疾病的定義

According to the American Psychiatric Association (APA), Paranoid personality disorder

(PPD) is a psychiatric condition listed in the current edition of the Diagnostic and Statistical
Manual of Mental Disorders. PPD is a type of eccentric personality disorder. An eccentric
personality disorder means that the person’s behavior may seem odd or peculiar to others. The
essential characteristic of people with PPD is paranoia, a relentless mistrust and suspicion of
others without adequate reason to be suspicious. They tend to carry pervasive feelings of mistrust
towards others, to perceive others and their environment as being dangerous regardless of
evidence of threat, and to hold grudges or act in a vindictive manner towards others in response
to perceived attacks or slights.

可能致病的原因
The exact cause of PPD is not known. However, researchers believe that it likely involves
a combination of biological and psychological factors. The fact that PPD is more common in
people who have close relatives with schizophrenia and delusional disorder suggests a genetic
link between the two disorders (may run in the family). It is also believed that early childhood or
early adolescence experiences, including physical or emotional trauma, play a role in the
development of PPD.

主要症狀
In clinical presentation, the symptoms of PPD often overlap with features of other
disorders. The social withdrawal that is often seen in paranoid patients is also present in
individuals meeting criteria for schizoid and avoidant personality disorders, and suspiciousness
of others is frequently seen in individuals diagnosed with borderline and schizotypal personality
disorders. Even when other personality disorders are not present, paranoid patients often display
symptoms of mood or anxiety disorders such as depression, anxiety, and social phobia. Mood
changes can make someone with PPD more likely to feel paranoid and isolated. Often, people
with PPD do not believe that their behavior is abnormal. It may seem completely rational to a
person with PPD to be suspicious of others. Yet, those around them may believe this distrust is
unwarranted and offensive. These generally unfounded beliefs, as well as their habits of blame
and distrust, interfere with their ability to form close or even workable relationships.

治療方式與經驗
If a person has symptoms, the doctor will begin an evaluation by performing a complete
medical history and physical examination. Although there are no laboratory tests to specifically
diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical
illness as the cause of the symptoms. For example, difficulty hearing or long-lasting substance
abuse may be confused with PPD. If the doctor finds no physical reason for the symptoms, he or
she might refer the person to a psychiatrist or psychologist, health care professionals who are
specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use
specially designed interview and assessment tools to evaluate a person for a personality disorder.
For example, they may ask about your childhood, school, work and relationships. They may also
ask you how you would respond to an imagined situation. This is to gauge how you might react
to certain situations. Treatment for PPD can be very successful. However, most individuals with
this condition have trouble accepting treatment. Someone with PPD doesn’t see their symptoms
as unwarranted. If an individual is willing to accept treatment, talk therapy or psychotherapy are
helpful. For instance, helping the individual to learn how to cope with the disorder, learning how
to communicate with others in social situations and help reducing feeling of paranoia.
Medications such as antidepressants, benzodiazepines and antipsychotics can also be helpful,
especially if the person with PPD has other related conditions such as depression or anxiety
disorder. Combining medication with talk therapy or psychotherapy can be very successful.

Mr. J is a 65-years old Caucasian man with no prior psychiatric history, history of
chronic obstructive pulmonary disease, and a benign vocal cord lesion. He was brought to the
emergency department by police for concerns of psychosis and delusions. Upon initial contact
with the emergency department psychiatrist, the patient reported feeling that the staff at the
hospital were against him. 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. During the latter part of the assessment, the
patient became loud, intrusive, and agitated. The patient was involuntarily admitted to the
inpatient unit due to aggressive behavior and risk of harm to others. He remained at the hospital
for 15 days. During the initial part of his stay, he was easily agitated, displayed verbal
aggression, exhibited paranoia, and refused treatment. He would not engage in conversation with
most team members. He was suspicious and mistrustful of the treatment providers and mostly
focused his conversations on legal issues. He claimed that he was being held in the hospital
illegally and threatened to sue the providers for holding him against his will. He reported being
estranged from most of his family since his wife’s death. His daughter described him as always
being an “eccentric and distrustful person.” She described him as someone who “often held
grudges and for a long time.” She reported a chronic pattern of behavioral problems, aggression,
strained relationships, and suspicious thinking. Following court approval, he was started on
olanzapine and gradually up titrated. He subsequently remained medication compliant and
tolerated the medication well while showing gradual improvement in his disorganized thought
process. Initially, he displayed angry outbursts that precluded meaningful discussions about
discharge planning. However, he eventually became calm enough to develop a safe discharge
plan. At the time of discharge, he was calm and cooperative and denied all psychiatric
symptoms. Nevertheless, he continued to be mistrustful of providers and continued to report
paranoid ideations about family members. The patient’s final diagnosis was cannabis induced
psychosis with intoxication, with underlying paranoid personality disorder.

If I’m coming across someone who is paranoid, I’ll ask questions about the person's
fears, and talk to the person about the paranoia if the person wants to listen to me. If someone is
threatening me, I should call for help. Otherwise, I’ll give the person enough personal space so
that he or she does not feel trapped or surrounded. Stay with the person but a distance that is
comfortable for him or her and me.