Transtornos de personalidade
Resumo
Definition
História e exame físico
Principais fatores diagnósticos
- paranoia
- pensamentos estranhos
- amplitude de emoções limitada
- raiva e irritabilidade
- estados de humor instáveis e emocionalidade excessiva
- ansiedade e tensão
- comportamentos impulsivos
- grandiosidade
- evidência de autolesão (por exemplo, cicatrizes, queimaduras)
Fatores de risco
- história de abuso
- história familiar de esquizofrenia
- história familiar de transtorno de personalidade limítrofe (TPL)
- interações parentais negativas
- transtorno disruptivo/emocional na infância
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- entrevista clínica
Investigações a serem consideradas
- perguntas para o rastreamento do risco de suicídio
- Standardized Assessment of Personality-Abbreviated Scale (SAPAS)
- Inventário Multiaxial Clínico de Millon III (MCMI-III)
- Entrevista Clínica Estruturada para o Modelo Alternativo do DSM-5-TR para Transtornos de Personalidade (SCID-5-AMPD)
- Entrevista Clínica Estruturada para o DSM-5-TR para Transtornos de Personalidade
- tomografia computadorizada/ressonância nuclear magnética (TC/RNM) cranioencefálica
- exame de urina para detecção de drogas
- Avaliação de Transtornos Mentais na Atenção Primária (PRIME-MD)
- PHQ-9
- questionário de transtorno de humor
- Transtorno de Ansiedade Generalizada-7 (TAG-7) e TAG-2
Algoritmo de tratamento
em risco de se prejudicar a si mesmo ou aos outros, ou incapaz de atender às suas próprias necessidades básicas
grupo A (estranho/excêntrico): sem risco de vida, não gestante ou lactante
grupo B (dramático): sem risco de vida, não gestante ou lactante
grupo C (ansioso): sem risco de vida, não gestante ou lactante
múltiplas características de diferentes transtornos de personalidade: sem risco de vida, não gestante ou lactante
qualquer grupo ou múltiplas características de diferentes transtornos de personalidade: sem risco de vida, não gestante ou lactante
Colaboradores
Autores
Michael J. Schrift, DO, MA
Professor
Department of Psychiatry and Behavioral Sciences
University of Washington
Seattle
WA
Declarações
MJS declares he has no competing interests.
Agradecimentos
Dr Michael J. Schrift would like to gratefully acknowledge Dr Crystal T. Clark, and the late Dr Maria Devens, previous contributors to this topic. He would also like to acknowledge Dr Eric Gausche, who contributed the psychopharmacology sections for the initial version, and Dr Richard Stringham, who reviewed and approved information on the use of imaging and laboratory tests in the diagnosis section in the initial version. MD was an author of references cited in this topic. CTC, EG, and RS declare that they have no competing interests.
Peer reviewers
Anthony W. Bateman, FRCPsych
Consultant Psychiatrist and Visiting Professor
Halliwick Psychotherapy Unit
St Ann’s Hospital
London
UK
Disclosures
AWB declares that he has a bias towards the use of mentalization in the treatment of personality disorder.
Robin L. Kissell, MD
Director
Borderline Personality Disorder Initiative
Semel Institute
UCLA
Los Angeles
CA
Disclosures
RLK declares that she has no competing interests.
Justin Trevino, MD
Medical Director
Opioid Treatment Program
Dayton Veterans Affairs Medical Center
Dayton
OH
Disclosures
JT declares that he has no competing interests.
Dietmar Winkler, MD
Department of Psychiatry and Psychotherapy
Medical University of Vienna
Vienna
Austria
Disclosures
DW has received lecture fees from CSC Pharmaceuticals, GlaxoSmithKline, and Pfizer, and has served as a consultant for GlaxoSmithKline.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.Full text
Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with borderline personality disorder Am J Psychiatry. 2024 Nov 1;181(11):1024-8. Abstract
Storebø OJ, Stoffers-Winterling JM, Völlm BA, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020 May 4;5:CD012955.Full text Abstract
Cristea IA, Gentili C, Cotet CD, et al. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(4):319-28.Full text Abstract
Abbass AA, Kisely SR, Town JM, et al. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev. 2014 Jul 1;(7):CD004687.Full text Abstract
Herpertz SC, Zanarini M, Schulz CS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders. World J Biol Psychiatry. 2007;8(4):212-44.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Transtornos de humor
- Transtornos psicóticos
- Transtornos de ansiedade
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