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