小结
定义
病史和体格检查
关键诊断因素
- 偏执
- 古怪思维
- 限制情绪范围
- 愤怒和易激惹
- 过度情绪化和不稳定的心境状态
- 焦虑和紧张
- 冲动行为
- 自大
- 自伤的证据（如，瘢痕、烧伤）
危险因素
- 虐待史
- 精神分裂症家族史
- 不利的父母养育作用
- 儿童期情绪/分裂性障碍
诊断性检查
首要检查
- 临床访谈
需考虑的检查
- 自杀风险筛查问卷
- 标准化的简明人格评估量表（SAPAS）
- 米隆临床多轴问卷第三版 (MCMI-III)
- DSM-5 人格障碍替代模型的结构化临床访谈版（SCID-5-AMPD）
- DSM-5-TR 人格障碍的结构化临床访谈
- MRI/CT脑扫描
- 尿液药物筛查
- 精神障碍的初级评定(PRIME-MD)
- 患者健康问卷-9 (PHQ-9)
- 情绪障碍问卷
- 广泛焦虑障碍-7(GAD-7)和广泛焦虑障碍-2（GAD-2）量表
治疗流程
有自我伤害或伤害他人的风险，或不能满足自我需要
A类：奇特/古怪：无生命威胁
B类（表演型）：无生命威胁
C类（焦虑的）：无生命威胁
人格障碍的多特征：无生命威胁
撰稿人
作者
Michael J. Schrift, DO, MA
Professor
Department of Psychiatry and Behavioral Sciences
University of Washington
Seattle
WA
利益声明
MJS declares he has no competing interests.
鸣谢
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.
同行评议者
Anthony W. Bateman, FRCPsych
Consultant Psychiatrist and Visiting Professor
Halliwick Psychotherapy Unit
St Ann’s Hospital
London
UK
利益声明
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
利益声明
RLK declares that she has no competing interests.
Justin Trevino, MD
Medical Director
Opioid Treatment Program
Dayton Veterans Affairs Medical Center
Dayton
OH
利益声明
JT declares that he has no competing interests.
Dietmar Winkler, MD
Department of Psychiatry and Psychotherapy
Medical University of Vienna
Vienna
Austria
利益声明
DW has received lecture fees from CSC Pharmaceuticals, GlaxoSmithKline, and Pfizer, and has served as a consultant for GlaxoSmithKline.
鉴别诊断
- 心境障碍
- 精神病性障碍
- 焦虑障碍
更多 鉴别诊断指南
- 人格障碍治疗指南
- 在初级医疗机构筛查青少年、成年、老年人的自杀风险
更多 指南患者教育信息
人格障碍：是什么？
人格障碍：如何有效治疗？
更多 患者教育信息
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