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Assessment of potential violence in the paranoid worker.

Violence in the workplace is sometimes a manifestation of an untreated psychiatric disorder. Paranoid personality disorder, paranoid schizophrenia, and delusional (paranoid) disorder are three psychiatric syndromes in which paranoid ideation is a prominent feature. While the vast majority of people with these conditions are not violent, paranoid workers can exhibit violent behavior as a reaction to beliefs that co-workers or supervisors are threatening or persecuting them. Three cases are described to illustrate the clinical presentation of these disorders and their management in an occupational setting.

Adult

Schizotypal and paranoid personality disorder in the relatives of patients with schizophrenia and affective disorders: a review.

This review considers the possible familial relationship of schizotypal and paranoid personality disorders (SPD, PPD) to schizophrenia (SCZ) and affective disorders (AD). There have been few controlled studies on familial risk of SPD and PPD based on direct semi-structured interviews of relatives, blind to proband diagnosis. Three of six studies reported increased familial risk of SPD for SCZ probands, but with considerable variability in estimates of this risk. None of four studies reported a significant relationship between AD and familial SPD. There is substantial but less consistent evidence for a familial relationship between PPD and SCZ: three of six studies supported such a relationship, but one large study reported increased familial risk of PPD for AD and not for SCZ probands. There is also some evidence that negative symptoms are most characteristic of SPD in relatives of SCZ probands. Also discussed are issues concerning the adequacy of current criteria for defining schizophrenia spectrum pathology, and of diagnostic methods in this area.

Adoption

Paranoid personality disorder: a synthesis of developmental, dynamic, and descriptive features.

Suspiciousness, feeling persecuted, and grandiosity constitute the classical triad associated with paranoid personality. However, a more important feature appears to be the discrepancy between the outer persona and the inner world of such individuals. The split is pervasive and involves self-concept, object-relations, affects, morality, sexuality, and cognitive style. Outwardly, paranoid individuals are demanding, arrogant, mistrustful, driven, unromantic, moralistic, and acutely vigilant towards the external environment. Internally, however, they are frightened, timid, self-doubting, gullible, inconsiderate, vulnerable to erotomania, and cognitively unable to grasp the totality of actual events. This way of conceptualizing the paranoid symptomatology is superior to ordinary check-list methods since it (1) links the phenomenological and psychostructural aspects of the condition, (2) helps in a more meaningful differential diagnosis of paranoid from other personality disorders, and most importantly, (3) hints at areas that require exploration in the psychotherapeutic management or psychoanalysis of such individuals.

Diagnosis, Differential

An independent analysis of the Danish Adoption Study of Schizophrenia. VI. The relationship between psychiatric disorders as defined by DSM-III in the relatives and adoptees.

In this report, modified DSM-III criteria were applied to all the available interviews with adoptees from the greater Copenhagen sample of the Danish Adoption Study of Schizophrenia. In the adoptees, reasonable agreement was found between our DSM-III diagnoses and the original diagnoses using global DSM-II-based criteria by Kety et al for their categories of chronic and acute, but not borderline, schizophrenia. Comparing DSM-III-based diagnoses in adoptees and relatives, schizophrenia, schizotypal personality disorder, and paranoid personality disorder were all significantly more common in the biologic relatives of schizophrenic v screened control adoptees. These three diagnoses, which together form a tentative "schizophrenia spectrum," were also significantly concentrated in the biologic relatives of adoptees with schizoaffective disorder, mainly schizophrenic subtype, and schizotypal personality disorder, but not in biologic relatives of adoptees with schizophreniform disorder or atypical psychosis.

Adoption

Psychiatric morbidity in the first-degree relatives of schizophrenic patients.

First-degree relatives (FDRs) of 162 schizophrenic and 106 control probands were investigated [corrected]. Psychiatric morbidity was present in 34.8% of FDRs of schizophrenic probands and in 9.2% of FDRs of controls. There was significantly more psychiatric illness in the siblings and parents than in the offspring of both schizophrenic and control subjects. The morbidity risks for schizoid-schizotypal personality disorders, cannabis-use disorder and paranoid personality disorder were significantly higher in the FDRs of schizophrenic patients than in those of controls, suggesting a biological relationship.

Adolescent

The comorbidity of alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables.

This study assessed prevalence rates and overlap among Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; DSM-III-R; American Psychiatric Association, 1987) personality disorders in a multisite sample of 366 substance abusers in treatment. In addition, the relation of antisocial personality disorder (APD), borderline personality disorder (BPD), and paranoid personality disorder (PPD) to alcohol typology variables was examined. Structured diagnostic interviews and other measures were administered to participants at least 14 days after entry into treatment. Results indicated high prevalence rates for APD and non-APD disorders. There was extensive overlap between Axis I disorders and personality disorders, and among personality disorders themselves. APD, BPD, and PPD were linked to more severe symptomatology of alcoholism and other clinical problems. However, only APD and BPD satisfied subtyping criteria, after controlling for other comorbidity. Implications for classifying alcoholics by comorbid disorders are discussed.

Adult

[Personality disorders related to schizophrenia].

Personality disorders related to schizophrenia were described since Kraepelin's works. According to the DMS III-R those disorders are gathered into the A cluster of personality disorders consisting in: schizotypal, schizoid and paranoid personality disorders. Schizotypal and paranoid personalities are biologically linked to schizophrenia and support the concept of "schizophrenia spectrum". Until now such a link is not found between schizoid personality and schizophrenia. Future research in the field of those personality disorders will bring a better knowledge in the pathogenesis of schizophrenia.

Female

Increased morbid risk for schizophrenia-related disorders in relatives of schizotypal personality disordered patients.

To evaluate whether probands from a clinical sample diagnosed as having DSM-III schizotypal and/or paranoid personality disorder have a familial relationship to the schizophrenia-related disorders, the morbid risk for schizophrenia-related disorders and other psychiatric disorders were evaluated in the first-degree relatives of patients with schizotypal and/or paranoid personality disorder and compared with the corresponding risk for these disorders in the first-degree relatives of patients with other non-schizophrenia-related personality disorders. The morbid risk for all schizophrenia-related disorders, and specifically for schizophrenia-related personality disorders, was significantly greater among the relatives of the probands with schizotypal and/or paranoid personality disorder than among the relatives of probands with other personality disorder. The morbid risk for other psychiatric disorders did not differ significantly between the first-degree relatives of the schizotypal/paranoid personality disorder and the other personality disorder control proband samples. These results suggest a specific familial association between schizophrenia-related disorders, particularly schizophrenia-related personality disorders, and clinically diagnosed schizotypal patients.

Adolescent

A family study of schizophrenic and normal control probands: implications for the spectrum concept of schizophrenia.

Morbidity risks for mental illness were determined in 750 first-degree relatives of chronic schizophrenic and normal control probands. Psychiatric disorders that were more frequent in relatives of schizophrenic probands than in relatives of normal control probands were chronic schizophrenia (5.8% versus 0.6%), schizotypal personality disorder (definite, 14.6% versus 2.1%; probable, 12.1% versus 6.5%), and paranoid personality disorder (7.3% versus 2.3%). The data suggest that schizotypal and paranoid personality disorders are genetically related to schizophrenia. The implications for schizophrenia research are discussed.

Adolescent

Paranoid personality traits in a panic disorder population: a pilot study.

To better understand the relationship between panic disorder and paranoid personality, panic disorder patients (N = 28) who were referred to an anxiety disorder clinic in a community mental health center were evaluated for paranoid personality traits on a standardized personality self-report instrument. Paranoid personality disorder was found in 54% of subjects. Paranoid subjects were found to have an earlier age of onset, longer duration of illness, and more psychopathology. Possible etiologies and implications for treatment of these findings are discussed.

Adult

A comparative study of paranoid and schizoid personality disorders.

OBJECTIVE: Family studies have demonstrated a higher rate of schizoid personality in the families of probands with schizophrenia and a higher rate of paranoid personality in the families of probands with delusional disorder. The authors sought to investigate the familial characteristics of probands with schizoid and paranoid personality disorders and to delineate the clinical characteristics of the two groups. METHOD: Records of 351 inpatients with discharge diagnoses that included the term "schizoid personality" or "paranoid personality" were examined to identify patients who met DSM-III-R criteria for schizoid personality disorder (N = 34) or paranoid personality disorder (N = 19). Comparisons were made between the two groups with respect to clinical symptoms, familial characteristics, and longitudinal course. RESULTS: The authors found that probands with schizoid personality disorder were hospitalized at an earlier age than probands with paranoid personality disorder, had more intervention before the index admission, and had greater morbidity following the index admission. They also found that descriptors of the two syndromes tended to congregate in the respective family material, but the differences were not statistically significant. Differences in the familial prevalence of schizophrenia were also not statistically significant. CONCLUSIONS: These familial data do not support the hypothesis that schizophrenia congregates in the families of probands with schizoid personality disorder. Possible explanations for this finding are discussed.

Adult

[Apropos of a misdiagnosed form of paranoia: paranoia of the elderly].

The expression of elements of a paranoid symptomatology (suspicion, mistrust, hostility, etc.) is frequently seen in the elderly patients. Paranoid symptom is non-specific in geronto-psychiatric practice. The association with a cognitive disorder is frequent. The relationship between this trouble and a previous paranoid personality disorder appears, according to literature, looser than in the younger patients. The paranoid behavioral pattern often stands for the elderly as a defense against feelings of inferiority and humiliation. The expression of a paranoid symptomatology is a hamper for the subject's social autonomy, as well as an actual risk factor so far as it may involve a delay in the demands for medical care. Therapeutical attitudes, reassurant and preventing the patient from a rough awareness of his deficit, seem to be useful in the alleviation of the trouble.

Aged

Delusions in schizophrenia spectrum disorders: diagnostic issues.

Family studies of schizophrenia frequently include relatives of schizophrenia probands with diagnoses falling within the schizophrenia spectrum. As part of an ongoing genetic linkage study of schizophrenia, the authors examined case material from 50 relatives (of schizophrenia probands) who received a DSM-III-R diagnosis of a nonaffective psychotic disorder or schizotypal or paranoid personality disorder. Eleven exhibited episodic or chronic delusions that resulted in diagnostic dilemmas, often arising from issues pertaining to the classification of delusional phenomena. Four of these cases are presented here. Unusual beliefs were often difficult to classify as odd beliefs versus full delusions, brief/transient versus persistent delusions, bizarre versus non-bizarre delusions. It is suggested that these might be considered continuous rather than dichotomous dimensions. Several possible implications for genetic studies of schizophrenia are discussed.

Adult

[Clinico-geneaological study of paranoid schizophrenia].

On the basis of a comparative analysis of aggravated familial history in cases of paranoiac and neurosis-like schizophrenia (73 families in the main and control groups), the authors established accumulation of disturbances of "the paranoid spectrum" (delirious, paranoiac psychoses, paranoid anomalies of the personality) predominant in the families of the main group. This fact is interpreted in favour of a considerable role of constitutional and genetic factors in the genesis of paranoiac schizophrenia.

Body Constitution

Independent diagnoses of adoptees and relatives as defined by DSM-III in the provincial and national samples of the Danish Adoption Study of Schizophrenia.

BACKGROUND: This report describes the independent application of DSM-III criteria to the adoptees and relatives in the Provincial sample of the Danish Adoption Study of Schizophrenia of Kety and colleagues. We report these results and combine them with those reported previously for the Copenhagen sample to form the National sample. METHODS: Personal interviews and institutional record summaries of adoptees and biological and adoptive relatives were "blindly" diagnosed using DSM-III criteria. "Schizophrenia spectrum" was a priori defined as schizophrenia; schizoaffective disorder, mainly schizophrenic subtype; and schizotypal and paranoid personality disorders. RESULTS AND CONCLUSION: In the Provincial sample, the prevalence of "spectrum" disorders was significantly greater in biological relatives of schizophrenia spectrum vs control adoptees. The results were also consistent with the genetic transmission of individual diagnoses within the spectrum. When combined into the National sample, the results provided strong evidence for (1) the genetic transmission of DSM-III schizophrenia; (2) a genetic relationship between DSM-III schizophrenia, mainly schizophrenic schizoaffective disorder, and schizotypal personality disorder; and (3) the absence of a significant genetic relationship between the schizophrenia spectrum and either psychotic nonspectrum disorders, major depression, or anxiety disorders. We found no evidence for the familial environment transmission of schizophrenia spectrum disorders. These results are consistent with the findings reported by Kety and coworkers from their diagnostic review.

Adoption

Twin concordance for DSM-III-R schizophrenia.

The monozygotic (MZ)/dizygotic (DZ) concordance rates for schizophrenia and the relationship between schizophrenia and schizophrenic spectrum disorders were studied in a sample of 31 MZ and 28 DZ schizophrenic probands and their co-twins. All subjects were personally interviewed with structured diagnostic instruments and classified according to DSM-III-R criteria. The concordance rates of 48% for MZ twins and 4% for DZ twins indicate a genetic transmission of DSM-III-R schizophrenia. In addition to the schizophrenic co-twins, 3 MZ co-twins had a noneffective psychotic disorder, thus supporting the hypothesis that genes are involved in the development of Axis I schizophrenic spectrum disorders. Schizotypal and paranoid personality disorders were observed in both MZ and DZ co-twins. These disorders may be familially related to schizophrenia, but a genetic relationship was not confirmed for the Axis II spectrum disorders. A substantial number of MZ co-twins of schizophrenic probands had no mental disorder.

Adult

[Paranoid states in the dynamics of psychopathies].

A total of 46 psychopathic personalities from 30 to 55 years of age were studied. Of them 40 subjects were examined by follow-up checkings. Under psychotraumatizing situations these patients demonstrated acute paranoiac syndromes the content of which was characterized by monotopical delusional ideas. The formation of such acute paranoiac reactions was determined by abnormal personality structures and by individual pathogenic psychotraumatizing situations. The paper contains a description of the psycho-pathological traits of acute paranoiac states in psychopaths and their impact on the general development of psychopathy.

Adult