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Paranoid Personality Disorder

Paranoid Personality Disorder

Gabe was in prison for killing a prostitute. During a bout of hyper-sexuality, intoxication, and paranoia, he believed the prostitute intended to rob him.

DSM-II was published in 1968. DSM-5 will be published in 2013. How much progress have we made? I propose that we approach this question with a quiz.

On February 12, 2009, the US Court of Federal Claims issued a trio of long-awaited decisions in its Omnibus Autism Proceeding.1 The 3 were representative cases chosen from more than 5500 pending MMR/autism cases by the Plaintiffs’ Steering Committee. Each presented the theory that the measles-mumps-rubella (MMR) vaccine in combination with thimerosal, a mercury-based ingredient contained in some diphtheria-tetanus-pertussis (DTP), diphtheria-tetanus–acellular pertussis (DTaP), hepatitis B, and Haemophilus influenzae type B (Hib) vaccines, causes autism. In nearly 700 combined pages that reviewed the scientific and epidemiological evidence, all 3 opinions determined that the plaintiffs had not demonstrated a link between these vaccines and autism.

The term “paranoia,” derived from the Greek &lduo;para” (beside) and “nous” (mind), was coined as a descriptor of psychopathology by Heinroth in 1818.1 By the end of the 19th century, 50% to 80% of patients in asylums in German-speaking coun­tries had received a diagnosis of paranoia.1 Beginning in 1899, Kraepelin’s efforts to define paranoia more precisely resulted in a decrease in diagnoses of paranoia in favor of dementia praecox and, later, schizophrenia.1,2 This narrowing of the definition of paranoia is reflected in current nosology and practice. In DSM-IV-TR, the prevalence of delusional disorder is estimated at 0.03% of the general population and accounts for 1% to 2% of psychiatric admissions. The prevalence of paranoid personality disorder is 0.5% to 2.5%; this condition accounts for 10% to 30% of psychiatric admissions.3

Psychotic symptoms--delusions, hallucinations, paranoia, thought disorder--are mostly attributed now to aberrations in brain structure and function.

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