A 38-year-old man is brought to the emergency department by ambulance due to severe abdominal pain and undergoes an emergency appendectomy. Following a successful operation and recovery, the patient questions whether the appendectomy was absolutely necessary. He doubts the surgeon's explanation that the surgery was potentially lifesaving, angrily suggests that the hospital is taking advantage of his excellent medical insurance, and makes vague threats to sue the hospital. He asks to be discharged immediately, and explains, "I've earned everything I have on my own, and this hospital isn't getting any of it." When asked if he has any relatives or friends the team can speak with, he says, "I haven't talked to my family in 20 years, and I wouldn't call anyone my friend. Even if I did, that's none of your business." Which of the following is the most likely explanation of this patient's behavior?

Question

A 38-year-old man is brought to the emergency department by ambulance due to severe abdominal pain and undergoes an emergency appendectomy.  Following a successful operation and recovery, the patient questions whether the appendectomy was absolutely necessary.  He doubts the surgeon's explanation that the surgery was potentially lifesaving, angrily suggests that the hospital is taking advantage of his excellent medical insurance, and makes vague threats to sue the hospital.  He asks to be discharged immediately, and explains, "I've earned everything I have on my own, and this hospital isn't getting any of it."  When asked if he has any relatives or friends the team can speak with, he says, "I haven't talked to my family in 20 years, and I wouldn't call anyone my friend.  Even if I did, that's none of your business."  Which of the following is the most likely explanation of this patient's behavior?

Quizplus · Accepted Answer

11ec160b_3638_dbea_9249_f9fcc14b2267_MD0001_00 This patient's distrust, suspicion about the surgeon's motives, and lack of sustained relationships are suggestive of paranoid personality disorder. Patients with this disorder exhibit a pattern of pervasive distrust of others beginning in early adulthood. These individuals tend to have minimal interpersonal relationships due to doubts about others' intentions and concerns that personal information will be used against them. Although paranoid personality disorder involves paranoid interpretations of benign comments and events, it can be differentiated from psychotic disorders by the lack of persistent, well-developed delusions and other psychotic symptoms (eg, hallucinations, disorganized speech or behavior). (Choice A) Antisocial personality disorder is characterized by a pattern of disregard for, and violation of, the rights of others. (Choice B) Although onset of brief psychotic disorder (≥1 psychotic symptoms lasting ≥1 day and <1 month) is usually sudden and in the context of a stressor, this patient's pattern of pervasive distrust of others started well before his appendectomy and is more consistent with paranoid personality disorder. (Choice C) This patient does not have persistent, fixed, false beliefs as found in delusional disorder, which is characterized by ≥1 delusions lasting ≥1 months in the absence of other psychotic symptoms. (Choice D) Narcissistic personality disorder consists of a pervasive pattern of grandiosity, need for admiration, sense of entitlement, and lack of empathy. Behaviors and interactions are often motivated by a need for attention and praise. (Choice F) Individuals with schizoid personality disorder are aloof and socially detached but do not have overt paranoid ideation. (Choice G) Schizotypal personality disorder is characterized by magical beliefs, social anxiety, eccentric behavior, and odd perceptual experiences. Educational objective: Individuals with paranoid personality disorder exhibit a lifelong pattern of pervasive suspicion and distrust. Unlike patients with psychotic disorders, they do not have fixed delusions and other psychotic symptoms. __________ References: Mistrustful and misunderstood: a review of paranoid personality disorder. (http://www.ncbi.nlm.nih.gov/pubmed/29399432)

A 38-Year-Old Man Is Brought to the Emergency Department by Ambulance