![]() His daughter described him as always being an “eccentric and distrustful person.” She described incidents in the past in which he had held beliefs about others “being against” him, resulting in isolation from friends and family. He stated that his daughters “did not understand him.” Very reluctantly, he gave permission for one of his daughters to be contacted. He reported being estranged from most of his family since his wife’s death. He claimed that he was being held in the hospital illegally and threatened to sue the providers for holding him against his will. He was suspicious and mistrustful of the treatment providers and mostly focused his conversations on legal issues. He would not engage in conversation with most team members, with the exception of a medical student on the team to whom he reported paranoid ideations about various family members and friends. During the initial part of his stay, he was easily agitated, displayed verbal aggression, exhibited paranoia, and refused treatment. The patient was involuntarily admitted to the inpatient unit due to aggressive behavior and risk of harm to others. He declined voluntary inpatient hospitalization and threatened to sue the emergency department psychiatrist if he were to be involuntarily committed. ![]() He requested discharge but would not elaborate on a safe discharge plan nor allow his family to be contacted. ![]() He pounded his cane on the ground and threw it to the floor in a threatening manner. During the latter part of the assessment, the patient became loud, intrusive, and agitated. He reported never having seen a psychiatrist before, although he reported having been on a selective serotonin reuptake inhibitor in the past to help equilibrate his “serotonin levels.” He did not fully cooperate with the interview, was guarded and evasive, and often said, “You don’t need to know.” His mental status examination was notable for disorganized process and paranoid content. Upon initial contact with the emergency department psychiatrist, the patient reported feeling that the staff at the hospital were against him. Records stated that the “patient is delusional, in a state of acute psychosis, easily agitated.” He was brought to the emergency department by police for concerns of psychosis and delusions. J” is a 65-year-old Caucasian man with no prior psychiatric history, history of chronic obstructive pulmonary disease, and a benign vocal cord lesion. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or a depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.ī. ![]() Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.ħ. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).Ħ. Reads hidden demeaning or threatening meanings into benign remarks or events.ĥ. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.Ĥ. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.ģ. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.Ģ. 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:ġ. DSM-5 Criteria for Paranoid Personality Disorder a A. ![]()
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