • Melatonin, secreted by the pineal gland (which is important to sleep).
  • MT1 and MT2 receptors are located in the suprachiasmatic nucleus of the hypothalamus(the sleep center).
  • Common side effects include diarrhea, headache, and nausea.


General Principles When using Antidepressants.

  • Start Low, Go Slow

    •          Start at a low dose.

    •          Increase dose gradually(if needed).

    • Review mental state regularly.

    • Monitor for side effects.

    • Avoid 'poly-pharmacy'(using more than one antidepressant, except for treatment-resistant Depression)

NOTE- It usually takes at least 2 to 3 weeks for an anti-depressant effect to manifest. If the patient improves, continue medication for several months after recovery. 


If the patient doesn't improve, gradually change to the other anti-depressant. If repeated relapses, consider long-term maintenance treatment.


COGNITIVE BEHAVIOR THEORY (CBT)

The aim of CBT is to help the patient'to correct the negative cognitions and other unhelpful behaviors that maintain the depression because of negative cognitions and maladaptive behaviors can cause one to feel low in mood and which leads to depression.


Management Of Bipolar Depression-
  • Among atypicals: Quetiapine may be the drug of choice.

  • Among anti-epileptics: Lamotrigine may be the drug of choice.

  • For severe, treatment-resistant depression: ECT may be an option.

General Management Principles

  • Assess suicidal risk during depressive/mixed episodes.

  • Assess safety issues(to the patient and others as well) during manic episodes.

  • Identify and try to address contributory factors such as work stressors, physical health issues, alcohol misuse, etc.

  • Educate the patient about the illness and rationale of treatment.

  • Advice patients about Sleep Hygiene as disturbed sleep is a prominent risk factor for relapse and also for switching from Depression to Mania.

Long-term course of Bipolar Disorder-
    
  • The average duration of a Depressive episode is (months) is more than that of Manic episodes.

  • Women with the Bipolar disorder may experience more Depressive episodes than men with Bipolar disorder.

  • Patients with Bipolar disorder tends to have more and longer Depressive episodes in the course of their lifetime than patients with the Unipolar disorder.

  • On an average, a Bipolar patient will experience about 10 episodes in their lifetime with a roughly equal number of depressive/manic episodes.




Monday, 30 April 2018

Personality Disorder: Types, Causes And Symptoms :Cluster A, Cluster B and Subtypes

April 30, 2018

What is a Personality Disorder?

Personality Disorder: Types, Causes And Symptoms :

A Personality Disorder is a type of mental disorder in which a person has the unhealthy pattern of thinking, behaving and functioning. 


According to the ICD-10 the Personality disorder is defined as 

"Characteristic and enduring pattern of inner experience and behavior, that, as a whole, deviates markedly from the culturally, expected and accepted range.


 Usually, Personality Disorder started in teenage or in early adulthood.




Major Symptoms Of  Personality Disorder:

   Persistent, maladaptive, inflexible patterns:
  • Of thinking(about self, other and the world)

  • Feeling(intensity of emotions)

  • Behavior

  • Relationship with others

  • Cause significant distress to self and to others.


                    Types Of Personality Disorder:


1) Cluster A (Odd or Eccentric disorder)

     Cluster A personality disorder includes- Paranoid Personality Disorder, Schizoid Personality Disorder and Schizotypal Disorder.
  
a) Paranoid Personality Disorder
  • Pervasive mistrust/suspiciousness - misinterpreting friendly or neutral actions of others as hostile.
  • Self- referential attitude.

  • A tendency to bear grudges.

  • A combative sense of personal rights.

  • Excessive sensitivity to criticism and setbacks.

  • Preoccupation with conspiratorial explanations for personal or universal events.


b) Schizoid Personality Disorder
  • Inability to express both positive tenders feelings as well as negative feelings like anger.

  • No desire for relationships or close friends.

  • Emotional coldness/ detachment.

  • Indifference to criticism or praise.

  • Unintentional disregard for social norms.


c) Schizotypal Disorder

  • Appearance and behavior are odd and eccentric.

  • The tendency to social withdrawal.

  • Old Belief.

  • Paranoid Ideas.

  • Ruminations involving violent or sexual themes.

  • Depersonalization / Derealization / illusions.

  • Transient quasi-psychotic episodes.


2) Cluster B Personality Disorder


Cluster B Personality disorders are characterized by dramatic, erratic and emotional behavior. 

They include- 

Antisocial Personality Disorder,

Borderline Personality Disorder, 

Histrionic Personality Disorder, 

Avoidant Personality Disorder, 

Dependent Personality Disorder, 

Obsessive-Compulsive(Anankastic) Personality Disorder, 

Passive-aggressive Personality Disorder



a) Antisocial Personality Disorder: This disorder is also known as Dissocial Personality Disorder in ICD-10. Other related terms include Psychopathic Personality, Sociopathic Personality, Dangerous and Severe Personality disorder.

  • Low threshold for aggression/impulsivity resulting in fights, assaults.

  • Incapacity to experience remorse and to learn from punishments.

  • Can easily establish relationships, but ain't maintain them.

  • Callous unconcern for feelings of others.

  • Disregard for social rules as evidenced by repeatedly breaking the law.

b) Borderline Personality Disorder:

A borderline personality disorder is generally characterized by unstable effects of intense anxiety, irritability that last usually for only a few hours at a time.


  • Involvement in intense, unstable relationships in which the other person is alternately idealized and devalued.

  • Recurrent threats or acts of self-harm, especially self-mutilation.

  • Chronic feelings of emptiness.

  • The patient makes frantic efforts to avoid abandonment.

  • A tendency to quarrelsome behaviors.

  • A tendency to act impulsively without consideration of results such as alcohol, drugs, sex, driving, etc.

  • Frequent outbursts of anger or violence, physical fights.

  • A patient may expierence dissociative symptoms, paranoid ideas, etc.



c) Histrionic Personality Disorder
  
   Histrionic Personality Disorder is characterized by wanting to be the center of attention in events that one participates.

  • Usually, the patient feels uncomfortable in situations where one cannot be the center of attention.

  • Exaggerated expression of emotions.

  • Shallow and labile affect.

  • Theatrical speech that lacks specific details.

  • Inappropriate seductiveness in behavior.

  • Over-concern with physical attractiveness, in an attempt to draw the attention of others.

  • Easily suggestible and influenced by others.

  •  Histrionic Personality Disorder is associated with Somatization Disorder.



d) Narcissistic Personality Disorder
Named after Narcissus, a hunter in Greek mythology, who fell in love with his own reflection in a pool of water.

  • A belief that one is special.

  • Lack of empathy: inability/unwillingness to identify with the feelings of others.

  • Envious of others, but also feels that others are envious of her/him.

  • Arrogant attitude or behavior.

  • Need for an excessive admiration or attention seeking.

  • Preoccupation with fantasies of success, power, beauty, ideal love, etc.

  • Exploitation of others in relationships and taking advantages of others to achieve one's goal.


e) Avoidant Personality Disorder
  • Avoidance of activities that involve interpersonal contact for fear of criticism or rejection.

  • A belief that one is inept, unappealing or inferior to others.

  • Preoccupied with the fear of being criticised or rejected in social situations.

  • General feelings of tension.

  • Restrictions on lifestyle because of the need for physical security.

  • Unwillingness to get involved unless certain of being accepted and liked.



f) Dependent Personality Disorder

 In Dependent Personality disorder the person excessively depending on others for an emotional support.

  • Inability to make even everyday decisions without advice or reassurance from others.

  • Allowing others or wanting others to make important life decisions.

  • Subordinating one's own needs to the needs of those that one depends on.

  • Difficulty in doing things due to lack of self-confidence.

  • Fear of losing support.

  • Feeling helpless when alone.

  • Preoccupied with exaggerated fears of being unable to care for oneself if alone.


g) Obsessive-Compulsive(Anankastic) Personality Disorder

  • Preoccupied with Perfectionism.

  • Excessive doubting.

  • Preoccupied with details, lists, rules, etc that interferes with the main objective of the task being done.

  • Excessive conscientiousness and inflexibility with morals, ethics, and values.

  • General Stubbornness.

  • Rigid adherence to social conventions


h) Passive-aggressive Personality Disorder

  • Procrastination.

  • Failing to do one's share of teamwork.

  • Avoids obligations by claiming to have forgotten.

  • Protesting that others make unreasonable demands.

  • General disdain for people in authority.

  • Sulkiness/irritability when asked to do something that one doesn't want. 



Sunday, 29 April 2018

Personality Disorders :Assessment, Management and Treatment

April 29, 2018

        Assessment of Personality Disorders



Personality Disorders :Assessment, Management and Treatment
  • Personality Disorder shares many common features with functional Mental Disorder. The main differentiating feature is that in Personality Disorder, the one set is early and the features have been persistent and stable, while in functional Mental Disorder, the onset is usually later and the symptoms tend to be episodic. However, this distinction is not clear.

  • Knowing the background personality in a patient with a Mental Disorder helps the Clinician be more realistic with respect to the treatment outcome expectations.

  • So, it is very important to access the patient's Personality as a part of the initial assessment(usually with extra information from another source such as Parents, Siblings, Spouse, Family, Physician, etc) who has known the patient for many years.


  •   It is generally not appropriate to make a diagnosis of a Personality Disorder after just one Assessment session. Usually, a  patient would need to be seen at least a few times.

  • Previous Medical/Psychiatric records, if available, should also be studied.

  • while the exception of Borderline Personality Disorder, most other Personality Disorders are diagnosed the only incidentally in routine psychiatric services in patients presenting with other problems like Psychosis, Depression, Anxiety, etc.

  • Patients with a Personality disorder are at higher risk of developing Mental Disorder.


Management Of Personality Disorder


Apart from the Borderline PD, the vast majority of patients with Personality Disorders(with no co-morbid Mental Disorder) do not to the attention of mental health services. Hence, most of the studies of treatment have been on Borderline PD.


The other Personality Disorders are usually incidentally diagnosed in patients presenting with the other disorders like Depression, Anxiety, Psychosis or Addiction.


 Antisocial PD is, as expected, very common in the prison/criminal justice settings. It is usually diagnosed formally only after the person has committed a crime.


Management Of Borderline Personality Disorder:

 The goals of treatment include:

  • Better management of one's emotion.

  • Avoidance of / reduction of self-harm behavior.

  • Having more clarity about one's purpose in life.

  • Building better quality relationships with others.

  • Improvement in functioning.

  • Addressing the co-morbid Psychiatric/substance misuse issues.

Psychotherapy for Borderline PD-

    • Psychodynamic Psychotherapy

    • Dialectical Behaviour Therapy (DBT)

    • Transference-Focused Psychotherapy (TFT)

    • Mentalisation -Based Therapy (MBT)

    • Emotion Regulation Training (ERT)

    • Cognitive Behaviour Therapy (CBT)

    • Schema-Focused Therapy (SFT)

    • Interpersonal Psychotherapy (IPT)

 Pharmacotherapy for Borderline PD


  • Not used as a primary treatment as it is unlikely to alter the natural course of the disorder.

  • Mainly used for symptoms management.

  • Risk of overdose needs to be borne in mind while prescribing psychotropics.

  • Drugs that may have some benefits include:
              a) Antidepressants: usually SSRIs.

              b)Antipsychotics: usually low/dose atypicals.

              c)  Mood stabilizers: e.g. Valproate, Lithium.

                     d) Others e.g. Clonidine, Omega-3 fatty acids.



Management Of Paranoid Personality Disorder-

Patient with Paranoid Personality Disorder is very difficult to treat as they are mistrustful of most people, including Psychiatrists. A patient with Paranoid PD is unlikely to present for treatment unless there are significant immediate problems. 


For examples, a patient may be at risk of losing a job because of complaints from colleagues or a wife is deciding to leave unable to tolerate suspicious nature of the husband.


Low dose Antipsychotics may be helpful.



Treatment for Personality Disorders


If the patient is willing and motivated to change, and depending on the PD, and the availability of services the following treatments may help.


  • Psychotherapies: ranging from Supportive, through CBT, to Exploratory therapies like Psychodynamic Psychotherapy.

  • Self-help: books and online support groups.

  • Treatment of any co-morbid disorders such as Depression, Anxiety, etc with Medication or Psychotherapy to optimize functioning.