Schizoid personality disorder

Background

A pattern of detachment from social relationships and a restricted range of emotional expression

Clinical Features

• Four (or more) of the following criteria, beginning in early adulthood and present in a variety of contexts:
  • Neither desires nor enjoys close relationships, including being part of a family.
  • Almost always chooses solitary activities.
  • Has little, if any, interest in having sexual experiences with another person.
  • Takes pleasure in few, if any, activities.
  • Lacks close friends or confidants other than first-degree relatives.
  • Appears indifferent to the praise or criticism of others.
  • Shows emotional coldness, detachment, or flattened affectivity.

Differential Diagnosis

• Other mental disorders with psychotic symptoms
  
• Autism spectrum disorder
  
• Personality change due to another medical condition
  
• Substance use disorders
  
• Other personality disorders and personality traits
  

Evaluation

A clinical diagnosis; however if entertaining other organic causes may initiate workup below

General ED Psychiatric Workup

• Point-of-care glucose
• CBC
• Chem 7
• LFTs
• ECG (for toxicology evaluation)
• ASA level
• Tylenol level
• Urine toxicology screen/Blood toxicology screen
• EtOH
• Urine pregnancy/beta-hCG (if female of childbearing age)
• Consider:
  • Ammonia (see Hepatic encephalopathy)
  • TSH (hypo or hyperthyroidism may mimic mental illness)
  • CXR (for Tb screen or rule-out delirium in older patient)
  • UA (for rule-out delirium in older patients)
  • Head CT (to rule-out ICH in patients with AMS)
  • Lumbar puncture (to rule-out meningitis or encephalitis)

Management

Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, anti-psychotics and anti-anxiety medications

Disposition

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