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Personality disorder differential diagnosis

2021-10-13T18:53:27Z

Ayesha Anwar: /* Differentiating Personality Disorder from other Diseases */

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==Overview==
Boderline disorder needs to be differentiated from [[mood disorders]] like [[Bipolar disorder]], [[anxiety]] and [[delusional disorder]].
Cluster-A disorders have to distinguished from [[delusional disorder (persecutory type)]], [[schizophreniform]], [[bipolar disorder with psychotic symptoms]] and [[schizophrenia]].
[[Post-traumatic stress disorder]] (PTSD) can also have interchangeable presenting complaints to the cluster-C PDs..
Thus, [[Axis-1 disorders]] and [[Axis-2 disorders]] have similar presentation and needs to be evaluated and ruled out before making the diagnosis of Axis-2 disorders.

==Differentiating Personality Disorder from other Diseases==
Personality disorders present with symptoms which corresponds to other psychiatric illnesses as well. It makes imperative to employ the [DSM-5] criterion to make the diagnosis of PD. Additionally, many patients with PDs also suffer from co-morbid conditions like [[mood disorders]], [[substance abuse]] and organic brain [[lesions]] which have overlapping symptoms and signs with PDs. This requires a complete long history including duration of symptoms and developmental history and essential investigations.

===Differentiating personality disorders from other diseases===

{|
!rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
!colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
!colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical Examination
!colspan="8" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Investigations
!rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold Standard
|-
|
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 1
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 2
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 3
|
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical Examination 1
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical Examination 2
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical Examination 3
|
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
!style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging Findings
|
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Axis I Psychiatric disorders
|
| style="background: #F5F5F5; padding: 5px;" |mood dysregulatory symptoms; depressed mood, euphoria or anxious
| style="background: #F5F5F5; padding: 5px;" |delusions, hallucinations and paranoia
| style="background: #F5F5F5; padding: 5px;" |nighttime awakenings and nightmares
|
| style="background: #F5F5F5; padding: 5px;" |dishevelled appearance, provocative, fleeting eye contact, and repeated purposeless movements.
| style="background: #F5F5F5; padding: 5px;" |self-inflicted wounds
| style="background: #F5F5F5; padding: 5px;" |dysphoria, disorganised thought process
|
| style="background: #F5F5F5; padding: 5px;" |no findings
| style="background: #F5F5F5; padding: 5px;" |volumetric changes in gray matter in hypothalamus and limbic system
|
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Adjustment Disorder
|
| style="background: #F5F5F5; padding: 5px;" |low mood
| style="background: #F5F5F5; padding: 5px;" |poor concentration
| style="background: #F5F5F5; padding: 5px;" |insomnia
|
| style="background: #F5F5F5; padding: 5px;" |tenderness at various points, depressed mood
| style="background: #F5F5F5; padding: 5px;" |DSM-V criteria
| style="background: #F5F5F5; padding: 5px;" |varying blood pressure and heart rate
|
| style="background: #F5F5F5; padding: 5px;" |hemoglobin, vitamin D, TSH
| style="background: #F5F5F5; padding: 5px;" |decreased gray matter volume in the right medial frontal gyrus
|
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Central Nervous System Disorder
|
| style="background: #F5F5F5; padding: 5px;" |early morning headache
| style="background: #F5F5F5; padding: 5px;" |vomiting
| style="background: #F5F5F5; padding: 5px;" |paresis or numbness
|
| style="background: #F5F5F5; padding: 5px;" |dysarthria, echolalia, palilalia or alogia
| style="background: #F5F5F5; padding: 5px;" |focal neurological deficit
| style="background: #F5F5F5; padding: 5px;" |raised intracranial pressure, papilledema
|
| style="background: #F5F5F5; padding: 5px;" |deranged sodium, increased calcium, cytology in CSF, abnormal tumor markers
| style="background: #F5F5F5; padding: 5px;" |single or multiple space-occupying lesion with contrast enhancement.
|
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Substance Use Disorder
|
| style="background: #F5F5F5; padding: 5px;" |low mood, ecstasy
| style="background: #F5F5F5; padding: 5px;" |abnormal sleep pattern
| style="background: #F5F5F5; padding: 5px;" |lack of concern for symptoms
|
| style="background: #F5F5F5; padding: 5px;" |dishevelled appearance, akathisia, bradykinesia
| style="background: #F5F5F5; padding: 5px;" |inability to follow commands and abnormal gait
| style="background: #F5F5F5; padding: 5px;" |dysarthria and anosognosia
|
| style="background: #F5F5F5; padding: 5px;" |abnormal liver, renal tests and cardiac enzymes, urine or serum drug screen
| style="background: #F5F5F5; padding: 5px;" |homogenous hypo-density in case of infarction with cocaine use
|
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic Derangement
|
| style="background: #F5F5F5; padding: 5px;" |waxing and waning consciousness
| style="background: #F5F5F5; padding: 5px;" |seizures
| style="background: #F5F5F5; padding: 5px;" |constipation, dry skin, hair loss, weight changes
|
| style="background: #F5F5F5; padding: 5px;" |not oriented in time, place and person
| style="background: #F5F5F5; padding: 5px;" |impaired memory, speech and gait
| style="background: #F5F5F5; padding: 5px;" |changes in blood pressure and heart rate
|
| style="background: #F5F5F5; padding: 5px;" |sodium, potassium, calcium, glucose, cortisol, TSH, urine examination
| style="background: #F5F5F5; padding: 5px;" |hyperintense signals in t1-weighted images in basal ganglia, thalami, and hemispheric white matter
|
|}

==References==
{{reflist|2}}
{{WS}}
{{WH}}

[[Category:Psychiatry]]
[[Category:Personality disorders]]
[[Category:Mental illness diagnosis by DSM and ICD]]
[[Category:Needs content]]

Personality disorder differential diagnosis

2021-10-13T18:40:50Z

Ayesha Anwar: /* Differentiating personality disorders from other diseases */

Personality disorder differential diagnosis

2021-10-13T18:33:51Z