¶ … patient C.W.:
Discuss the differential diagnoses and rationale for choosing the primary diagnoses
"There has been little systematic study of personality disorders in older people (65 years of age and above). However, with an ageing population worldwide we should expect to find increased numbers of people with Axis II disorders surviving into old age" (Mordekar & Spence 2007 ). Based upon the patient C.W.'s previous psychiatric history, his likely primary diagnosis would be that of a paranoid personality disorder. According to the definition provided by the ICD9 301 codes for this condition, paranoid personality disorder is distinct from full-blown schizophrenia. Unlike schizophrenics, the patient does not exhibit the hallucinations and delusions characteristic of individuals suffering this condition.
However, the patient does show a persistent pattern of mistrust that is damaging for his health. He has refused any type of medical intervention, including vaccinations as well as medications and therapy. He repeatedly denies the presence of even obvious injuries to medical practitioners because of his mistrust of others. He similarly refuses treatment, stating that drugs are money-making schemes and not designed to help him. "Individuals with Paranoid Personality Disorder falsely believe that they are being victimized...
... Minor slights arouse major hostility, and the hostile feelings persist for a long time. Their combative and suspicious nature may elicit a hostile response in others, which then serves to confirm their original expectations" (Long 2015). The patient shows marked hostility to all members of the medical profession and even his close family members have had difficulties in ensuring that he undertake positive and proactive measures to engage in self-care in the face of the inevitable symptoms of aging.
Although some older individuals experience paranoia as a consequence of dementia, based on the patient's medical history this appears to be a long-standing personality problem. "The effectiveness of treatment for Paranoid Personality Disorder is unknown because there are no randomized controlled trials. Individuals with this disorder seldom voluntarily present for treatment" (Long 2015). A full evaluation by a psychiatrist would be needed to see if any antipsychotics might be helpful but in general personality disorders do not respond well to psychopharmacology, in contrast to schizophrenia. The patient has admitted to heavy drinking and some of his symptoms may be the result of substance abuse. This should also be evaluated by the psychiatrist when prescribing a course of treatment. When diagnosing a personality disorder, it is…
