According to the dsm 5, psychopathy cannot be given as a dx if schizophrenia is already a dx for the person.
Is that because schizophrenics have a common delusion that they are psychopaths? Or maybe because schizophrenics display psychopathic behaviour? Idk.
I feel like a psychopath because i basically wrote my family off yesterday. Did they deserve it? Was it mainly due to delusional thought? Or am i just a psychopath and they all know it? Idk.
Thoughts?
Nope, you’re not a psychopath.
No, it’s because any personality disorder diagnosis made when a patient has sz should ideally predate the sz, since sz is a very severe form of mental illness that can easily explain personality disorder symptoms. So if the personality disorder did not predate the sz, there’s probably not adequate evidence of it actually being present.
I’m not an expert on the DSM but I would expect that you will find the same criterion in the other personality disorder diagnoses.
I Googled it and it only mentions that criterion under schizotypal and antisocial. I don’t know why it specifically mentions it only under those diagnoses. ICD-10 makes no such distinction. But the DSM-V does allow a diagnosis of both sz and antisocial/schizotypal as long as there is evidence that it exists independently of sz (e.g. predates it).
Also, the symptoms of APD must not be better explained by schizophrenia (e.g. running around picking fights with people who have wronged others due to a delusional belief that you’re a vengeance demon).
That’s interesting @anon9798425
My diagnostic history: Schizophrenia 1975- to some time between 1983 -1988, schizoaffective mixed type(mainly)/bipolar (very occasionally) some time between 1983-1988 to 2005.,personality disorder 2005 - 2018, Latest psychiatrist Oct 2018 likely diagnoses Autism and Schizophrenia .(Diagnosed with Asperger’s this month) .
Most likely, the personality disorder diagnosis was made because the schizophrenia/sza/bipolar was assumed not to be present at that time, and then the personality disorder diagnosis was removed when you got the sz + autism diagnoses because there wasn’t evidence of it having existed before the mood + psychotic disorders. It is possible that the autism could also explain the PD symptoms, but I don’t know enough about autism to say for certain.
Adults with ASD might have a hard time connecting and relating to other people or find it difficult to see things from another person’s perspective, which may be misconstrued as a personality disorder.
Conclusion: Psychiatrists who have insufficient experience of ASD may overlook some symptoms of the overall clinical picture and misdiagnose ASD as personality disorders, schizophrenia, phobia or even as a non-psychiatric condition, so is hopeful for future increased knowledge about HF ASD in adulthood.
I think a lot of is down to a pdoc being open to the possibility of an autism spectrum disorder. What could have helped was my stepdaughter being with me , and stating she had noticed autistic traits. As a care worker she has interacted with people on the spectrum.
Does this rule hold for sza also? And if not, why not?
Yes. It is a general rule, so it holds for all possible disorders that can explain the PD symptoms. Sz/sza and other psychotic disorders are especially relevant alternative explanations to PD symptoms, though. The DSM mentions sz, mood disorders with psychotic features and other psychotic disorders under schizotypal PD and antisocial PD, but the rule still holds for the other personality disorders through the general criterion E: “The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.”
The ICD-10 has a similar general criterion, and an unstated rule is that a PD must predate sz/sza to be diagnosable.
Schizotypal is not diagnosable alongside schizophrenia/schizoaffective in the ICD as the ICD classifies it as a psychotic disorder and not a PD, and all other psychotic disorders are an exclusion criterion for schizotypal.
You’re very helpful Treebeard. I hope things are going well for you!
Ä° don t know anything about except my country. But at here sz patient seen as dangerous people who use dangerous drugs. And this stigmas making suspicious thoughts about psycopathy at me. Ä° don t feel psycopath but when society thinks about negative thoughts about you just get suspicious about yourself.
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