Psychiatry
Psychotic & Personality Disorders
Psychiatry

Psychotic & Personality Disorders

Schizophrenia spectrum + personality clusters.

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◆Schizophrenia spectrum

  • •≥2 symptoms (delusions, hallucinations, disorganized speech, behavior, negative) with ≥1 from first three
  • •<1 month: brief psychotic disorder
  • •1–6 months: schizophreniform
  • •≥6 months: schizophrenia
  • •First-line: atypical antipsychotic (lower EPS than typical)
  • •Clozapine for refractory; monitor for agranulocytosis (weekly CBC)
  • •Nonadherence/recurrent relapse → long-acting injectable (LAI)

◆Other psychotic

  • •Delusional disorder: fixed non-bizarre belief without hallucinations or impairment
  • •Acute new-onset psychosis: rule out substance/medical causes FIRST

◆Personality disorders

  • •Cluster A: paranoid, schizoid (emotionally flat), schizotypal (magical thinking)
  • •Cluster B: antisocial (CONDUCT disorder before 15), borderline (DBT first), histrionic, narcissistic
  • •Cluster C: avoidant, dependent, OCPD (perfectionism, ego-syntonic)

◆Defense mechanisms

  • •Denial: refuses to accept reality
  • •Rationalization: justifying behavior with logical-sounding reasons
  • •Projection: attributing own feelings to others
  • •Splitting: all good or all bad (BPD)
  • •Displacement: redirect to safer target
  • •Sublimation: channel impulses to socially acceptable activity (mature)
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